For many, familiarity can be a comfort. Familiarity of specific scientific experts can instill confidence and credibility in data and their interpretation. The same holds true for authorship of scientific publications; the authorship of so many primary and secondary publications of clinical trial data comprise of top-tier key opinion leaders (KOLs) who are recognized worldwide for their expertise. But at what expense? With the importance of diversity, equity, and inclusion becoming progressively better understood within all aspects of scientific research, should scientific publications sacrifice diversity of thought for the sake of a top-tier author list?
Diversity in authorship is important for a publication to resonate with and reflect its readership or the population to whom the data apply. For example, why should a publication of a clinical trial in which 50% of the participants are women, not aspire to have an author list in which half the authors are women too? Similarly, if a study or analysis is particularly relevant to a certain racial profile, does it not make sense for the author list to predominantly fit that profile? Diversity in authorship could potentially impact the relevance of the interpretation of the data, and acceptability within a given community, and ultimately, therefore, patient outcomes. This principle can be extended to geographic location (including that of trial study sites), subject area of expertise, and even professional profile—sometimes giving the “rising stars” their chance to shine.
This could mean that the diverse author list may include authors who are well known and those who are not so well known, which emphasizes that publication decisions are made purely on the merit of the data rather than personal connections with journals or reputation.
Who is responsible for this? The answer: everyone. Authorship diversity should be considered as early as publication pre-conception. As authorship should also ideally reflect the clinical trial setting, trial design, steering committee establishment, and even selection of trial sites can feed into this. This means that diversity can then be considered at the publication-planning level, to ensure it is proactively incorporated into the strategy. Other authors and publication professionals can also play a role in suggesting diversity where it is lacking. Finally, journal editors themselves may want to assess an author group to ensure it is appropriate, diverse, and relevant.
In terms of how this is done, there is little in the way of formal guidance so far; some kind of framework or best practice guidance would be a useful starting point. Artificial intelligence may be one way to ensure that authors are selected in a way that enhances the clinical implications of the data, improves the publication impact, and ensures the data are reaching the right audience.
The above sentiments apply not only to the scientists and KOLs of an author panel, but also expand authorship to include patients or patient representatives. Despite the lack of formal guidance on diverse authorship, Good Publication Practice 2022 recognizes the inclusion of patient authors as valuable. They can help make a publication more appealing, accessible, and relatable to a patient audience, and can provide useful contributions to elements for nonscientific audiences, such as a plain language summary. Some teams within the medical publications industry have gone as far as developing a framework that supports the inclusion of patient authors, as presented at the recent 2024 European Meeting of the International Society for Medical Publication Professionals. This only highlights the increasing importance and relevance of including patient authors, and encourages its uptake across the industry.
So, what do we really think? There can be genuine benefits to increasing the diversity of authorship, mainly to enhance the interpretation, reach, and impact of data, which will ultimately influence patient outcomes. Including patient authors can enhance this by furthering the reach within the nonscientific community. However, we must not forfeit everything “just” for the sake of diversity: authors still need to have had a relevant role in the trial and/or data analysis. Ultimately, it is the responsibility of everyone involved in publications to ensure authorship is fair and relevant, and diversity continues to evolve in the right way. Afterall, imagine how the scientific landscape could change if we challenged the comfort zone, and if publication authorships were as varied as the populations they seek to understand?