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Special Article
September 1, 2004


Author Affiliations

From the Centers for Surgical Anatomy and Technique, Emory University, Atlanta, Ga (Drs Skandalakis and Mirilas); and the Department of Anatomy and Embryology, University of Crete Medical School, Heraklion, Crete, Greece (Dr Mirilas).

Arch Surg. 2004;139(9):1022-1024. doi:10.1001/archsurg.139.9.1022

The theft of someone's words or thoughts—plagiarism—has long been a concern in medical literature. The phenomenon applies to unreferenced published or unpublished data that belong to someone else, including applications for grants and a publication submitted in a different language. Other acts of plagiarism are paraphrasing without crediting the source, using "blanket" references, "second-generation" references, and duplicate or repetitive publication of one's own previously published work. Does incorporating a peer reviewer's ideas constitute plagiarism? The requirement of many journals for a short list of references is problematic, as is confusion about what constitutes common knowledge. What criteria should be used for detecting plagiarism? To make an accusation of plagiarism is serious and perilous. Motivations for plagiarism are considered, and 2 striking historical examples of plagiarism are summarized. We believe that with insight into its causes and effects, plagiarism can be eliminated.

The poet's eye in a fine frenzy rolling, Doth glance from heaven to earth, from earth to heaven, And, as imagination bodies forth The forms of things unknown, the poet's pen Turns them to shapes, and gives to airy nothing A local habitation and a name.

Shakespeare in A Midsummer Night's Dream

In the above lines, Shakespeare portrays the gift of the poet: the ability to shape unique thoughts into memorable words on paper. The theft of someone's words or thoughts—plagiarism—has long been a concern. Historically, Timae1(p1056) attributed the term plagiarism to Empedocles (circa 490-430 BC). At that time the Greek word plagios, which denotes obliquity, already had the sense of being "morally crooked, practicing double-talk."1(p1410) (Conversely, in contemporary English usage, the expression "a straight arrow" indicates moral qualities.2) Nevertheless, many investigators and many current English dictionaries3,4 contend that the term plagiarism comes from the Latin plagiarius, meaning kidnapper. However, in classical Latin, plagiarius never refers to a plagiarist; its first use was metaphorical in Martial's epigrams5; the next use of this metaphor was by Lorenzo Valla (Elegantiae, preface of Book 2) to refer to someone who used his work.6 Thus, ironically, the etymology of plagiarism is often wrongly attributed.

As published in the British Journal of Surgery, the Committee on Publication Ethics7 defined plagiarism as follows:

Plagiarism ranges from the unreferenced use of others' published and unpublished ideas, including research grant applications to submission under "new" authorship of a complete paper, sometimes in a different language.

It may occur at any stage of planning, research, writing, or publication: It applies to print and electronic versions.

Although detailed, the above definition is not complete. It is evident that there are numerous expressions of plagiarism in more innocent terms, such as presenting slides for lectures without copyright permission. Plagiarism of illustrations8,9 should be clearly stated in the definition.

We are very skeptical of the notion that most authors who plagiarize do so deliberately, and we believe that motivation is a critical factor in attempting to understand plagiarism. We suspect that authors do not understand what actually constitutes plagiarism. Indeed, there is no general consensus on the subject, so confusion is inevitable. In an excellent article, but one that is based on a very strict view of plagiarism, Armstrong10 wrote that paraphrasing may be plagiarism if the source of the idea has not been credited. Incomplete or careless attribution, also, may be plagiarism. Plagiarism may be seen in "blanket" references, ie, numerous references given together; "second-generation" references; and duplicate or repetitive publication of one's own previously published work (self-plagiarism). Furthermore, consider whether a peer reviewer should be cited when his comments have been incorporated into an article.11 Does failure to cite the peer reviewer constitute a plagiaristic action? What about paraphrasing the remarks? In addition, there is the anonymous reference: Is it a reference?12 Would it be harmful to the anonymous author not to cite him or her?10

Armstrong10 raised the complex question of common knowledge, which does not need citation. He wrote:

Common knowledge in one scholarly arena may not be common in another; thus, citation would be necessary if one is in doubt that an assertion is common knowledge, and generosity in citation may be prudent.

Beyond this, he argued: "Every specific fact or assertion requires a specific reference." A response by Haramati and Amis11 to Armstrong's article expressed disagreement with Armstrong's concept of common knowledge. Haramati and Amis refer to the requirement of many journals for a short list of citations, and to textbooks that have only a short list of references or only a list of readings because of restrictions imposed by the publisher. They state that the restrictions are justified because the author should include only the minimum number of articles necessary to give readers the proper perspective. They conclude: "Referencing practices should not be based on the fear of being labeled a plagiarist." Contradictory opinions such as these cause much confusion for the naïve young academic.

An editorial by Lutter13 stated:

Overt plagiarism in medical publishing is quite rare. It is unclear to me why anyone would think that they could copy someone's words and ideas and not be discovered. . . . More frequently seen is a passive plagiarism or attribution failure. The passive type of plagiarism is one that most of us have done.

In academic life, scholarship, and research, we understand the ethos to incorporate the ideas of others into our science. All teaching consists of transmission of what is known, and all research projects have as a background the state of the art. The fine line between ethos and ethical deviation is invisible and often difficult to discern. Stearns14 stated:

Given this interdependence of human creative efforts, the idea of plagiarism is something of a paradox. Why condemn an author for borrowing from another if such borrowing is inevitable and even fundamental to the creative process?

Stearns14 also stated: "Plagiarism is, then, a failure of the creative process, not a flaw in its result."

We totally agree. However, the point at which the process moves from originality to plagiarism is not easily defined and creates the great paradox that surrounds plagiarism.

Plagiarism is a terrible old disease, fatal to the plagiarist. It is illegal, immoral, and unethical. James P. Smith15 stated: "Plagiarists must have a death wish for their actions can result in professional suicide." However, as in all cases of ethical dilemmas, whether the action is a crime depends on the individual's intent. Consciousness of the act and its profits marks the difference between deliberate plagiarism and accidental plagiarism or simple coincidence.

Maddox16 has written an editorial titled "Plagiarism is worse than mere theft." Plagiarism is not only worse than mere theft, it is also less clever. In plagiarism, stolen material is not concealed but, on the contrary, is thrown to the eyes of interested people. Normally, the same few people will read both the original and the plagiarized publications in their specialty journals or during an electronic bibliography search.

How are we, finally, to understand the plagiarist's motivation? Maddox16 wonders: "Does guilt, or the wish not to face up to the enormity of the crime being perpetrated, prevent plagiarists from taking elementary precautions against discovery?" The only rational explanation for colleagues exposing themselves to the danger of professional disaster is that they are in an irrational state, that they are being guided by a primitive, but overwhelming, academic motivation: the desire to enhance their reputation.

Copyright law has established boundaries for authors.17 However, scientific (and human) interaction often surpasses what the law has predicated.

In previous eras plagiarism could more easily escape detection, but today the simple process of searching a string of words in an electronic database makes plagiarism more obvious. Some definitions of plagiarism are based on verbatim use of a specific number of letters (up to 30)18 or words (7-10 according to Schrader19 and ≤48 according to Julliard20) without quotation marks. Obviously, these standards have to be reexamined.

Several situations of plagiarism have been pointed out in the past. In the Bidloo-Cowper case—reported in French by Gysel21—Govert (Gottfreid) Bidloo (1649-1713) first observed the junction of the common bile duct and the pancreatic duct and described the ampulla and the projection into the duodenum (papilla).22 These were redescribed by Vater in 1720.23 According to Persaud,24 in 1685 Bidloo published his Anatomia Humani Corporis22 with 105 copperplate engravings by Pieter van Gunst. In 1698, William Cowper (1666-1709) plagiarized these engravings in his book.25 Garrison26 wrote, in History of Medicine: "Bidloo scolds about this plagiarism in his Gulielmus Cowper, Criminis Literarii Citatus. "27

Cowper also "discovered" the bulbourethral glands, known as the Cowper glands. But, according to Persaud,24 they had been discovered 15 years earlier by Jean Mery (1645-1722). Zimmerman28 stated that Cowper was "[d]riven by an ambition so powerful that it blinded his scruples," and Norman29 stated that the action of Cowper was " . . . one of the most extraordinary plagiarisms in the entire history of medicine." According to Mettler,30 it was Realdo Colombo (1516-1559) who actually discovered the glands, also described by Jean Mery.

Olof Rudbeck31 in 1652 announced his discovery of lymphatics, and especially those of the liver.32 Jean Pecquet (1622-1674) had already worked with the lymphatic system and discovered the thoracic duct.33 Thomas Bartholin (1616-1680) also claimed the discovery and introduced the word lymphatics. Kanter33 wrote that "they [Rudbeck and Bartholin] openly argued and accused each other of plagiarism," and believes that both made their discoveries independently.

Certainly, the above cases are not unique. Giants such as Ptolemy, Galileo, Newton, and Mendel have been accused of plagiarism by modern scientists who reexamined their data.34 Pythagoras has been called a systematic plagiarist who stole all his knowledge from Egyptians.16 One might say that it takes no courage to accuse the giants of the past. In contrast, it would take great courage for a victimized young academic to act against a senior who plagiarizes. In our academic life, dishonest attitudes such as plagiarism—among others—are prompted not only by the "human," let us say, vision of reputation and glory but also (mostly) by the artificial publish-or-perish hysteria. Such a mentality encourages quantity rather than quality, and, as we know from experience, quantity without quality has negative (if not disastrous) results.

Academic institutions react to this "intellectual disease" of plagiarism by establishing specific antiplagiarism committees and policies35 while requiring their faculty, especially new members, to meet high expectations that include a long list of publications. In our opinion, insight into the causes and effects of plagiarism, although painful, is necessary and will provide the only path to the Greek concept of gnothi safton (know thyself). It is essential to acquire this insight as the basis for understanding and eliminating the plagiaristic attitude, which is contagious to the morally weak.

Correspondence: John E. Skandalakis, MD, PhD, Centers for Surgical Anatomy and Technique, Emory University School of Medicine, 1462 Clifton Rd NE, Suite 303, Atlanta, GA 30322 (

We thank Phyllis Bazinet for editorial assistance.

Dr Mirilas was partially supported by the Onassis Foundation, Athens, Greece.

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