SPECIAL ARTICLE

Plagiarism
John E. Skandalakis, MD, PhD; Petros Mirilas, MD, MSurg

T
he theft of someone’s words or thoughts—plagiarism—has long been a concern in medi-
cal literature. The phenomenon applies to unreferenced published or unpublished data
that belong to someone else, including applications for grants and a publication sub-
mitted in a different language. Other acts of plagiarism are paraphrasing without cred-
iting the source, using “blanket” references, “second-generation” references, and duplicate or re-
petitive 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 prob-
lematic, 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.
Arch Surg. 2004;139:1022-1024
The poet’s eye in a fine frenzy rolling, many investigators and many current En-
Doth glance from heaven to earth, from earth glish dictionaries3,4 contend that the term
to heaven, plagiarism comes from the Latin plagia-
And, as imagination bodies forth rius, meaning kidnapper. However, in clas-
The forms of things unknown, the poet’s pen
sical Latin, plagiarius never refers to a pla-
Turns them to shapes, and gives to airy
nothing giarist; its first use was metaphorical in
A local habitation and a name. Martial’s epigrams5; the next use of this
metaphor was by Lorenzo Valla (Elegan-
Shakespeare in A Midsummer Night’s Dream tiae, preface of Book 2) to refer to some-
one who used his work.6 Thus, ironi-
cally, the etymology of plagiarism is often
In the above lines, Shakespeare portrays wrongly attributed.
the gift of the poet: the ability to shape As published in the British Journal of
unique thoughts into memorable words on Surgery, the Committee on Publication
paper. The theft of someone’s words or Ethics7 defined plagiarism as follows:
thoughts—plagiarism—has long been a
concern. Historically, Timae1(p1056) attrib- Plagiarism ranges from the unreferenced use
uted the term plagiarism to Empedocles of others’ published and unpublished ideas, in-
cluding research grant applications to submis-
(circa 490-430 BC). At that time the Greek sion under “new” authorship of a complete pa-
word plagios, which denotes obliquity, al- per, sometimes in a different language.
ready had the sense of being “morally It may occur at any stage of planning, re-
crooked, practicing double-talk.”1(p1410) search, writing, or publication: It applies to
(Conversely, in contemporary English us- print and electronic versions.
age, the expression “a straight arrow” in-
dicates moral qualities.2) Nevertheless, Although detailed, the above defini-
tion is not complete. It is evident that there
From the Centers for Surgical Anatomy and Technique, Emory University, Atlanta, Ga are numerous expressions of plagiarism in
(Drs Skandalakis and Mirilas); and the Department of Anatomy and Embryology, more innocent terms, such as presenting
University of Crete Medical School, Heraklion, Crete, Greece (Dr Mirilas). slides for lectures without copyright per-

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 mission. Plagiarism of illustrations8,9 should be clearly
stated in the definition.
We are very skeptical of the notion that most au-
thors 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 gen-
eral 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” refer-
ences, ie, numerous references given together; “second-
generation” references; and duplicate or repetitive publi-
cation of one’s own previously published work
(self-plagiarism). Furthermore, consider whether a peer re-
viewer should be cited when his comments have been in-
corporated into an article.11 Does failure to cite the peer re-
viewer constitute a plagiaristic action? What about
paraphrasing the remarks? In addition, there is the anony-
mous 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 com-
mon knowledge, which does not need citation. He wrote:
Common knowledge in one scholarly arena may not be com-
mon 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 disagree-
ment with Armstrong’s concept of common knowledge.
Haramati and Amis refer to the requirement of many jour-
nals 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 au-
thor should include only the minimum number of ar-
ticles 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 na-
ı̈ve young academic.
An editorial by Lutter13 stated:
Overt plagiarism in medical publishing is quite rare. It is un-
clear to me why anyone would think that they could copy some-
one’s words and ideas and not be discovered. . . . More fre-
quently 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 un-
derstand 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 back-
ground the state of the art. The fine line between ethos
and ethical deviation is invisible and often difficult to dis-
cern. Stearns14 stated:
Given this interdependence of human creative efforts, the idea
of plagiarism is something of a paradox. Why condemn an au-
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thor for borrowing from another if such borrowing is inevi-
table 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 eas-
ily defined and creates the great paradox that surrounds
plagiarism.
Plagiarism is a terrible old disease, fatal to the pla-
giarist. It is illegal, immoral, and unethical. James P.
Smith15 stated: “Plagiarists must have a death wish for
their actions can result in professional suicide.” How-
ever, as in all cases of ethical dilemmas, whether the ac-
tion is a crime depends on the individual’s intent. Con-
sciousness of the act and its profits marks the difference
between deliberate plagiarism and accidental plagia-
rism or simple coincidence.
Maddox16 has written an editorial titled “Plagia-
rism is worse than mere theft.” Plagiarism is not only
worse than mere theft, it is also less clever. In plagia-
rism, stolen material is not concealed but, on the con-
trary, is thrown to the eyes of interested people. Nor-
mally, the same few people will read both the original
and the plagiarized publications in their specialty jour-
nals or during an electronic bibliography search.
How are we, finally, to understand the plagiarist’s mo-
tivation? 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 col-
leagues 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 au-
thors.17 However, scientific (and human) interaction of-
ten surpasses what the law has predicated.
In previous eras plagiarism could more easily es-
cape detection, but today the simple process of search-
ing a string of words in an electronic database makes pla-
giarism 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 ⱕ48
according to Julliard20) without quotation marks. Obvi-
ously, 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 pro-
jection into the duodenum (papilla).22 These were re-
described 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 engrav-
ings in his book.25 Garrison26 wrote, in History of Medi-
cine: “Bidloo scolds about this plagiarism in his Guliel-
mus Cowper, Criminis Literarii Citatus.”27
Cowper also “discovered” the bulbourethral glands,
known as the Cowper glands. But, according to Per-
saud,24 they had been discovered 15 years earlier by Jean
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 Mery (1645-1722). Zimmerman28 stated that Cowper was
“[d]riven by an ambition so powerful that it blinded his 3.
scruples,” and Norman29 stated that the action of Cow-
per was “ . . . one of the most extraordinary plagiarisms 4.
in the entire history of medicine.” According to Met-
tler,30 it was Realdo Colombo (1516-1559) who actually
5.
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 Pec-
quet (1622-1674) had already worked with the lym- 6.
phatic system and discovered the thoracic duct.33 Tho-
mas Bartholin (1616-1680) also claimed the discovery 7.
and introduced the word lymphatics. Kanter33 wrote that
“they [Rudbeck and Bartholin] openly argued and ac- 8.
cused each other of plagiarism,” and believes that both 9.
made their discoveries independently. 10.
Certainly, the above cases are not unique. Giants such
as Ptolemy, Galileo, Newton, and Mendel have been ac- 11.
cused of plagiarism by modern scientists who reexamined
12.
their data.34 Pythagoras has been called a systematic pla-
giarist who stole all his knowledge from Egyptians.16 One 13.
might say that it takes no courage to accuse the giants of
the past. In contrast, it would take great courage for a vic- 14.
timized young academic to act against a senior who pla-
giarizes. In our academic life, dishonest attitudes such as 15.
plagiarism—among others—are prompted not only by the 16.
“human,” let us say, vision of reputation and glory but also 17.
(mostly) by the artificial publish-or-perish hysteria. Such
a mentality encourages quantity rather than quality, and, 18.
19.
as we know from experience, quantity without quality has
negative (if not disastrous) results. 20.
Academic institutions react to this “intellectual dis-
ease” of plagiarism by establishing specific antiplagia- 21.
rism committees and policies35 while requiring their fac-
22.
ulty, especially new members, to meet high expectations
that include a long list of publications. In our opinion, 23.
insight into the causes and effects of plagiarism, al-
though painful, is necessary and will provide the only 24.
path to the Greek concept of gnothi safton (know thyself).
25.
It is essential to acquire this insight as the basis for un-
derstanding and eliminating the plagiaristic attitude, which 26.
is contagious to the morally weak.
27.
We thank Phyllis Bazinet for editorial assistance.
28.
Dr Mirilas was partially supported by the Onassis Foun-
dation, Athens, Greece.
Correspondence: John E. Skandalakis, MD, PhD, Cen- 29.
ters for Surgical Anatomy and Technique, Emory Univer-
30.
sity School of Medicine, 1462 Clifton Rd NE, Suite 303, At- 31.
lanta, GA 30322 (pbazine@emory.edu).
32.
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