Claims to primacy or priority (being the ‘first’) are an unnecessary conceit

The merit of an article submitted for publication rests in its clinical relevance, scientific validity and, usually, its novelty. Exceptions to the latter might include studies specifically designed to reproduce or retest prior work. Novelty typically relates to addressing an identified knowledge gap, but may occasionally refer to an original idea or observation that the authors wish to communicate. It is usually necessary for authors to explain the knowledge gap their submission addresses, thereby justifying the need for their study or report and hopefully stimulating the reviewers’ and editor’s interest. However, in some instances, the authors go further and emphasise that their article is the ‘first’ on a particular topic, making this claim prominently in their abstract, the introduction, early in their discussion, or in the conclusion. This emphasis is rarely necessary, may well be incorrect, and is likely to be questioned by the editors.

Firstly, how do the authors know that their study or report is a ‘first’? For all they know, innumerable studies or reports on the same topic could have been submitted by other authors to various journals previously, but not accepted for publication due to lack of interest. Perhaps to account for this possibility, authors often state that there have been ‘no previous published articles’ on the topic, but this would also be open to question. Did the authors undertake a systematic review and carefully screen all articles to confirm that there were no previous similar articles? If so, what was the scope of their review (i.e. how many databases were included, what language limitations were imposed, and how far back was the search)? Many older publications are not digitally indexed, and relevant article content may not be identified in the title or abstract. Often, then, they further qualify their statement with ‘to their knowledge’ there were ‘no previous published articles’, but this could still not be interpreted fully without knowing the extent and detail of their search.

Notwithstanding the problems in proving a claim that an article is a ‘first’, what is the potential benefit? Whether or not priority is claimed, the authors must still identify the knowledge gap that they propose to fill, or the educational or scientific merit of their original idea or report. It is only on these latter aspects that a decision will be made on whether or not the article is sufficiently novel to warrant publication (given the requisite scientific validity and clinical relevance). The fact that the article might be a ‘first’ is almost never an independent criterion. Moreover, the educational message the authors wish to convey should pertain whether or not an article is a ‘first’. Therefore, while in some instances the fact that an article is a ‘first’ may be of interest, it is rarely a primary consideration requiring emphasis by the authors prior to discussion of other aspects.

Perhaps the main potential perceived benefit by the authors in claiming a ‘first’ is the establishment of priority, should there be future studies or reports on the same topic. However, this is also unnecessary. Priority, if it exists, will be established by the date of publication. Inclusion of a claim to be ‘first’ will add nothing to this priority.

In contrast to the lack of necessity and potential inaccuracy of an early emphasis on claiming priority in any article, there is an appropriate opportunity in the discussion sections to comment on whether there have been previous studies or reports on the same topic. This is when the authors place their findings in the context of previous studies or reports and typically occurs after the results are interpreted, the implications are explained, the strengths are outlined and any weaknesses defended. While it might be informative in this context, we nevertheless caution against strident claims, even with the caveat ‘to our knowledge’, that there have been no previous studies or reports on the same topic with which to compare the current findings. Authors would need to be very certain of their ground and should be modest in their commentary. The reference list (no doubt very incomplete!) for this particular editorial, for example, required a nuanced search using Google when a PubMed search was largely fruitless.

Irrespective of whether a claim of priority might be appropriate in a discussion section, it is almost never appropriate in a conclusion. The conclusion or concluding remarks should relate to the educational message of the article and may include recommendations based on the data or details presented, with suggestions for future research. Concluding that an article is a ‘first’ will not contribute meaningfully to these objectives.

Claims and disputes over priority are certainly nothing new in science, the Leibniz–Newton calculus controversy being an early and well-documented example. ¹ Published priority disputes are also nothing new at all in medicine. ² Nor are we by any means the first to decry the habit of authors to include statements and claims regarding primacy, or to suggest the inclusion of such comments in manuscripts is unnecessary.^3–6 Some journals, we have learned, and including at least one in our own field, specifically proscribe statements of priority in their instructions to authors. ⁶ , ⁷ In the light of this, Anaesthesia and Intensive Care will soon also include a similar request in our guidelines. As presciently noted by William Strauss in 1993, ⁶ ‘We are not the first to take this step, but to the best of our knowledge, neither are we the last.’