PhiliPPine Journal of otolaryngology-head and neck Surgery                                                      Vol. 38  no. 1  January - June  2023                                PhiliPPine Journal of otolaryngology-head and neck Surgery                                                     Vol. 38  no. 1  January - June  2023

PhiliPPine Journal of otolaryngology-head and neck Surgery  54  PhiliPPine Journal of otolaryngology-head and neck Surgery

EDITORIAL

On January 20, 2023, the World Association of Medical Editors published a policy statement 
on  Chatbots, ChatGPT, and Scholarly Manuscripts: WAME Recommendations on ChatGPT and 
Chatbots in Relation to Scholarly Publications.1 There were four recommendations, namely: 
1. Chatbots cannot be authors; 2. Authors should be transparent when chatbots are used 
and provide information about how they were used; 3. Authors are responsible for the work 
performed by a chatbot in their paper (including the accuracy of what is presented, and the 
absence of plagiarism) and for appropriate attribution of all sources (including for material 
produced by the chatbot); and 4. Editors need appropriate tools to help them detect content 
generated or altered by AI and these tools must be available regardless of their ability to 
pay.1  This statement was spurred in part by some journals beginning to publish papers in which 
chatbots such as ChatGPT were listed as co-authors.2

First, only humans can be authors. Chatbots cannot be authors because they cannot meet 
authorship requirements “as they cannot understand the role of authors or take responsibility 
for the paper.”1  In particular, they cannot meet the third and fourth ICMJE criteria for authorship, 
namely “Final approval of the version to be published” and “Agreement to be accountable for 
all aspects of the work in ensuring that questions related to the accuracy or integrity of any 
part of the work are appropriately investigated and resolved.”1,3  Moreover,  “a chatbot cannot 
understand a conflict of interest statement, or have the legal standing to sign (such a) statement,” 
nor can they “hold copyright.”1 Because authors submitting a manuscript must ensure that all 
those named as authors meet ICMJE authorship criteria, chatbots clearly should not be included 
as authors.1

Correspondence: Prof. Dr. José Florencio F. Lapeña, Jr.
Department of Otolaryngology - Head and Neck Surgery
Ward 10, Philippine General Hospital
Taft Avenue, Ermita, Manila 1000 
Philippines
Phone: (632) 8554 8467
Telefax: (632) 8524 4455
Email:  lapenajf@upm.edu.ph 
               jflapena@up.edu.ph 

The author declared that this represents original material 
that is not being considered for publication or has not been 
published or accepted for publication elsewhere, in full or 
in part, in print or electronic media; that the manuscript 
has been read and approved by the author, that the 
requirements for authorship have been met by the author, 
and that the author believes that the manuscript represents 
honest work. 

José Florencio F. Lapeña, Jr., MA, MD

Department of Otolaryngology - Head and Neck Surgery
College of Medicine, University of the Philippines Manila

Department of Otorhinolaryngology 
Head and Neck Surgery
East Avenue Medical Center, Diliman, Quezon City

The Updated World Association 
of Medical Editors (WAME) Recommendations 

on Chatbots and Generative AI in Relation 
to Scholarly Publications  and International 

Committee of Medical Journal Editors (ICMJE) 
Recommendations for the Conduct, Reporting, 

Editing, and Publication of Scholarly Work 
in Medical Journals (May 2023)

c  Philippine Society of Otolaryngology – Head and Neck Surgery, Inc.
Creative Commons (CC BY-NC-ND 4.0)
Attribution - NonCommercial - NoDerivatives 4.0 International Philipp J Otolaryngol Head Neck Surg 2023; 38 (1): 4-6



PhiliPPine Journal of otolaryngology-head and neck Surgery                                                      Vol. 38  no. 1  January - June  2023                                PhiliPPine Journal of otolaryngology-head and neck Surgery                                                     Vol. 38  no. 1  January - June  2023

PhiliPPine Journal of otolaryngology-head and neck Surgery  54  PhiliPPine Journal of otolaryngology-head and neck Surgery

EDITORIAL

Second, authors should acknowledge the sources of their 
materials. When chatbots are used, authors “should declare this fact 
and provide full technical specifications of the chatbot used (name, 
version, model, source) and method of application in the paper they 
are submitting (query structure, syntax),” “consistent with the ICMJE 
recommendation of acknowledging writing assistance.”1,4 

 Third, authors must take public responsibility for their work; 
“Human authors of articles written with the help of a chatbot are 
responsible for the contributions made by chatbots, including their 
accuracy,” and “must be able to assert that there is no plagiarism in 
their paper, including in text produced by the chatbot.”1 Consequently, 
authors must  “ensure … appropriate attribution of all quoted material, 
including full citations,” “seek and cite the sources that support,” as well 
as oppose (since chatbots can be designed to omit counterviews), the 
chatbot’s statements.1

Fourth, to facilitate all this, medical journal editors (who “use 
manuscript evaluation approaches from the 20th century”) “need 
appropriate (digital) tools … that will help them evaluate … 21st 
century … content (generated or altered by AI) efficiently and 
accurately.”1 

The “proliferation of chatbots and their expanding use in scholarly 
publishing over the last few months, as well as emerging concerns 
regarding lack of authenticity of content when using chatbots” 
prompted the issuance in May 2023 of a revised policy statement: 
Chatbots, Generative AI, and Scholarly Manuscripts: WAME 
Recommendations on Chatbots and Generative Artificial Intelligence 
in Relation to Scholarly Publications.5

A new recommendation has been added to the four original 
principal recommendations: Editors and reviewers should specify, 
to authors and each other, any use of chatbots in evaluation of 
the manuscript and generation of reviews and correspondence. If 
they use chatbots in their communications with authors and each 
other, they should explain how they were used.5 Journal “editors and 
reviewers are responsible for any content and citations generated by 
a chatbot, and should be aware that chatbots retain the prompts fed 
to them, including manuscript content, and supplying an author’s 
manuscript to a chatbot breaches confidentiality of the submitted 
manuscript.”5  

In addition, the second recommendation (Authors should be 
transparent when chatbots are used and provide information about 
how they were used) has been expanded, with two sub-headings: 2.1. 
Authors submitting a paper in which a chatbot/AI was used to draft 
new text should note such use in the acknowledgment; all prompts 
used to generate new text, or to convert text or text prompts into tables 
or illustrations, should be specified; and 2.2: When an AI tool such as 
a chatbot is used to carry out or generate analytical work, help report 
results (e.g., generating tables or figures), or write computer codes, 
this should be stated in the body of the paper, in both the Abstract 
and the Methods section. In the interests of enabling scientific 
scrutiny, including replication and identifying falsification, the full 
prompt used to generate the research results, the time and date of 
query, and the AI tool used and its version, should be provided.5

The revised WAME recommendations also reflec t the M ay 
2023 updated ICMJE recommendations that added a new sec tion 
(II.A.4) and revised other sec tions (II.C.3, III.D.2, IV.A.3.g) to 
provide guidance on how wor k conduc ted with the assistance 
of AI technology (including ChatGPT ) should and should not 
be ack nowledged. 6  These updated recommendations have 
also been incor porated in the revised I nstruc tions to Authors 
(https://pjohns.pso-hns.org/index.php/pjohns/libraryFiles/downloadPublic/121) 
and Author Forms
(https://pjohns.pso-hns.org/index.php/pjohns/libraryFiles/downloadPublic/123) 
of the Philippine Journal of Otolaryngology Head and Neck Surgery.6  
In particular, the sections on Requirements for Authorship, 
Acknowledgements, and References reflect the May 2023 ICMJE 
recommendations.6,7

Insofar as authorship is concerned,   the ICMJE revised criterion #2 
from “Drafting the work or revising it critically for important intellectual 
content” to “Drafting the work or reviewing it critically for important 
intellectual content”.6 The ICMJE made this change “because some 
authors may interpret ‘revising’ to indicate the requirement to make 
changes to earlier versions of the manuscript (in order to qualify for 
authorship) even if authors agree with the content,” believing that “this 
new change more accurately captures the original intent of the criterion 
-- which is that all authors must at a minimum review the manuscript 
critically for important intellectual content AND have the opportunity 
to make changes if warranted.”6 In our context, this particularly calls 
out (mostly ‘senior’) co-authors who relegate the tasks of drafting and 



PhiliPPine Journal of otolaryngology-head and neck Surgery                                                      Vol. 38  no. 1  January - June  2023                                PhiliPPine Journal of otolaryngology-head and neck Surgery                                                     Vol. 38  no. 1  January - June  2023

PhiliPPine Journal of otolaryngology-head and neck Surgery  76  PhiliPPine Journal of otolaryngology-head and neck Surgery

EDITORIAL

REFERENCES 
1. Zielinski C, Winker M, Aggarwal R, Ferris L, Heinemann M, Lapeña JF, Pai S, Ing E, Citrome 

L on behalf of the WAME Board. Chatbots, ChatGPT, and Scholarly Manuscripts: WAME 
Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications. January 20, 
2023. World Association of Medical Editors. Available from:  https://wame.org/page3.php?id=110; 
Republished as: Zielinski C, Winker M, Aggarwal R, Ferris L, Heinemann M, Lapeña, Jr JF, Pai S, 
Ing E, Citrome L. Chatbots, ChatGPT, and Scholarly Manuscripts: WAME Recommendations on 
ChatGPT and Chatbots in Relation to Scholarly Publications. Open Access Maced J Med Sci. 2023 
Jan. 30;11(A):83-6. Available from: https://oamjms.eu/index.php/mjms/article/view/11502.

2. Stokel-Walker C. ChatGPT listed as author on research papers: many scientists disapprove. 
Nature 2023 January 18; 613:620-621. DOI: 10.1038/d41586-023-00107-z; PubMed PMID: 
36653617.

3. International Committee of Medical Journal Editors (ICMJE). Recommendations  for the Conduct, 
Reporting, Editing, and Publication of Scholarly work in Medical Journals. Updated May 2022. Who 
Is an Author? Defining the Role of Authors and Contributors. [cited 2023 January 18] Available from: 
https://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html.

4. I n t e r n a t i o n a l  C o m m i t t e e  o f  M e d i c a l  J o u r n a l  E d i t o r s  ( I C M J E ) .   R e c o m m e n d a t i o n s  f o r 
t h e  C o n d u c t ,  R e p o r t i n g ,  E d i t i n g ,  a n d  P u b l i c a t i o n  o f  S c h o l a r l y  w o r k  i n  M e d i c a l 
J o u r n a l s .  U p d a t e d  M a y  2 0 2 2 .  N o n - A u t h o r  C o n t r i b u t o r s ,  D e f i n i n g  t h e  R o l e  o f 
A u t h o r s  a n d  C o n t r i b u t o r s .  [ c i t e d  2 0 2 3  J a n u a r y  1 8 ]  Av a i l a b l e  f r o m :

 https://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html.

5. Zielinski C, Winker MA, Aggarwal R, Ferris LE, Heinemann M, Lapeña JF, Pai S, Ing E, Citrome 
L, Alam M, Voight M, Habibzadeh F. on behalf of the WAME Board. Chatbots, Generative AI, 
and Scholarly Manuscripts: WAME Recommendations on Chatbots and Generative Artificial 
Intelligence in Relation to Scholarly Publications. World Association of Medical Editors. May 31, 
2023. Available from:  https://wame.org/page3.php?id=106.

6. International Committee of Medical Journal Editors (ICMJE) [Homepage on the Internet]. 
Recommendations  for the Conduct, Reporting, Editing, and Publication of Scholarly 
work in Medical Journals. Updated May 2023. [cited 2023 May 29]. Available from:                      
https://www.icmje.org/news-and-editorials/icmje-recommendations_annotated_may23.pdf.

 7. Philipp J Otolaryngol Head Neck Surg. Official Publication of the Philippine Society of 
Otolaryngology - Head and Neck Surgery. [Homepage on the Internet; accessed 2023 May 29]. 
Available from: https://pjohns.pso-hns.org/index.php/pjohns.

8. Lapeña JF. Truth and Transparency, Compromise and Climate Change. Philipp J Otolaryngol 
Head Neck Surg. 2022 Nov. 15;37(2):4-5. DOI: 10.32412/pjohns.v37i2.2015.

9. Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and Gender Equity in Research: rationale for 
the SAGER guidelines and recommended use. Res Integr Peer Rev. 2016 May 3;1:2. DOI: 10.1186/
s41073-016-0007-6 PubMed PMID: 29451543 PubMed Central PMCID: PMC5793986.

revising the manuscript to the first (usually ‘junior’) author, failing to 
even review the manuscript as it undergoes revisions based on editor 
and reviewer comments, corrections, and recommendations. 

Insofar as the peer review process is concerned, the ICMJE has 

replaced the terms “blinded” with “anonymized.”6 This is not new to us, 

as the Philipp J Otolaryngol Head Neck Surg already made this transition 

in 2022.8  In addition, the ICMJE now encourages authors “to refer to 

the SAGER guidelines for reporting of sex and gender information in 

study design, data analyses, results, and interpretation of findings.9 

Without officially adapting SAGER guidelines, the PJOHNS has long 

considered sex as pertaining to biological and gender as pertaining to 

psycho-socio-cultural differences between men, women, boys, girls, 

and gender-diverse people.

The bulk of changes in the new ICMJE recommendations concern 

the use of AI technology (including ChatGPT). These recommendations 

have all been incorporated in our journal. 

Requirements for Authorship now state: “Artificial Intelligence (AI)-
assisted technologies (such as Large Language Models [LLMs], chatbots 

or image creators) should not be listed or be cited as authors, because 

they cannot be responsible for the accuracy, integrity, and originality of 

the work, and these responsibilities are required for authorship.”7

Acknowledgements now include: “Authors must disclose whether 
they used artificial intelligence (AI)-assisted technologies (such as Large 
Language Models [LLMs], chatbots or image creators) in the production 
of submitted work. Authors who use such technology should describe, 
in both the cover letter and the submitted work, how they used it.  
Humans are responsible for any submitted material that included the 
use of AI-assisted technologies. Authors should carefully review and 
edit the manuscript because AI can generate authoritative-sounding 
output that can be incorrect, incomplete or biased.”7

References now instruct: “Do not cite references listing AI as an 
author, because AI cannot fulfill authorship criteria. Authors should 
be able to assert that there is no plagiarism in their paper, including 
in text and images produced by the AI. Humans must ensure there is 
appropriate attribution of all quoted material including full citations.”7

The WAME Recommendations on Chatbots and Generative AI 
(including ChatGPT) in Relation to Scholarly Publications will continue 
to be modified as the software and its applications develop,5 and we 
can expect the ICMJE Recommendations for the Conduct, Reporting, 
Editing, and Publication of Scholarly Work in Medical Journals6 to be 
continuously updated also. As a Journal of a WAME Member Editor 
(https://wame.org/journals-whose - editors-belong-to -wame#M-R) 
and o n e  s t a t i n g  t h a t  i t  f o l l o w s  t h e  I C M J E  R e c o m m e n d a t i o n s 
(https://www.icmje.org/journals-following-the-icmje-recommendations/#P), 
the Philippine Journal of Otolaryngology Head and Neck Surgery will 
update its policies and practice as well.