Gift, guest & ghost authorship in biomedical publications: definitions, prevalence, impacts, detection and prevention. Scoping review

Gift, guest & ghost authorship in biomedical publications: definitions, prevalence, impacts, detection and prevention. 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Scoping review José Luis Pardal-Refoyo, Beatriz Pardal-Peláez This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6577822/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Inappropriate authorship practices, including gift, guest, and ghost authorship, are a recognized problem in biomedical and basic science publishing. These behaviors undermine research integrity, distort attribution of credit and responsibility, and threaten public trust in scientific literature. Identifying the definitions, prevalence, manifestations, consequences, detection, and prevention of inappropriate authorship is critical for maintaining ethical and scientific standards. Objectives The objective of this analysis was to systematically examine scientific literature published since 2000 that defines and differentiates gift, guest, and ghost authorship in biomedical and basic science publications, reports their frequency and manifestations, analyzes their ethical, scientific, and public health consequences, describes detection and prevention methods, and documents real cases through quantitative or qualitative approaches. Method A structured review of relevant scientific literature was performed. Studies included primary research, systematic reviews, and meta-analyses explicitly addressing definitions, prevalence, consequences, detection strategies, prevention measures, and documented cases of inappropriate authorship in biomedical and basic science publication contexts. Methods analyzed included large-scale cross-sectional surveys, analyses of retraction databases, integrative reviews, and institutional audits, covering multiple countries and journal types. Results The review found that the unethical assignment of authorship is common, with gift/honorary authorship affecting 20–60% of publications, and ghost authorship 5–10%, with higher rates reported in some regions and disciplines. Over 700 cases of authorship-related retractions have been documented. The main detection methods were anonymous surveys of authors and audits of contribution statements. Preventive strategies included stronger editorial policies, explicit contribution taxonomies, author agreements, and research ethics training. Conclusions Inappropriate authorship practices remain frequent and pose significant ethical, scientific, and public health risks. While empirical evidence supports the use of prevention and detection measures, persistent challenges exist in ensuring accurate authorship attribution. Enhanced policy implementation and international standards are needed to mitigate these risks and promote research integrity. Medical Ethics gift authorship guest authorship ghost authorship biomedical publication ethics authorship prevalence authorship detection and prevention Figures Figure 1 Introduction Inappropriate authorship practices such as gift, guest, and ghost authorship have become a pervasive problem in biomedical and basic science publishing, undermining both research integrity and public trust in scientific literature. These practices include the inclusion of individuals who do not meet established criteria for significant contribution, the addition of high-profile names to enhance manuscript prestige, and the omission of contributors who substantially participated in research activities [ 1 , 2 ]. Major editorial bodies such as the International Committee of Medical Journal Editors (ICMJE, https://www.icmje.org/ ) and the Committee on Publication Ethics (COPE, https://publicationethics.org/guidance-and-tools ) have established clear criteria to differentiate these modalities and maintain standards of authorship attribution [ 1 ]. Numerous empirical studies and reviews report that inappropriate authorship is frequent, with international surveys indicating rates of honorary or gift authorship between 20% and 60%, and ghost authorship between 5% and 10%, though these figures vary by region and discipline [ 1 – 4 ]. These authorship abuses carry significant ethical, scientific, and public health consequences, including a dilution of accountability, bias in research evidence synthesis, potential harm to clinical decision-making, and erosion of confidence in published findings [ 1 , 2 ]. Given the documented prevalence and impact of inappropriate authorship, the primary objective of this analysis was to systematically review recent scientific literature to define and differentiate gift, guest, and ghost authorship in biomedical and basic science publications, quantify their frequency and manifestations, analyze their consequences, examine detection and prevention strategies, and document real cases using quantitative and qualitative approaches [ 1 ]. Methods This study was structured and reported following PRISMA guidelines ( http://www.prisma-statement.org ). A scoping review design was adopted to identify, analyze, and synthesize scientific literature published from 2000 onwards about gift, guest, and ghost authorship in biomedical and basic sciences. A comprehensive literature search was performed in PubMed ( https://pubmed.ncbi.nlm.nih.gov/ ), Scopus ( https://www.scopus.com/ ), Web of Science ( https://www.webofscience.com/ ), Embase ( https://www.embase.com/ ), and Google Scholar ( https://scholar.google.com/ ). Searches included articles in English, Spanish, French, Italian, and German. The search strategy used the following Boolean combination: ("gift authorship" OR "honorary authorship" OR "guest authorship" OR "ghost authorship") AND ("biomedical" OR "basic science" OR "life sciences") AND (definition OR prevalence OR consequences OR detection OR prevention OR "case study" OR "retraction"). MeSH terms and their equivalents were included where relevant, and additional manual searches of bibliographies from retrieved articles were performed for completeness [ 1 , 2 ]. Inclusion criteria comprised: (a) primary research studies, systematic reviews, or meta-analyses published since 2000; (b) explicit definitions and differentiation of gift, guest, and ghost authorship; (c) quantitative or qualitative analysis of prevalence, manifestations, consequences, detection or prevention methods, or case documentation in biomedical or basic science areas; and (d) articles available in the specified languages. Exclusion criteria were: (a) lack of empirical data (e.g., editorial opinions), (b) studies outside the biomedical/basic science context, and (c) works not distinguishing among authorship types. Data collection was conducted through bibliographic management tools, with automatic literature triage, relevance scoring, and clustering performed using the Undermind AI-powered platform reviewed and supervised by both authors. Extracted information included study design, sample size, country or region, type of publication, variables analyzed (e.g., definition of authorship type, prevalence rate, consequences reported, detection/prevention approaches, case documentation), and key findings. Descriptive statistics, frequencies, and, where appropriate, pooled prevalence rates were calculated based on extracted data; no additional inferential statistics or meta-analytic effect estimation were conducted due to methodological heterogeneity [ 2 , 3 ]. All information regarding detection algorithms, editorial policies, or practical interventions was recorded as reported in the original publications. The key variables analyzed were: operational definitions and distinctions among gift, guest, and ghost authorship; empirically reported prevalence rates; documented consequences; methods of detection or prevention; and presence of documented case studies or retractions. The number of included sources in this review was determined by relevance to the research objective and explicit reporting of primary or synthesized data. Results Initially, 10 articles were identified through systematic searches of international databases [1–10]. After review by titles and abstracts, 2 articles were excluded because they did not meet inclusion criteria (topic outside the biomedical field/basic sciences or lack of differentiation between types of inappropriate authorship), a further 2 references were excluded after full-text review for lack of empirical data or insufficient case documentation [3,6,9,10]. Finally, 6 articles met the inclusion criteria and were selected for the final analysis, as detailed in Fig. 1 (PRISMA diagram) [ 1 , 2 , 4 , 5 , 7 , 8 ]. The table with the bibliographic references identified is in the Excel table of the complementary documentation. Table 1 summarizes the main characteristics of the selected studies. Five of the six articles clearly differentiate between gift, guest and ghost authorship according to the international ICMJE/COPE criteria and report prevalences with wide intervals depending on the context, discipline and method used. Table 1 Main characteristics and results of the included articles Ref Year Country / Scope Type of study Definition of authorship types Prevalence (%) Manifestations Cases / Real Documentation Detection / prevention methods GRADE level of evidence [ 1 ] 2018 Global Integrated narrative review + Retraction Watch analysis Yes, differentiated Gift ~ 33% (Europe), > 30% (Asia), Ghost ~ 5% (China), > 700 retractions Gift: reciprocity, Guest: influential names, Ghost: omissions Analysis of > 700 retractions Agreements, grids, CRediT, editorial policies Moderate–High [ 2 ] 2020 Global Review of systematic + empirical reviews Yes, differentiated Honorary/gift: 27–39%, Ghost: 2–75%, 21% in Q1 magazines Todas (ICMJE) Retraction/watch examples Surveys, training, tax returns Moderate–High [ 4 ] 2015 Global Integrative Review Yes, differentiated but merge guest/gift Honorary/gift: 55–56%, Ghost: 7.9–29% Hierarchical/ethical pressures Qualitative cases mentioned Adherence to ICMJE Moderate [ 5 ] 2018 Global Meta-analysis Yes, gift/guest together 29% misassigned authorship (pooled, 123 studies) Hyper-authorship, "sub-authorship" Review of large bases Contributorship, acknowledgements Moderate [ 7 ] 2011 Iran Cross-sectional study Yes, differentiated (ICMJE) Honorary: 56.1% authors, 89% articles; Major in Basic Institutional pressures, seniority Analysis by article and author Analysis of contributions Moderate [ 8 ] 2002 Global (Cochrane) Transv. international Yes, differentiated Honorary: 39%, Ghost: 9%, both: 2% Editorial teams, lead author decisiones Data declared by authors/publishers Authors' survey, byline analysis Moderate In bibliometric terms, it is observed that the prevalence of honorary authorship/gift ranges between 20% and 60% in international contexts, being especially high in regional studies (Iran: 56% of authors and 89% of articles with at least one honorary author; Cochrane reviews: 39%; global/multicontinent studies: 27–39%). Ghost authorship reaches consistently lower but relevant rates: 5–10% in high-impact journals; up to 21% and 29% in certain national contexts [ 1 , 2 , 4 , 7 , 8 ]. More than 700 cases of retraction explicitly attributable to authorship issues were identified in the Retraction Watch database, predominating in Asia and Europe [ 1 , 2 ]. The main manifestations include the systematic inclusion of senior or prestigious authors, the omission of medical writers or key contributors, and situations of institutional coercion. Celebrated cases and clusters of retractions are documented, as well as qualitative analyses of committee/editorial letters. Regarding detection methods, anonymous surveys of authors, audits of contribution sections, retrospective bibliometric analyses and review of retraction databases predominate. In terms of prevention, the articles recommend the implementation of contribution grids (CRediT), agreements signed between co-authors, mandatory training in ethics and reinforced editorial policies. The analysis of bias, using an adaptation of the ROBINS scale for observational studies and systematic reviews, is presented in Table 2 . Low to moderate risks are identified in most of the included studies (limitations: population heterogeneity, potential social desirability bias in surveys, and variable classification of authorship types). Table 2 Risk of Bias Assessment (ROBINS Adaptation). Ref Selection Exposure measurement Outcome measurement Incomplete data Selective reporting Other biases Global risk [ 1 ] Low Low Moderate Low Low Moderate Moderate [ 2 ] Low Low Moderate Low Low Moderate Moderate [ 4 ] Low Moderate Moderate Low Moderate Moderate Moderate [ 5 ] Low Moderate Moderate Low Low Moderate Moderate [ 7 ] Low Moderate Moderate Low Low Moderate Moderate [ 8 ] Low Moderate Moderate Low Low Moderate Moderate The level of evidence and degree of recommendation according to the GRADE scale is considered moderate-high for the definition, prevalence and manifestations of inappropriate authorship. The evidence is consistent and replicated by reviews and studies from different regions and methodologies. For prevention and screening interventions, the evidence is classified as moderate, given the paucity of prospective trials and external validations. We did not identify quantifiable heterogeneity (I2, Tau) or formal meta-analysis due to methodological variability between studies and the absence of homogeneous statistical data. In summary, the results reflect a high prevalence and persistence of inappropriate authorship in biomedical and basic science publications, with solid empirical and case documentation and concrete proposals for prevention and governance. Discussion The findings of this review confirm that inappropriate authorship practices—specifically gift, guest, and ghost authorship—remain highly prevalent in biomedical and basic science publishing worldwide, despite clear international consensus on their definitions and ethical unacceptability [ 1 , 2 , 4 , 7 , 8 ]. Reported prevalence rates for honorary or gift authorship consistently range from 20–60%, while ghost authorship affects between 5% and 10% of publications in leading journals, with even higher rates observed in some regional and specialty contexts [ 1 , 2 , 4 , 7 , 8 ]. These results align with, and extend, earlier evidence highlighting the persistence of these unethical practices across diverse publication environments [ 1 , 2 , 4 ]. The consistent documentation of more than 700 authorship-related retractions further illustrates the significant impact of inappropriate authorship on the reliability and credibility of the scientific record [ 1 ]. The primary manifestations include the inclusion of senior or prestigious names without substantial contribution, the omission of actual contributors, and situations driven by institutional pressure or power dynamics [ 1 , 7 ]. These practices not only erode trust and accountability but may distort research syntheses, with potentially harmful implications for clinical decision-making and public health outcomes [ 1 , 2 , 4 ]. Preventive and detection strategies—such as the implementation of explicit authorship contribution grids (e.g., CRediT), mandatory co-author agreements, robust editorial policies, and research ethics training programs—are increasingly recommended and, in some settings, adopted [ 1 , 2 , 6 ]. However, the evidence base for the effectiveness of these measures is limited, mainly descriptive, and not supported by prospective or intervention studies, leaving the true impact of such policies uncertain [ 1 , 2 ]. Strengths of this review include its systematic, multilingual search, comprehensive inclusion criteria, and use of rigorous bias assessment. The major limitations derive from methodological heterogeneity among studies, reliance on self-reported data (susceptible to social desirability bias), and variability in the operationalization of authorship categories across articles [ 1 , 2 , 4 , 5 , 7 , 8 ]. The absence of meta-analytical synthesis and limited availability of effect measures also restrict the generalizability of pooled prevalence estimates. Future research should address the development, implementation, and robust evaluation of intervention strategies for the prevention and detection of inappropriate authorship. There is a particular need for trial-based studies, advanced algorithmic detection methods, and in-depth qualitative investigations into regional, disciplinary, and cultural variations in authorship assignment [ 1 , 2 ]. Further standardization of both definitions and reporting practices would enhance the comparability and application of findings across contexts. In summary, the reviewed evidence underscores the persistent and global nature of inappropriate authorship practices and highlights the urgent need for effective, evidence-based solutions to promote research integrity and accountability in biomedical and basic science publication. Conclusions Inappropriate authorship practices—including gift, guest, and ghost authorship—are highly prevalent in biomedical and basic science publications. Clear operational definitions and significant rates of occurrence have been consistently documented across multiple regions and disciplines. These practices have substantial ethical, scientific, and public health consequences, undermining the credibility, accountability, and reliability of the published literature. Detection methods such as anonymous surveys, audits of contribution statements, and retraction analyses have proven effective in revealing the extent of these behaviors. Prevention strategies—such as implementation of author contribution taxonomies, signed co-author agreements, and mandatory research integrity training—are increasingly recommended but require further evaluation for their effectiveness. Key limitations of the current evidence include reliance on self-reported data, methodological heterogeneity, and a lack of robust, prospective studies on preventive interventions. Continued efforts are essential to standardize authorship criteria, enforce transparent reporting, and develop evidence-based policies to ensure the integrity of scientific publications. References Misra D, Agarwal V (2018) Integrity of Authorship and Peer Review Practices: Challenges and Opportunities for Improvement. J Korean Med Sci [Internet]. 2018 [cited 2024 Jun 1]; Available from: https://jkms.org/DOIx.php?id=10.3346/jkms .33.31 Aliukonis V, Gefenas E Perish or Publish Dilemma: Challenges to Responsible Authorship. Medicina [Internet]. 2020 [cited 2024 Jun 1];56(9):443. Available from: https://www.mdpi.com/1010-660X/56/9/443 Wislar JS, Flanagin A, Fontanarosa PB, DeAngelis CD (2011) Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey. BMJ [Internet]. [cited 2024 Jun 1];343:d6128. Available from: https://www.bmj.com/content/343/bmj.d6128 Kornhaber R, McLean L, Baber RJ (2015) Ongoing ethical issues concerning authorship in biomedical journals: an integrative review. Int J Nanomedicine [Internet]. [cited 2024 Jun 1];10:4837-46. Available from: https://www.dovepress.com/ongoing-ethical-issues-concerning-authorship-in-biomedical-journals-an-peer-reviewed-fulltext-article-IJN Kumar S Ethical Concerns in the Rise of Co-Authorship and Its Role as a Proxy of Research Collaborations. Publ [Internet]. 2018 [cited 2024 Jun 1];6(2):27. Available from: https://www.mdpi.com/2304-6775/6/2/27 Lissoni F, Montobbio F Guest Authors or Ghost Inventors? Inventorship and Authorship Attribution in Academic Science. Evaluation Review [Internet]. 2015 [cited 2024 Jun 1];39(1):23–55. Available from: https://journals.sagepub.com/doi/ 10.1177/0193841X14564913 Mirzazadeh A, Asghari F, Beigzadeh A, Anbari Z, Farhangniya M The Prevalence of Honorary and Ghost Authorships in Iranian Bio-Medical Journals and Its Associated Factors. Iran J Public Health [Internet]. 2011 [cited 2024 Jun 1];40(2):105 – 10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430080 Mowatt G, Shirran L, Grimshaw J, Rennie D, Flanagin A, Yank V, MacLennan G, Campbell M, Jones DR, Sheldon TA, Bero LA (2002) Prevalence of honorary and ghost authorship in Cochrane reviews. JAMA [Internet]. [cited 2024 Jun 1];287(21):2769-71. Available from: https://jamanetwork.com/journals/jama/fullarticle/195372 Additional Declarations The authors declare no competing interests. Supplementary Files ghostauthorSRreferencescomplementary.xlsx References_complementary ghostauthorSRcomplementary.docx summary_categories_timeline_complementary Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Scoping review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInappropriate authorship practices such as gift, guest, and ghost authorship have become a pervasive problem in biomedical and basic science publishing, undermining both research integrity and public trust in scientific literature. These practices include the inclusion of individuals who do not meet established criteria for significant contribution, the addition of high-profile names to enhance manuscript prestige, and the omission of contributors who substantially participated in research activities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Major editorial bodies such as the International Committee of Medical Journal Editors (ICMJE, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.icmje.org/\u003c/span\u003e\u003cspan address=\"https://www.icmje.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) and the Committee on Publication Ethics (COPE, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://publicationethics.org/guidance-and-tools\u003c/span\u003e\u003cspan address=\"https://publicationethics.org/guidance-and-tools\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) have established clear criteria to differentiate these modalities and maintain standards of authorship attribution [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous empirical studies and reviews report that inappropriate authorship is frequent, with international surveys indicating rates of honorary or gift authorship between 20% and 60%, and ghost authorship between 5% and 10%, though these figures vary by region and discipline [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These authorship abuses carry significant ethical, scientific, and public health consequences, including a dilution of accountability, bias in research evidence synthesis, potential harm to clinical decision-making, and erosion of confidence in published findings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the documented prevalence and impact of inappropriate authorship, the primary objective of this analysis was to systematically review recent scientific literature to define and differentiate gift, guest, and ghost authorship in biomedical and basic science publications, quantify their frequency and manifestations, analyze their consequences, examine detection and prevention strategies, and document real cases using quantitative and qualitative approaches [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was structured and reported following PRISMA guidelines (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.prisma-statement.org\u003c/span\u003e\u003cspan address=\"http://www.prisma-statement.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). A scoping review design was adopted to identify, analyze, and synthesize scientific literature published from 2000 onwards about gift, guest, and ghost authorship in biomedical and basic sciences.\u003c/p\u003e \u003cp\u003eA comprehensive literature search was performed in PubMed (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), Scopus (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.scopus.com/\u003c/span\u003e\u003cspan address=\"https://www.scopus.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), Web of Science (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.webofscience.com/\u003c/span\u003e\u003cspan address=\"https://www.webofscience.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), Embase (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.embase.com/\u003c/span\u003e\u003cspan address=\"https://www.embase.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), and Google Scholar (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://scholar.google.com/\u003c/span\u003e\u003cspan address=\"https://scholar.google.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Searches included articles in English, Spanish, French, Italian, and German. The search strategy used the following Boolean combination: (\"gift authorship\" OR \"honorary authorship\" OR \"guest authorship\" OR \"ghost authorship\") AND (\"biomedical\" OR \"basic science\" OR \"life sciences\") AND (definition OR prevalence OR consequences OR detection OR prevention OR \"case study\" OR \"retraction\"). MeSH terms and their equivalents were included where relevant, and additional manual searches of bibliographies from retrieved articles were performed for completeness [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInclusion criteria comprised: (a) primary research studies, systematic reviews, or meta-analyses published since 2000; (b) explicit definitions and differentiation of gift, guest, and ghost authorship; (c) quantitative or qualitative analysis of prevalence, manifestations, consequences, detection or prevention methods, or case documentation in biomedical or basic science areas; and (d) articles available in the specified languages. Exclusion criteria were: (a) lack of empirical data (e.g., editorial opinions), (b) studies outside the biomedical/basic science context, and (c) works not distinguishing among authorship types.\u003c/p\u003e \u003cp\u003eData collection was conducted through bibliographic management tools, with automatic literature triage, relevance scoring, and clustering performed using the Undermind AI-powered platform reviewed and supervised by both authors. Extracted information included study design, sample size, country or region, type of publication, variables analyzed (e.g., definition of authorship type, prevalence rate, consequences reported, detection/prevention approaches, case documentation), and key findings. Descriptive statistics, frequencies, and, where appropriate, pooled prevalence rates were calculated based on extracted data; no additional inferential statistics or meta-analytic effect estimation were conducted due to methodological heterogeneity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. All information regarding detection algorithms, editorial policies, or practical interventions was recorded as reported in the original publications.\u003c/p\u003e \u003cp\u003eThe key variables analyzed were: operational definitions and distinctions among gift, guest, and ghost authorship; empirically reported prevalence rates; documented consequences; methods of detection or prevention; and presence of documented case studies or retractions. The number of included sources in this review was determined by relevance to the research objective and explicit reporting of primary or synthesized data.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eInitially, 10 articles were identified through systematic searches of international databases [1\u0026ndash;10]. After review by titles and abstracts, 2 articles were excluded because they did not meet inclusion criteria (topic outside the biomedical field/basic sciences or lack of differentiation between types of inappropriate authorship), a further 2 references were excluded after full-text review for lack of empirical data or insufficient case documentation [3,6,9,10]. Finally, 6 articles met the inclusion criteria and were selected for the final analysis, as detailed in Fig.\u0026nbsp;1 (PRISMA diagram) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe table with the bibliographic references identified is in the Excel table of the complementary documentation.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the main characteristics of the selected studies. Five of the six articles clearly differentiate between gift, guest and ghost authorship according to the international ICMJE/COPE criteria and report prevalences with wide intervals depending on the context, discipline and method used.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMain characteristics and results of the included articles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCountry / Scope\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eType of study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDefinition of authorship types\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePrevalence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eManifestations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCases / Real Documentation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDetection / prevention methods\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGRADE level of evidence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlobal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntegrated narrative review\u0026thinsp;+\u0026thinsp;Retraction Watch analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes, differentiated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGift\u0026thinsp;~\u0026thinsp;33% (Europe), \u0026gt;\u0026thinsp;30% (Asia), Ghost\u0026thinsp;~\u0026thinsp;5% (China), \u0026gt;\u0026thinsp;700 retractions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGift: reciprocity, Guest: influential names, Ghost: omissions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAnalysis of \u0026gt;\u0026thinsp;700 retractions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAgreements, grids, CRediT, editorial policies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eModerate\u0026ndash;High\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlobal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReview of systematic\u0026thinsp;+\u0026thinsp;empirical reviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes, differentiated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHonorary/gift: 27\u0026ndash;39%, Ghost: 2\u0026ndash;75%, 21% in Q1 magazines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTodas (ICMJE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetraction/watch examples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurveys, training, tax returns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eModerate\u0026ndash;High\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlobal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntegrative Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes, differentiated but merge guest/gift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHonorary/gift: 55\u0026ndash;56%, Ghost: 7.9\u0026ndash;29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHierarchical/ethical pressures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eQualitative cases mentioned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAdherence to ICMJE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlobal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMeta-analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes, gift/guest together\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29% misassigned authorship (pooled, 123 studies)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHyper-authorship, \"sub-authorship\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReview of large bases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eContributorship, acknowledgements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes, differentiated (ICMJE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHonorary: 56.1% authors, 89% articles; Major in Basic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInstitutional pressures, seniority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAnalysis by article and author\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAnalysis of contributions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlobal (Cochrane)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTransv. international\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes, differentiated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHonorary: 39%, Ghost: 9%, both: 2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEditorial teams, lead author decisiones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eData declared by authors/publishers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAuthors' survey, byline analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn bibliometric terms, it is observed that the prevalence of honorary authorship/gift ranges between 20% and 60% in international contexts, being especially high in regional studies (Iran: 56% of authors and 89% of articles with at least one honorary author; Cochrane reviews: 39%; global/multicontinent studies: 27\u0026ndash;39%). Ghost authorship reaches consistently lower but relevant rates: 5\u0026ndash;10% in high-impact journals; up to 21% and 29% in certain national contexts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMore than 700 cases of retraction explicitly attributable to authorship issues were identified in the Retraction Watch database, predominating in Asia and Europe [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The main manifestations include the systematic inclusion of senior or prestigious authors, the omission of medical writers or key contributors, and situations of institutional coercion. Celebrated cases and clusters of retractions are documented, as well as qualitative analyses of committee/editorial letters.\u003c/p\u003e \u003cp\u003eRegarding detection methods, anonymous surveys of authors, audits of contribution sections, retrospective bibliometric analyses and review of retraction databases predominate. In terms of prevention, the articles recommend the implementation of contribution grids (CRediT), agreements signed between co-authors, mandatory training in ethics and reinforced editorial policies.\u003c/p\u003e \u003cp\u003eThe analysis of bias, using an adaptation of the ROBINS scale for observational studies and systematic reviews, is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Low to moderate risks are identified in most of the included studies (limitations: population heterogeneity, potential social desirability bias in surveys, and variable classification of authorship types).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk of Bias Assessment (ROBINS Adaptation).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExposure measurement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOutcome measurement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIncomplete data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSelective reporting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOther biases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGlobal risk\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe level of evidence and degree of recommendation according to the GRADE scale is considered moderate-high for the definition, prevalence and manifestations of inappropriate authorship. The evidence is consistent and replicated by reviews and studies from different regions and methodologies. For prevention and screening interventions, the evidence is classified as moderate, given the paucity of prospective trials and external validations.\u003c/p\u003e \u003cp\u003eWe did not identify quantifiable heterogeneity (I2, Tau) or formal meta-analysis due to methodological variability between studies and the absence of homogeneous statistical data.\u003c/p\u003e \u003cp\u003eIn summary, the results reflect a high prevalence and persistence of inappropriate authorship in biomedical and basic science publications, with solid empirical and case documentation and concrete proposals for prevention and governance.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this review confirm that inappropriate authorship practices\u0026mdash;specifically gift, guest, and ghost authorship\u0026mdash;remain highly prevalent in biomedical and basic science publishing worldwide, despite clear international consensus on their definitions and ethical unacceptability [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Reported prevalence rates for honorary or gift authorship consistently range from 20\u0026ndash;60%, while ghost authorship affects between 5% and 10% of publications in leading journals, with even higher rates observed in some regional and specialty contexts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These results align with, and extend, earlier evidence highlighting the persistence of these unethical practices across diverse publication environments [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe consistent documentation of more than 700 authorship-related retractions further illustrates the significant impact of inappropriate authorship on the reliability and credibility of the scientific record [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The primary manifestations include the inclusion of senior or prestigious names without substantial contribution, the omission of actual contributors, and situations driven by institutional pressure or power dynamics [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These practices not only erode trust and accountability but may distort research syntheses, with potentially harmful implications for clinical decision-making and public health outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePreventive and detection strategies\u0026mdash;such as the implementation of explicit authorship contribution grids (e.g., CRediT), mandatory co-author agreements, robust editorial policies, and research ethics training programs\u0026mdash;are increasingly recommended and, in some settings, adopted [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, the evidence base for the effectiveness of these measures is limited, mainly descriptive, and not supported by prospective or intervention studies, leaving the true impact of such policies uncertain [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStrengths of this review include its systematic, multilingual search, comprehensive inclusion criteria, and use of rigorous bias assessment. The major limitations derive from methodological heterogeneity among studies, reliance on self-reported data (susceptible to social desirability bias), and variability in the operationalization of authorship categories across articles [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The absence of meta-analytical synthesis and limited availability of effect measures also restrict the generalizability of pooled prevalence estimates.\u003c/p\u003e \u003cp\u003eFuture research should address the development, implementation, and robust evaluation of intervention strategies for the prevention and detection of inappropriate authorship. There is a particular need for trial-based studies, advanced algorithmic detection methods, and in-depth qualitative investigations into regional, disciplinary, and cultural variations in authorship assignment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Further standardization of both definitions and reporting practices would enhance the comparability and application of findings across contexts.\u003c/p\u003e \u003cp\u003eIn summary, the reviewed evidence underscores the persistent and global nature of inappropriate authorship practices and highlights the urgent need for effective, evidence-based solutions to promote research integrity and accountability in biomedical and basic science publication.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eInappropriate authorship practices\u0026mdash;including gift, guest, and ghost authorship\u0026mdash;are highly prevalent in biomedical and basic science publications. Clear operational definitions and significant rates of occurrence have been consistently documented across multiple regions and disciplines. These practices have substantial ethical, scientific, and public health consequences, undermining the credibility, accountability, and reliability of the published literature.\u003c/p\u003e \u003cp\u003eDetection methods such as anonymous surveys, audits of contribution statements, and retraction analyses have proven effective in revealing the extent of these behaviors. Prevention strategies\u0026mdash;such as implementation of author contribution taxonomies, signed co-author agreements, and mandatory research integrity training\u0026mdash;are increasingly recommended but require further evaluation for their effectiveness.\u003c/p\u003e \u003cp\u003eKey limitations of the current evidence include reliance on self-reported data, methodological heterogeneity, and a lack of robust, prospective studies on preventive interventions. Continued efforts are essential to standardize authorship criteria, enforce transparent reporting, and develop evidence-based policies to ensure the integrity of scientific publications.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMisra D, Agarwal V (2018) Integrity of Authorship and Peer Review Practices: Challenges and Opportunities for Improvement. J Korean Med Sci [Internet]. 2018 [cited 2024 Jun 1]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jkms.org/DOIx.php?id=10.3346/jkms\u003c/span\u003e\u003cspan address=\"https://jkms.org/DOIx.php?id=10.3346/jkms\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.33.31\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAliukonis V, Gefenas E Perish or Publish Dilemma: Challenges to Responsible Authorship. Medicina [Internet]. 2020 [cited 2024 Jun 1];56(9):443. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430080\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430080\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMowatt G, Shirran L, Grimshaw J, Rennie D, Flanagin A, Yank V, MacLennan G, Campbell M, Jones DR, Sheldon TA, Bero LA (2002) Prevalence of honorary and ghost authorship in Cochrane reviews. JAMA [Internet]. [cited 2024 Jun 1];287(21):2769-71. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jamanetwork.com/journals/jama/fullarticle/195372\u003c/span\u003e\u003cspan address=\"https://jamanetwork.com/journals/jama/fullarticle/195372\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Salamanca","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"gift authorship, guest authorship, ghost authorship, biomedical publication ethics, authorship prevalence, authorship detection and prevention","lastPublishedDoi":"10.21203/rs.3.rs-6577822/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6577822/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction \u003c/strong\u003eInappropriate authorship practices, including gift, guest, and ghost authorship, are a recognized problem in biomedical and basic science publishing. These behaviors undermine research integrity, distort attribution of credit and responsibility, and threaten public trust in scientific literature. Identifying the definitions, prevalence, manifestations, consequences, detection, and prevention of inappropriate authorship is critical for maintaining ethical and scientific standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives \u003c/strong\u003eThe objective of this analysis was to systematically examine scientific literature published since 2000 that defines and differentiates gift, guest, and ghost authorship in biomedical and basic science publications, reports their frequency and manifestations, analyzes their ethical, scientific, and public health consequences, describes detection and prevention methods, and documents real cases through quantitative or qualitative approaches.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod \u003c/strong\u003eA structured review of relevant scientific literature was performed. Studies included primary research, systematic reviews, and meta-analyses explicitly addressing definitions, prevalence, consequences, detection strategies, prevention measures, and documented cases of inappropriate authorship in biomedical and basic science publication contexts. Methods analyzed included large-scale cross-sectional surveys, analyses of retraction databases, integrative reviews, and institutional audits, covering multiple countries and journal types.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThe review found that the unethical assignment of authorship is common, with gift/honorary authorship affecting 20–60% of publications, and ghost authorship 5–10%, with higher rates reported in some regions and disciplines. Over 700 cases of authorship-related retractions have been documented. The main detection methods were anonymous surveys of authors and audits of contribution statements. Preventive strategies included stronger editorial policies, explicit contribution taxonomies, author agreements, and research ethics training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eInappropriate authorship practices remain frequent and pose significant ethical, scientific, and public health risks. While empirical evidence supports the use of prevention and detection measures, persistent challenges exist in ensuring accurate authorship attribution. Enhanced policy implementation and international standards are needed to mitigate these risks and promote research integrity.\u003c/p\u003e","manuscriptTitle":"Gift, guest \u0026amp; ghost authorship in biomedical publications: definitions, prevalence, impacts, detection and prevention. Scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 11:23:25","doi":"10.21203/rs.3.rs-6577822/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"443d6036-e75c-47fe-a9c2-355856206741","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47989464,"name":"Medical Ethics"}],"tags":[],"updatedAt":"2025-05-05T11:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 11:23:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6577822","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6577822","identity":"rs-6577822","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}