In the realm of scientific research and the production of articles in healthcare, there are often customs or pressures to include authors who have made minimal or no contributions to the scientific content of an article, yet they are placed in a prominent position, such as first authorship. This practice is referred to as honorary authorship, which involves individuals who have not contributed in any way to the work described in the manuscript but are included among the authors based on their seniority, rank, or position within the institution or organization. This poses a significant ethical issue in the field of research as honorary authorship undermines the principles of academic integrity and authenticity¹.

The International Committee of Medical Journal Editors (ICMJE) has established specific authorship criteria for manuscripts submitted to biomedical journals: 1) Substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; 2) drafting the work or reviewing it critically for important intellectual content; 3) final approval of the version to be published; and 4) 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. The ICMJE asserts that these four criteria must be met before authorship is granted².

The use of honorary authorship can be categorized into three distinct modalities or subtypes, each reflecting a different motivation or rationale for its application³. One such modality is gift authorship, where an individual is listed as the author as an expression of respect or gratitude towards the person in question⁴. This practice is often employed with the expectation that the honorary author will reciprocate by acknowledging the original author in future publications. Another modality is guest authorship, in which a well-known author is invited to be a co-author with the aim of enhancing the perceived quality of the paper or concealing industry involvement in a study by adding an academic author^3,4. Finally, coercive authorship occurs when a senior investigator compels a junior investigator to include them as a gift or guest author³. This form of authorship deviation is the most severe, as it not only involves the inclusion of an author who has not contributed to the research, but also incorporates the power differential between senior and junior authors⁴. While these modalities may overlap, they all share the commonality of incorporating the participation of an external actor in research they did not contribute to.

The author(s) of the described modalities acknowledge the existence of power dynamics and the benefits associated with them. For instance, inviting a well-known author to contribute to a publication can increase the likelihood of being cited, which benefits both the real and the invited author⁵. Additionally, it is common for research groups or group leaders to exchange authorship in the form of reciprocal gift-giving⁶. New researchers in a research center or group may also feel pressured to include senior researchers as authors to repay them for employment, position, supervision, or funding^6,7. However, it should be noted that supervising junior researchers is often part of a senior researcher's duties and does not necessarily imply fulfilling the authorship criteria to be listed as an author in the article produced by the junior researcher.

Honorary authorship has become a common issue in academic publication. A study conducted in 2020 aimed to determine the prevalence of honorary and ghost authorships in Cochrane reviews from to 2016-2018. A total of 666 first authors were evaluated, and 41% had engaged in honorary authorship. Furthermore, 15% of the authors were unaware of ICMJE authorship criteria. The study also revealed that honorary authorship was significantly associated with a lack of familiarity with the ICMJE guidelines, an increase in the number of authors, and the first author having previously been offered inappropriate authorship in their academic career⁸.

Honorary authorship has engendered a plethora of harmful consequences that go beyond unethical noncompliance with the criteria established by the international research community. Public trust in science and researchers is crucial for facilitating scientific understanding and enabling informed opinions on technological and scientific issues. Violations of scientific integrity, including honorary authorship, erode this trust in experts⁹. Moreover, it negatively affects researchers because the contributions of genuine authors are hidden among honorary authors, who are undeservedly granted a competitive advantage in terms of scientific output and citations, allowing them to access research funding or obtain higher positions within institutional hierarchies¹⁰. The institutions themselves are also harmed, as this practice perpetuates a vicious cycle in which authors collaborate with honorary authors to enhance their careers and expect the same from junior researchers, often motivated by the same institution to increase citations or obtain research funding but at the cost of compromising the scientific integrity of all parties involved⁴.

Addressing the issue of honorary authorship is essential for all parties involved in scientific research. First, further investigations should be conducted to assess the consequences of such practices within our environment, with the aim of identifying the most affected sectors and implementing measures to reduce these occurrences. Second, it is imperative to incorporate specific training in research ethics into the educational curricula for young researchers and medical students. Finally, the responsible authorities within institutions, departments, or research groups ought to be apprised of the most recent guidelines pertaining to authorship and must strive to ensure that these criteria are upheld in all research conducted within their respective areas of jurisdiction. This will help break the existing vicious cycle and ensure that true authors are appropriately recognized for their contributions to advancing scientific knowledge.