Transatlantic divide in publication of content relevant to de-
veloping countries
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Dear colleagues,
An interesting article in this week's issue of the British Medi-
cal Journal (Copied as fair use)
BMJ 2004;329:1429-1430 (18 December), doi:10.1136/bmj.329.7480.1429
http://bmj.com/cgi/content/full/329/7480/1429?etoc
Politics and Health
Transatlantic divide in publication of content relevant to de-
veloping countries
Asad J Raja, Mohammed Bhai professor1, Peter A Singer, Sun Life
financial chair and director2
1 Department of Surgery, Aga Khan University, Nairobi, Kenya, 2
Joint Centre for Bioethics, University of Toronto, Toronto, ON,
Canada M5G 1L4
Correspondence to: A J Raja
mailto:Asad.Raja@akhskenya.org
Although 112 countries now receive 2200 medical journals free or
at reduced prices, improving access to information on obesity is
of little value to physicians treating patients dying of malnu-
trition. Ninety per cent of the US$70bn (38bn; E54bn) spent an-
nually on health research is focused on the diseases of 10% of
the world's population.
http://bmj.bmjjournals.com/cgi/content/full/329/7480/1429?etoc#REF1 [1]
Researchers in eight industrialised countries produce almost 85%
of the world's leading science; 163 countries, including most of
the developing world, account for less than 2.5%.
http://bmj.bmjjournals.com/cgi/content/full/329/7480/1429?etoc#REF2 [2]
Less than 8% of articles published in the six leading tropical
medicine journals in 2000-2 were generated exclusively by scien-
tists from developing countries.
http://bmj.bmjjournals.com/cgi/content/full/329/7480/1429?etoc#REF3 [3]
Medical journals cannot single handedly right these inequities,
but they have an important role to play. The BMJ's ethics com-
mittee identified publication of content relating to developing
countries as an important ethical issue to examine. Our objec-
tives were to review the relevance of the contents of four lead-
ing medical journals to developing countries, compare the jour-
nals, and observe trends.
Participants, methods, and results
The research priorities outlined for developing countries in the
Global Forum for Health Research's report for 2000 are child
health and nutrition (including diarrhoea, pneumonia, HIV, tu-
berculosis, malaria, other vaccine preventable diseases, and
malnutrition); maternal and reproductive health (including mor-
tality, nutrition, sexually transmitted diseases, HIV, and fam-
ily planning); non-communicable diseases (including cardiovascu-
lar diseases, mental illness, and disorders of the nervous sys-
tem); injuries; and health systems and health policy research.
http://bmj.bmjjournals.com/cgi/content/full/329/7480/1429?etoc#REF1 [1]
We compared these research priorities with the content in four
leading medical journals: Lancet, BMJ, New England Journal of
Medicine, and JAMA. A single observer, from a developing coun-
try, systematically reviewed all the articles published in these
journals during January 2002 and January 2003 for relevance de-
fined as concordance with the Global Forum's priorities to de-
veloping countries.
In January 2002, 17 issues of these journals were published,
containing 784 articles, of which 135 (17%) were relevant to re-
search priorities of developing countries. In January 2003, a
similar number of issues contained 725 articles, of which 104
(14%) were relevant. However, the data show important transat-
lantic differences. The Lancet and BMJ had better coverage, with
102/461 (22%) and 110/515 (21%) of articles relevant to develop-
ing countries compared with 17/318 (5%) and 10/215 (5%) of arti-
cles published in JAMA and the New England Journal of Medicine.
The difference between UK and US journals was significant (x2 =
71.74, P < 0.001). The
http://bmj.bmjjournals.com/cgi/content/full/329/7480/1429?etoc#TBL1
table shows detailed information on various types of articles,
showing that the transatlantic divide in original research arti-
cles is even more pronounced than that for total content.
View this table:
http://bmj.bmjjournals.com/cgi/content/full/329/7480/1429/TBL1
[in this window]
http://bmj.bmjjournals.com/cgi/content-nw/full/329/7480/1429/TBL1
[in a new window]
Content relevant to developing countries of four leading medical
journals in January 2002 and January 2003. Values are numbers of
articles relevant to developing countries/all published articles
in that category (percentages).
Comment
This study shows a transatlantic divide in publication of arti-
cles relevant to problems of developing countries: UK journals
contained more such articles than did US journals. The results
may have differed if the study had been done over a longer pe-
riod of time. In particular, the publication of theme issues
might affect a journal's numbers. None of the journals had a
theme issue on global health during 2002 or 2003, although the
BMJ had one in January 2002 on "Global voices on the AIDS catas-
trophe," possibly inflating its numbers. An earlier study con-
ducted during the first eight months of 2001 showed similar re-
sults for three of the journals, although in that dataset the
distinction between the BMJ and the two US journals was less
pronounced.
http://bmj.bmjjournals.com/cgi/content/full/329/7480/1429?etoc#REF4 [4]
JAMA had a theme issue on global health in June 2004, perhaps
signalling an improvement in its numbers beyond the period of
this study.
http://bmj.bmjjournals.com/cgi/content/full/329/7480/1429?etoc#REF5 [5]
What is already known on this topic
The content of medical journals vastly under-represents the dis-
eases affecting populations in developing countries
What this study adds
A "transatlantic divide" exists compared with two leading US
medical journals, two leading UK medical journals publish much
more content relevant to developing countries
Hopefully we will see this transatlantic gap close. We recommend
audit of leading medical journals at regular intervals for con-
tent relevant to developing countries and publication of the re-
sults.