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Lead Kindly Light
- BM Hegde (20 May 2004)
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Unequal partnerships?
- Ike Anya (22 May 2004)
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Observed publication bias may reflect who is funding the research?
- Ranjit Manchanda, Rajesh Varma (24 May 2004)
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Quality medical research from low index of development countries could be privileged in high impact journals
- Joseph Y. S. Ting, Mater Public Hospitals, South Brisbane 4101, Australia (26 May 2004)
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BM Hegde, Retd. Vice Chancellor Mangalore 575004, India
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Dear Sir, This study only shows the reality in the world of medical jounalism. Those who have been in this business for long do know how difficult it is to get an article published in some of the "top" journals. Even if the editor is happy with the manuscript the peer reviewers do not let that article see the light of the day in print. There is an old Indian saying: "God is willing, but the priest is unhappy." I would like someone to do a serious study of the accepted Vs the rejected manuscripts from any good journal to see if there would be any real difference in the quality at the end of the day. I have a gut feeling that the rejected ones might even make the journal a wee bit better! The time-honoured rules of the game need to be relooked at, especially in the area of statistics as applied to medical research. Using linear maths. in the non-linear human system is our biggest problem. Who cares, anyway? David Eddy has done a lot of work in this area. I refer the reader to an old editorial "Where is the wisdom?" in the BMJ some years ago. An epidemiologist, Steven Milloy, brings out these facts in his beautiful small book "Science without Sense", and shows how inexact a science epidemiology is! yours ever, bmhegde Competing interests: None declared |
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Ike Anya, Specialist Registrar in Public Health Medicine Bristol North Primary Care Trust BS2 8EE
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The findings from Keiser et al with regard to poor representation of low human development index (HDI) countries on the boards of international journals in tropical medicine is not surprising. The authors have done well to highlight this disparity in an area where local knowledge is key. It would also be interesting to examine whether there was significant overlap between different boards. In other words did the developing country members consist of "the usual suspects"? There is no doubt that underinvestment in research and health care in many developing countries accounts for some of the disparity. Yet the issues of wider power dynamics play a role. For instance,the authors call for more research partnership between richer and poorer nations, but the question is whether you can have a partnership of unequals. With most of the funding for research coming from the wealthier countries of the West, it is extremely difficult and perhaps impossible, for the research agenda not to be dictated by them and for the richest of the "fruits" not to go to them. Perhaps the innovative scheme by the Wellcome Trust to help establish researchers in tropical medicine from developing countries and to support their careers may improve the situation. Similarly, the existence of African Journals On Line (supported by the International Network of the Availabilty of Science Publications) and other such initiatives may help foster relationships between researchers in different countries. That said,improved public and private sector funding of research from within developing countries must also be encouraged Competing interests: IA is a citizen of Nigeria |
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Ranjit Manchanda, Specialist Registrar Obstetrics & Gynaecology Bedford Hospital, MK42 9DJ, UK, Rajesh Varma
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The publication and editorial bias observed by Keiser et al 1 is well presented but the findings are disappointing. Despite most of the clinical epidemiological research in tropical medicine being undertaken in countries from low human development index (HDI), authorship and journal editorial opinion remains with countries from high HDI. This is entirely the reverse of what most readers would expect, and demands to be addressed, and potentially overturned. The largest providers of research funding for tropical medicine originate from countries of high HDI 2;3, and this is likely to be the central force driving the observed bias. Authors from these countries have prepared the international grant applications, acted as principle investigators despite being non-resident, and accordingly felt that they should take primary or terminal authorship in all resulting publications. However, for clinician scientists from low HDI countries to be considered primary or terminal authors, they either need to obtain international funding themselves or form research collaborations which engender enough research kudos to succeed in grant applications- both unlikely without assistance from authors of high HDI countries. It would have been useful if Keiser 1 examined the proportion of articles funded by international research grants or grants locally organised by low HDI countries, and compared this against author trends to elaborate on this potential confounding element. As pointed out by Keiser 1 one way to address the imbalance is to encourage greater International research collaborations between countries of high, low and medium HDI. However, and more importantly, researchers of high HDI countries on these collaborations should be more generous in their praise of ‘on-the-ground’ researchers in the tropical countries and allow them to publish as first authors, especially as they are the ones clinically conducting the study. This would nurture development of quality researchers in low HDI countries, who could then successfully apply as principle investigators thereafter. Consequently, more researchers from low HDI countries would hopefully enter the ‘grant application-undertake research-publish cycle’, which already sustains authors of high HDI countries, and allow them to be introduced to the editorial board of respected journals based on the currency of publication. We are sure that these publication biases are not just restricted to the field of tropical medicine. Therefore, we strongly advocate this approach is delivered uniformly across all clinical disciplines to support research and researchers in countries with low HDI, who are concurrently tackling substantial health care inequalities and unremitting disease 4, and deservedly need greater support. Conflict of interest We declare no conflict of interest. Reference List 1. Keiser J, Utzinger J, Tanner M, Singer BH. Representation of authors and editors from countries with different human development indexes in the leading literature on tropical medicine: survey of current evidence.BMJ 2004;328:1229-1232 . 2. Remme JH, Blas E, Chitsulo L, Desjeux PM, Engers HD, Kanyok TP et al. Strategic emphases for tropical diseases research: a TDR perspective.Trends Parasitol. 2002;18:421-6. 3. Global Forum for Health Research. 10/90 Report on Health Research 2003-2004. 10-5-2004. 4. Morel CM. Neglected diseases: under-funded research and inadequate health interventions. Can we change this reality? EMBO Rep. 2003;4 Spec No:S35-S38. Competing interests: None declared |
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Joseph Y. S. Ting, Staff Specialist Department of Emergency Medicine, Mater Public Hospitals, South Brisbane 4101, Australia
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Editor- In highlighting the marked under-representation of authors and editors from countries with low human development indexes in prestigious tropical medicine journals 1, the paradox of the greater burden of tropical disease afflicting people living in the under-developed world being studied, then published, by researchers in countries with a high development index is clearly demonstrated. Significant obstacles confront researchers who live and work in resource-poor but disease-prevalent countries in conducting and publishing medical research into diseases of poverty 2. These inequities are exacerbated by poor dissemination of, and reduced access to, quality medical research 3 amongst clinicians in countries where these diseases are endemic. This may be ameliorated by allowing duplicate publication within local journals 4 or forums of difficult to access articles from prestigious journals with high local relevance, for a lesser cost or for free. Journal space in high impact journals could be quarantined for articles on locally relevant medical research conducted by researchers from less developed countries. Publications could be actively solicited or commissioned from researchers who live and work in these countries in special focus issues. Although quality clinical research flow from research-rich to research-poor countries is limited 5, the reverse also occurs. Awareness of health issues pertaining to less developed countries amongst clinicians in the developed world could be improved by increased presence of article summaries and links to publications of note originating from less developed countries within sections such as Journal Watch. References 1. Keiser J, Utzinger J, Tanner M, Singer BH. Representation of authors and editors from countries with different human development indexes in the leading literature on tropical medicine: survey of current evidence. BMJ 2004; 328: 1229-32. 2. Horton R. Medical journals: evidence of bias against the diseases of poverty. Lancet 2003; 361: 712-3. 3. Zielinski C. New equities of information in an electronic age. BMJ 1995; 310: 1480-1. 4. Smith R. Publishing research from developing countries. Stat Med 2002; 21: 2869-77. 5. Horton R. North and South: bridging the information gap. Lancet 2000; 355: 2231-6. Competing interests: None declared |
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