Intended for healthcare professionals

Politics And Health

Transatlantic divide in publication of content relevant to developing countries

BMJ 2004; 329 doi: (Published 16 December 2004) Cite this as: BMJ 2004;329:1429
  1. Asad J Raja, Mohammed Bhai professor (Asad.Raja{at},
  2. Peter A Singer, Sun Life financial chair and director2
  1. 1 Department of Surgery, Aga Khan University, Nairobi, Kenya
  2. 2 Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada M5G 1L4
  1. Correspondence to: A J Raja

    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 malnutrition. Ninety per cent of the US$70bn (£38bn; €54bn) spent annually on health research is focused on the diseases of 10% of the world's population.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%.2 Less than 8% of articles published in the six leading tropical medicine journals in 2000-2 were generated exclusively by scientists from developing countries.3 Medical journals cannot single handedly right these inequities, but they have an important role to play. The BMJ's ethics committee identified publication of content relating to developing countries as an important ethical issue to examine. Our objectives were to review the relevance of the contents of four leading medical journals to developing countries, compare the journals, 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, tuberculosis, malaria, other vaccine preventable diseases, and malnutrition); maternal and reproductive health (including mortality, nutrition, sexually transmitted diseases, HIV, and family planning); non-communicable diseases (including cardiovascular diseases, mental illness, and disorders of the nervous system); injuries; and health systems and health policy research.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 country, systematically reviewed all the articles published in these journals during January 2002 and January 2003 for relevance—defined as concordance with the Global Forum's priorities—to developing countries.

    In January 2002, 17 issues of these journals were published, containing 784 articles, of which 135 (17%) were relevant to research 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 transatlantic differences. The Lancet and BMJ had better coverage, with 102/461 (22%) and 110/515 (21%) of articles relevant to developing countries compared with 17/318 (5%) and 10/215 (5%) of articles published in JAMA and the New England Journal of Medicine. The difference between UK and US journals was significant (χ2 = 71.74, P < 0.001). The table shows detailed information on various types of articles, showing that the transatlantic divide in original research articles is even more pronounced than that for total content.

    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)

    View this table:


    This study shows a transatlantic divide in publication of articles 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 period 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 catastrophe,” possibly inflating its numbers. An earlier study conducted during the first eight months of 2001 showed similar results for three of the journals, although in that dataset the distinction between the BMJ and the two US journals was less pronounced.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.5

    What is already known on this topic

    The content of medical journals vastly under-represents the diseases 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 content relevant to developing countries and publication of the results.


    • Contributors Both authors had the idea, developed the design, and wrote the manuscript. AJR collected and analysed the data and is the guarantor.

    • Funding PAS is supported by a distinguished investigator award from the Canadian Institutes of Health Research; AJR and PAS are supported by grants from the Fogarty International Center of the US National Institutes of Health.

    • Competing interests Both authors are members of the BMJ's ethics committee.


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