Under-representation of developing countries in the research literature: ethical issues arising from a survey of five leading medical journals

BMC Med Ethics. 2004 Oct 4:5:E5. doi: 10.1186/1472-6939-5-5.


Background: It is widely acknowledged that there is a global divide on health care and health research known as the 10/90 divide.

Methods: A retrospective survey of articles published in the BMJ, Lancet, NEJM, Annals of Internal Medicine & JAMA in a calendar year to examine the contribution of the developing world to medical literature. We categorized countries into four regions: UK, USA, Other Euro-American countries (OEAC) and (RoW). OEAC were European countries other than the UK but including Australia, New Zealand and Canada. RoW comprised all other countries.

Results: The average contribution of the RoW to the research literature in the five journals was 6.5%. In the two British journals 7.6% of the articles were from the RoW; in the three American journals 4.8% of articles were from RoW. The highest proportion of papers from the RoW was in the Lancet (12%). An analysis of the authorship of 151 articles from RoW showed that 104 (68.9%) involved authorship with developed countries in Europe or North America. There were 15 original papers in these journals with data from RoW but without any authors from RoW.

Conclusions: There is a marked under-representation of countries in high-impact general medical journals. The ethical implications of this inequity and ways of reducing it are discussed.

Publication types

  • Comparative Study

MeSH terms

  • Africa
  • Asia
  • Australia
  • Authorship
  • Biomedical Research / statistics & numerical data*
  • Canada
  • Developed Countries*
  • Developing Countries*
  • Europe
  • Journalism, Medical
  • New Zealand
  • Periodicals as Topic / statistics & numerical data*
  • Publication Bias / statistics & numerical data
  • Publishing*
  • United States