Debates in medicine: global representation in medical discourse

Abstract

It has been argued that research is disproportionately dedicated to diseases that affect developed countries. Accordingly, there is a dearth of publications by authors from developing countries in leading medical journals, and developing countries have limited representation on their editorial boards. Yet, Letters to the Editor (Correspondence) showcase debate and discussion in medicine and might be less influenced by structural supports and funding that otherwise lead to developed nations’ dominance 4 and could better reflect international discourse and perspectives. We assessed Letters to the Editor in the three most infl uential general medical journals according to Thomson Reuters’ Impact Factor, namely The Lancet, Journal of the American Association of Medicine, and the New England Journal of Medicine, which are likely to reflect debate surrounding some of the most important studies in the medical literature. We assessed 773 letters (575 letters, 195 replies, 2 journal responses, and 1 retraction) from July 1, 2013, to Dec 31, 2013, and extracted corresponding author’s institution (in two cases, we could not identify a corresponding author). Corresponding authors were from 57 countries (fi gure); 122 of 770 letters were international collaborations. 19 of 57 countries had one contribution to the debates. Correspondence was predominantly from North America and Europe, with most originating from the USA (317 of 768) and the UK (86 of 768). Using network analysis, we characterised the dynamics of international medical debate (appendix). The USA is a central hub for debate, with other important nodes in western Europe, Canada, and China. There is also substantial intranational discourse within the global debate, notably involving the USA, UK, France, the Netherlands, and Pakistan. Interestingly, Series such as The Lancet’s Health Transitions in Pakistan fostered national medical debate. Our analyses are limited by our inability to assess all correspondence submitted for publication and a relatively small window of observation. Nevertheless, the global debate in medicine is driven by contributors from developed nations, perhaps to the detriment of discourse on health concerns representative of the global burden of disease. However, our analyses suggest that highlighting health issues in developing countries can involve stakeholders in meaningful domestic and global medical debates.