![]() ![]() An article related to a DC was included in only a single category. The non-communicable disease articles were too few to analyze into large subcategories such as cardiovascular disease, respiratory disease or cancers. ![]() Articles were classified as: (1) HIV-related, (2) Communicable disease (non-HIV), (3) Non-communicable disease, (4) and other. Each article designated as pertaining to a DC was expressed as a percentage of the total number appearing in one of the six categories during each successive year.Īn article designated as relevant to a DC was then read to determine the factors that may have accounted for its publication. If the title or abstract concerned a topic pertinent to any health issue in the developing world, the article was reviewed.ĭesignation of a publication as pertaining to developing countries (DC) was determined by four criteria: the material originated in a DC, one of the authors lived in a DC, a disease addressed was largely limited to a poor country, for example HIV/AIDS or malaria, or the topic involved health policies largely pertaining to a DC. The content of each issue was evaluated in six categories: research, review articles, editorial, correspondence, book reviews and miscellaneous. A total of 8857 articles were reviewed by both authors. We examined 416 weekly issues of the New England Journal of Medicine (NEJM) over an eight-year period, January 1997 to December 2004. ![]() It has been described by its editor as "one of the pre-eminent biomedical publications in the world. and contributes significantly to shaping the culture of global medicine. The Journal was chosen because it is the flagship medical publication in the U.S.A. We examined the NEJM during the past eight years to assess both the magnitude and the trend over this timeframe in covering health issues of developing countries. A significant transatlantic disparity has been noted, with the British Medical Journal (BMJ) and The Lancet providing four times more coverage of diseases affecting primarily poor countries than the New England Journal of Medicine (NEJM) or the Journal of American Medical Association (JAMA). Leading international medical journals underreport on health research priorities for developing countries. In 2002, developing world scientists published only 8% of articles appearing in the six major tropical medical journals. Even when the subject matter is closely related to poor countries, their scientists are underrepresented. Eight industrialised countries account for nearly 85% of scientific articles, while 163 lower-income countries contribute only 2.5%. Similar striking gaps are evident in medical publications. Of the $70 billion spent annually, only 10% is allocated to poor countries that bear 90% of the world's disease burden- the so-called "10–90 gap". A stark illustration of this divide is provided by public and private sector expenditures on global health research. Rampant disease in poor countries impedes development and contributes to growing North-South disparities. The divide between rich and poor countries adversely affects world health, undermines global stability and is one of the challenging problems of the 21 st century. International medical journals cannot rectify global inequities, but they have an important role in educating their constituencies about the global divide. Under-representation of developing world health issues in the medical literature is a global phenomenon. The medical information gap between rich and poor countries as judged by publications in the NEJM appears to be larger than the gap in the funding for research. Only 23 articles addressed non-communicable disease in the DC and only a single article – a book review – discussed heart disease. Publications relevant to DC were largely concerned with HIV and communicable diseases and constituted 135 of the 202 articles of which 63 were devoted to HIV. Over the eight years covered in this study, 1997–2004, in the three essential categories of original research articles, review articles and editorials, less than 3.0 percent of these addressed health issues in the developing world. If the title or abstract concerned a topic pertinent to any health issue in the developing world, the article was reviewed. Rampant disease in poor countries impedes development and contributes to growing North-South disparities however, leading international medical journals underreport on health research priorities for developing countries. ![]()
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