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Open Access Research article

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

Athula Sumathipala14*, Sisira Siribaddana24 and Vikram Patel3

Author Affiliations

1 Section of Epidemiology, Institute of Psychiatry, Kings College, London SE5 8AF UK

2 Sri Jayewardenepura Postgraduate Teaching Hospital, Thalapathpitiya, Nugegoda, 10250, Sri Lanka

3 London School of Hygiene & Tropical Medicine, London, UK

4 Forum for Research and Development in Sri Lanka

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BMC Medical Ethics 2004, 5:5  doi:10.1186/1472-6939-5-5

Published: 4 October 2004



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


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.


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.


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.