Over the past few years a stream of reviews and commentaries has made us much more aware of the pervasive inequities between rich and poor countries in terms of both access to medical research information, and their role as contributors to the body of research.
We know that conditions and diseases affecting large proportions of the world population in the south are accorded disproportionately little space and weight in northern journals; treatment reviews of conditions such as gunshot wounds, diphtheria, tetanus or typhoid are ill-suited to maintaining a high impact factor (Richards 2004; Horton 2000). Much of the research relevant to practitioners in the south tends to stay in journals of the south, with all editorial and logistic problems that may ensue, such as antiquated presentation and uncertain, limited access. (That is after the editor, who may be the only thoracic surgeon in an area the size of France, has managed to procure funds for buying the month's paper supply and convinced a lot of lorry drivers to add a stack of issues to their usual cargo and drop them off in strategically.)
But much locally relevant research which health workers in developing countries need to treat their patients never reaches the print stage. Local doctors lack guidance on research methods and statistical techniques. They may have few, if any incentives, to conduct research –publish or perish does not apply everywhere. Political conflict or simply lack of facilities, staff, or medication may preclude any research activity (Horton 2000).
Far too few of those who do manage, against considerable odds, to write up their work, actually see it published in journals with the capacity to make it widely accessible. Jennifer Keiser et al. (2004) analysed the six leading tropical medicine journals over the period 2000–2002, pointing out the vanishingly small number of studies generated exclusively by authors from low-income countries – between 1.7% and 7%! On average, 45% of the published papers resulted from north-south collaborations, but only 14% of the authors originated from the south. In terms of governance of our journals we northerners do not present a better front either: Of the 315 board members of the top 6 tropical journals, only 76 (24%) come from middle-income nations, and just 16 (5%) from the poorest countries.
At least the problem has been recognised and is being widely discussed as well as addressed in a variety of ways. Starting in 2001, the six largest STM publishing houses agreed to give 100 developing countries (later extended to another 40 nations) free or nearly free electronic access to 1,000 of the world's leading medical and scientific journals (WHO 2001, 2003; Aronson 2004). TM&IH is part of this. Initiatives such as HINARI (Health Inter Network Access to Research Initiative), INASP (International Network for the Availability of Scientific Publications) and PERI (Program for the Enhancement of Research Information) facilitate the exchange of high-quality science information, provide free or very cheap electronic access to scientific literature and promote training in the use of internet technology (Pakenham-Walsh et al. 1997; Pakenham-Walsh & Priestley 2002; Katikireddi 2004). Apart from funding local research, local capacity-building is probably the most urgent task to be undertaken to change the long-term perspective for southern researchers. It is supported, for example, by the British Medical Journal, which maintains a regional editorial office in Accra and conducts annual workshops in African countries.
So what else can journal editors do? Not all of us in the north have huge budgets or preside over a large permanent staff who can be dispatched to sunnier shores. Most speciality scientific journals, such as those in tropical medicine, are run on surprisingly little manpower, often consisting of part-time administrative help to the editor(s) and editorial board who largely fulfill their editorial and managerial duties during their ‘‘free’’ time. Also, smaller journals are under pressure to keep up or raise their impact factor, rather than entirely ignore prevailing editorial wisdom and start new trends in publishing. Still, there are a number of small but significant steps we can take to narrow the information gap:
- • We can build, and maintain, a pool of reviewers willing to provide constructive criticism and useful contacts to authors – even and especially to authors of papers which we will not publish, if the topic is relevant to southern health research, and if the paper is based on the principles of scientific conduct.
- • We can foster scientific partnerships between rich and poor country authors. These should go beyond the opportunistic, short-term partnerships generated by individual studies, and should entail long-term mutual commitment to a structured scientific agenda. Both participants or parties should be rewarded in a concrete manner, such as credits counting towards promotion criteria. Journal editors are uniquely placed to facilitate such partnerships, because they have access to a lot of unpublished information, and often get a glimpse of the person behind a name. We know, for example, which referees genuinely and selflessly care about improving a manuscript entrusted to them, or who has an affinity to a particular country.
- • We must ensure that at least one referee lives in or is well acquainted with conditions in the country where the research was conducted.
- • We could commission reviews from southern authors and, if necessary, provide the advice and assistance needed to make them publishable.
- • We should not publish studies conducted in the south without southern authors. Ever.
Much of this is simply good editorial practice. For researchers in tropical medicine it should be obligatory – as authors, reviewers, editors and believers in the ethics of fair scientific exchange.