Medical journals: evidence of bias against the diseases of poverty

If leading general and specialist medical journals cannot find ways to publish work that more accurately reflects the burden of disease and risk factors that affect large parts of the world today, the editors of those journals are failing to discharge a vital professional responsibility, one which suggests that profit has finally trumped public service.
Some of the world's leading general medical journals include the Annals of Internal Medicine, BMJ, JAMA, New England Journal of Medicine, and The Lancet. [A survey of] these five general medical journals in 2001...found that the frequency of research articles relevant to diseases of poverty was low in the sample he studied - zero for Annals, 2% for JAMA, 4% for the New England Journal of Medicine, 6% for the BMJ, and 16% for The Lancet. He concluded that "as the journals control the global distribution of biomedical news and developments they have a responsibility to ensure that they provide essential information of an adequate quality, in sufficient quantity, and at a reasonable cost". These biases damage our democratic culture. Poverty is the most serious threat to the health of several billion people living on our planet. The way we discuss the responsibilities of the well off to those who live in poverty depends on the media - print, radio, and television - to present a balanced and accurate picture of the world and the predicaments of its peoples. For example, the lives of those living in poverty are rarely reported in most mass news media unless there is an acute humanitarian emergency. (A rare but exemplary instance of reporting the slow news of global health is the "Lives Lost" project launched recently by The Boston Globe). The values that influence judgments about the selection of content for medical journals (eg, randomised controlled trials of new medicines) are largely determined by priorities in science and public health - and commerce. This mix of forces is not wholly bad for medical research. Profit helps to protect editorial freedom. But if this commercial environment does seriously skew content away from what matters to those people the journal claims to serve, as it surely does at some journals, the culture of medicine is distorted, even harmed. Medical research therefore becomes shaped by the commercial values and agenda of its own media. The result? That the range of public debate narrows. And here is the danger to fair deliberation about diseases affecting the poor. Where are the forces countering these prevailing pressures? For medical journals, they seem to be weak and unpredictable. If leading general and specialist medical journals cannot find ways to publish work that more accurately reflects the burden of disease and risk factors that affect large parts of the world today, the editors of those journals are failing to discharge a vital professional responsibility, one which suggests that profit has finally trumped public service. Editors could use their journals to call for greater commitment to close the 10/90 gap - where 90% of research funding is channelled into diseases affecting only 10% of the world's population. Given the often fragile research capacity in the developing world, these efforts will take time to have their effect. Yet they are an essential first step. Perhaps editors will only seriously change their current policies when readers and advertisers demand it, when agencies such as WHO and non-governmental organisations campaign hard for it, or when research originating from developing country settings is improved in both quantity and quality. Nevertheless, a radical cultural transformation is needed within the editorial offices of leading medical journals today to reverse a deeply embedded ethnic bias. The public-service remit of journals needs to be carefully defined and protected. Community responsibility is one of medicine's core values; medicine's global responsibilities need to be strengthened in medical journals today.