Skip to main content

Why do Some Countries Publish More Than Others? An International Comparison of Research Funding, English Proficiency and Publication Output in Highly Ranked General Medical Journals


National factor(s) influencing publication output in the highest ranked medical journals are largely unknown. We sought to examine the relationship between national research funding and English proficiency on publication output. We identified all original research articles appearing in the five highest ranked general medical journals between 1997 and 2001. Using the country of the corresponding author as the source nation for each article, we determined a standardized publication rate across developed nations. We used multiple regression techniques to determine the influence of national expenditures on research and scores from the Test of English as a Foreign Language (TOEFL), a surrogate for English proficiency, on publication output. There was a significant relationship of national spending on research and TOEFL scores to publication output of developed countries (p= 0.04; p < 0.01, respectively). These two variables explained approximately 71.5% of the variation in publication rate across developed nations around the world (R= 0.85; p < 0.01). Normalized for population size, English-speaking nations and certain northern European countries such as Denmark, The Netherlands, Switzerland, and Sweden had the highest rate of publication in the five highest ranked general medical journals, while Asian countries had generally low rates of publication. Research spending and English proficiency were strongly associated with publication output in the highest ranked general medical journals. While these data cannot be considered definitive due to their observational nature, they do suggest that for English-language medical journals, research funding and English proficiency may be important determinants of publication.

This is a preview of subscription content, access via your institution.


  1. Rennie D, Yank V, Emanuel L. When authorship fails. A proposal to make contributors accountable. JAMA 1997; 278: 579–585.

    Google Scholar 

  2. Nelkin D. Publication and promotion. The performance of science. Lancet 1998; 352: 893–894.

    Google Scholar 

  3. Horton R. Publication and promotion. A fair reward. Lancet 1998; 352: 892.

  4. Stossel TP, Stossel SC. Declining American representation in leading clinical-research journals. N Engl J Med 1990; 322: 739–742.

    Google Scholar 

  5. Nahrwold DL, Pereira SG, Dupuis J. United states research published in major surgical journals is decreasing. Ann Surg 1995; 222: 263–266.

    Google Scholar 

  6. Tompkins RK, Ko CY, Donovan AJ. Internationalization of general surgical journals: origin and content of articles published in North America and Great Britain from 1983 to 1998. Arch Surg 2001; 136: 1345–1351.

    Google Scholar 

  7. Frist WH. Federal funding for biomedical research: commitment and benefits. JAMA 2002; 287: 1722–1724.

    Google Scholar 

  8. Nathan DG. Clinical research: perceptions, reality, and proposed solutions. National Institutes of Health Director's Panel on Clinical Research. JAMA 1998; 280: 1427–1431.

    Google Scholar 

  9. Thompson JN, Moskowitz J. Preventing the extinction of the clinical research ecosystem. JAMA 1997; 278: 241–245.

    Google Scholar 

  10. Measuring Expenditure on health-related research and development. Paris, France: OECD, 2001.

  11. Albert T. Scientific communication-not only in English. Lancet 2001; 358: 1388.

    Google Scholar 

  12. The Institute for Scientific Information Journal Citation Reports, 2000. Available at Accessed December 19, 2003.

  13. Yank V, Rennie D. Disclosure of research contributions: a study of original research articles in The Lancet. Ann Intern Med 1999; 130: 661–670.

    Google Scholar 

  14. Quarterly labour force statistics 2000. No. 4. Paris, France: OECD, 2001.

  15. Organization for Economic Co-operation and Development. Available at Accessed December 19, 2003.

  16. National Accounts of OECD countries 1998-1999. Paris, France: OECD, 2001; 2.

  17. Organization For Economic Co-Operation and Development. OECD Science, Technology, Industry Scoreboard. Towards a Knowledge-Based Economy. Paris, France: OECD, 2001.

    Google Scholar 

  18. TOEFL Test and score manual: 1997 Edition. Princeton, NJ: Educational Testing Services, 1997.

  19. TOEFL: Test and score data summary 1997-1998 Edition. Princeton, NJ: Educational Testing Services, 1998.

  20. Gagnon RE, Macnab AJ, Gagnon FA. A quantitative ranking of Canada's research output of original human studies for the decade 1989-1998. CMAJ 2000; 162: 37–40.

    Google Scholar 

  21. Link AM. US and non-US submissions. An analysis of reviewer bias. JAMA 1998; 280: 246–247.

  22. Rogers A. European Union favors research funding. Lancet 1998; 352: 1997.

  23. Check E. Bush's budget boost puts NIH on target for doubled figures. Nature 2002; 415: 459.

  24. Kondro W. Canada outlines 10-year research strategy that will take on the world. Lancet 2002; 359: 684.

  25. Buckley P, Marley J, Robinson J, et al. Country pro-file: Australia. Lancet 1998; 351: 1569–1578.

    Google Scholar 

  26. Porta M. The bibliographic ''impact factor'' of the institute for scientific information: How relevant is it really for public health journals? J Epidemiol Commun Health 1996; 50: 606–610.

    Google Scholar 

  27. Garfield E. Journal impact factor: A brief review. CMAJ 1999; 161: 979–980.

    Google Scholar 

  28. Hachinski V. The Impact of Impact Factors. Stroke 2001; 32: 2729.

  29. Joseph KS.Quality of impact factors of general medical journals. Br Med J 2003; 326: 283.

  30. Hoeffel C. Journal impact factors. Allergy 1998; 53: 1225.

    Google Scholar 

  31. Hefler L, Tempfer C, Kainz C. Geography of biomedical publications in the European Union, 1990-1998. Lancet 1999; 353: 1856.

  32. Ray J, Berkwits M, Davidoff F. The fate of manuscripts rejected by a general medical journal.Am J Med 2000; 109: 131–135.

    Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and Permissions

About this article

Cite this article

Man, J.P., Weinkauf, J.G., Tsang, M. et al. Why do Some Countries Publish More Than Others? An International Comparison of Research Funding, English Proficiency and Publication Output in Highly Ranked General Medical Journals. Eur J Epidemiol 19, 811–817 (2004).

Download citation

  • Issue Date:

  • DOI:

  • International comparison
  • Publication
  • Research funding