Declining American representation in leading clinical-research journals

Article Abstract:

One way to measure productivity in biomedical research for a country is to count the number of scientific papers published in journals by that country's researchers. The country of origin was determined for papers appearing in The New England Journal of Medicine, the Journal of Clinical Investigation, the Lancet, Blood, and the British Journal of Haematology, between 1977 and 1988. Since many articles submitted to journals are not ultimately published, data on submissions to The New England Journal of Medicine, Blood, and the Journal of Clinical Investigation were also provided. The information was not necessarily uniform or complete, since record-keeping by some journals had been erratic. Results showed that the proportion of published papers originating outside the United States increased substantially (between two- and three-fold) regardless of whether the number of papers published for a particular journal increased or decreased. While the total number of submitted articles remained approximately constant during this period, submissions from groups in the United States decreased. The rate of submission by non-United States groups has increased to balance this decline. Research published in these journals is of high quality and it is therefore reasonable to assume that the quality of research outside the United States is increasing. The results may be due, in part, to an increase in the number of submitted foreign articles, which now make up between 30 and 40 percent of total submissions to these British and American journals. It is possible that a decline in research productivity in the United States is occurring. Such a decline would correlate with a slowing in the rate of increase of federal funding for clinical research in recent years. Fewer and fewer research grants are funded each year by the National Institutes of Health. The implications of reduced dominance in clinical research by scientists in the United States should be considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Clinical medicine, Statistics, Demographic aspects, Science and technology policy, United States. National Institutes of Health, Medical literature

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Effect of a copayment on use of the emergency department in a health maintenance organization

Article Abstract:

Less people may use the emergency department of a health maintenance organization (HMO) after the introduction of a copayment for such services. Researchers analyzed the utilization rate of medical emergency services at Kaiser Permanente in northern California, before and after a policy change requiring 30,276 HMO members to pay $25 to $35 to gain access to the emergency department. Emergency care visits were compared to those of 60,408 members and 37,539 members not affected by the copayment requirement (the control groups). Compared to the control groups, emergency visits decreased by almost 15% in the year after the copayment was introduced, most notably among children under five years old. The number of cases not necessarily an emergency declined significantly, while people with truly urgent cases continued to seek medical attention at similar rates irrespective of copayment requirements.

Finance, Medical care utilization, Health maintenance organizations, Kaiser Foundation Health Plan Inc. Northern California Region

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Clinical research on out-of-hospital emergency care

Article Abstract:

Studying the effectiveness of treatments provided by paramedics is much more challenging than other types of medical research. One problem is that patients may be unconscious and would be unable to give informed consent to participate in research. It may be difficult to link patient outcome to paramedic care, which often lasts only a few minutes.

Editorial, Analysis

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