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Poor Countries Underrepresented in Tropical Disease Research Literature - 2004-05-30

Tropical diseases like malaria hit poor countries hardest. But a new study finds poor countries are underrepresented in the tropical disease research literature. The British Medical Journal study found that very few editors of the top tropical medicine journals are from poor countries. In 2003, only five percent of the editorial and advisory board members were from countries with a low human development index, or HDI.

And few poor-country scientists are publishing in these journals. Research done exclusively by scientists from low-HDI countries accounted for only 1/20th of the published work. Study author Jurg Utzinger says that's a problem because publications in the top journals help set the agenda for medical research.

"To acquire additional funds; you can in fact influence even the research needs; which diseases get most interest, or most funding as well. So, therefore, it should be pivotal that authors particularly from the developing countries have a say."

Professor Utzinger says the problem is partly a symptom of what's called the 10/90 gap: only 10 percent of research funding is spent on diseases that cause 90 percent of the world's health problems.

But he says it's also cultural. "Publish or perish" is the prevailing attitude in Western academia. But Professor Utzinger says many developing world scientists don't face the same pressure. "If at one point they have established a certain position, it's less required that they keep publishing in the top literature," he says.

Also, most of the money to study tropical medicine comes from rich countries. So rich-country scientists have better access to it. Professor Utzinger says academic partnerships between rich- and poor-country scientists are the key to correcting the imbalance. And he notes that these partnerships are on the rise.

More news of the 10/90 gap: new research shows that less than half of the clinical trials conducted in a recent survey dealt with the world's 35 most devastating diseases. The research, in the Canadian Medical Association Journal, looked at clinical trials published in six major international health journals in 1999. Study co-author Paula Rochon at the Baycrest Centre for Geriatric Care in Toronto, says seven of the top 35 went completely un-studied.

"Important conditions, like things like malnutrition, for example, and measles, for example, that are certainly leading causes of death, were not studied by any of our trials. And we also found that conditions like malaria, tuberculosis, diarrhea, things like that that are also very common and very important, were studied by very few."

The good news is that AIDS and heart disease, which are among the leading causes of death all over the world, were also among the most studied. But a panel of experts who examined the clinical trials for the study found that most were not helpful for poor countries for example, because the treatment studied was too expensive, or required advanced hospitals and training.

In other news, a new report says baby formula companies are violating international guidelines on marketing their products. The report criticizes formula makers for claiming that ingredients added to their products will make babies smarter, enhance their eyesight, or improve their health in other ways.

Policy director Patti Rundall of the Britain-based arm of the International Baby Food Action Networksays breast milk is almost always the best choice. "All these products are in breast milk anyway. And for a company to flag up [advertise] a particular ingredient on the label or in the materials is really dangerous because the mother thinks she's got to buy that product in order to have that wonderful ingredient."

Ms. Rundall also criticizes formula makers for promoting their products heavily to doctors and other health professionals. She says a World Health Organization code prohibits all marketing of breast milk substitutes.

The report says Swiss-based market leader, the Nestle corporation has the largest number of code violations. But Nestle spokesman Francois-Xavier Perrout says the report goes too far. "Experience shows that in the very, very large majority of the cases, these are based on an extensive interpretation of the code that is not shared by the WHO, either. In other words, these accusations or these complaints about non-compliance are based on very spurious grounds."

Nevertheless, Mr. Perrout says the company plans to investigate the claims.