Catering to the customers

It is not surprising that 6 English-language journals published in North America and the United Kingdom would tend to include articles on topics of interest to English-speaking patients, physicians and researchers in those industrialized, relatively wealthy countries, as reported by Paula Rochon and associates.1 Grant funding and the subsequent generation of manuscripts, driven by public and political advocacy and commercial interests, probably reinforce this practice.

This is not necessarily good or bad; it is simply a reflection of the professional interests of the readers. One could argue that these journals survive by focusing the bulk of their output on topics that are of interest to the subscribers and advertisers that generate their revenue streams — that's just good business practice.

The conduct and dissemination of a greater number of randomized controlled trials focused on world health priorities may ultimately depend on the development of a comparable research and publishing infrastructure in those less affluent countries, admittedly a daunting task.

Louis B. Jacques Faculty Georgetown University Washington, DC