Jerome P. Kassirer, the former editor-in-chief of the New England Journal of Medicine, once said that “very poor countries have much more to worry about than doing high-quality research.” He added, “there is no science there [in developing countries].” People like Kassirer believe that developing countries are not in need of publishing scientific journals. They also believe that in the rare case that anything significant is discovered in a developing country, it can simply be published in a mainstream journal (Gibbs 92-9).

But do developing countries really need their own journals? Scientists, physicians, and health policy-makers in developing countries are faced with situations far different from those encountered by practitioners in industrialized countries. Currently, many infectious diseases have been almost completely eradicated from some industrialized countries and are being replaced by cardiovascular and cerebrovascular diseases. In developing countries, however, infectious diseases such as malaria, hydatid cyst, and diarrhea are still among the major killers.

Thanks to evidence-based medicine, several of our local problems have been solved. However, the existing evidence established at the global level is sometimes not exactly what is needed to solve our local problems. It is thus essential for developing countries to conduct research on their own problems and to be able to make use of global knowledge in a local context.

For all these reasons, developing countries should conduct their own research and present their somewhat different medical findings. This in turn necessitates that they publish their own medical/scientific journals (Habibzadeh 2004 S6-7).

To seek an appropriate position among the hundreds of journals being published and disseminated worldwide everyday, however, developing world scientists should have something new to say. The primary fuel of scientific journals is research. To understand where developing world science journals stand, we must take a step backward and first understand the status of scientific research in developing countries.

In developed countries there is a clear belief that scientific and medical research are of paramount importance for progress and development. The governments of many developing countries, on the other hand, believe that scientific research is futile; an unnecessary activity that not only wastes time but also wastes scarce government funds.

The stark reality, however, is that more than 90 percent of the global burden of premature mortality is due to diseases in developing countries, while more than 90 percent of the global expenditure on health research is spent on the disease problems of developed nations (Secretariat of the Global Forum for Health Research). No doubt, this gap will become more pronounced by time and by globalization, which makes the rich richer and the poor poorer.

Many developing world researchers who go to industrialized countries for further training become involved in research that is currently running in those centers. This research, however, is normally intended to solve the problem of that particular country. Many of these researchers, upon return to their homelands, continue to spend funding and time on the same topic for which they received training. In other words, much of the research conducted in developing countries is a continuation of research already underway in developed countries and which indeed benefits these developed countries. One of the most important research topics each country should conduct, regardless of its size and wealth, is research to determine its “research priorities.”

Over 400 medical journals are currently published in the 23 countries of the Eastern Mediterranean region. In 2003, a group of biomedical journal editors from the region met at a conference held in Cairo, Egypt under the auspices of the World Health Organization’s Eastern Mediterranean Regional Office. The objective of the meeting was to assess the status of medical research and journal publication in the region. One outcome of this meeting was the recognition that editors working in the region, regardless of the social, cultural, political and economic status of their countries, face similar problems they had once thought were unique to themselves (Habibzadeh, First Regional Conference 2003). The problems of these small journals were, as was expected, far different from those facing many mainstream journals. While the mainstream journals primarily have problems with authorship, conflict of interests, ethical issues in conducting research and publication, and redundant publications, developing world journals have more fundamental problems including lack of infrastructure for running a journal, insufficient funding, lack of expertise in desktop publishing, editors having little knowledge of their craft, difficulties in dissemination of publications, low visibility, and problems with absorbing high-quality research articles.

Another problem arises from a self-diminishing mechanism that affects most of these small journals; to become a high-quality journal, it should publish high-quality research. The authors of high-quality research, however, would rather publish their work in high-impact mainstream journals. Publication of low-quality articles results in low credibility and limited international interest that translates into very little chance for being covered by international indexing systems. Not being indexed along with small circulation of the small journals results in low visibility; almost no one is aware of their existence. This results in low submission rates of high-quality research articles and it is this that completes the vicious circle of inadequacy. A journal that enters this downward spiral to death will eventually reach an ominous state; although it is published, it has almost no contribution to the science world, hence a dead-brain journal.

To publish a good high-quality journal, we also need good researchers/authors, good editors, good reviewers, good publishing/printing facilities, and good distribution services.

Editors need specific skills to acknowledge their readers’ needs, be familiar with publication practices, and exercise editorship. Many editors of biomedical journals published in developing countries, however, do not have any formal training for their craft and may do their job out of interest or simply because they have been assigned to the position. Eventually they find their way through trial and error among various pushes and pulls to which their information products are subjected.

Finding a good reviewer is not always simple. Sometimes there are only a small number of accessible experts in a subspecialty field. Some of these experts, although distinguished in their scientific disciplines, are not properly familiar with research methodology and therefore cannot serve as good reviewers (Yadollahie, Roshanipoor, Habibzadeh S44).

Another problem is the language barrier. English is a language de facto, internationally recognized as the language of science. To gain international acceptance, journal submissions are usually required to be written in English, which is a problem for most authors whose mother tongue is not English. However, English has not always enjoyed its present status. Indeed, other languages have in the past proven themselves equally competent. For example, in ancient times Greek, Latin, and Arabic played such a role. The change in scientific language into English from Greek, Latin, and Arabic, then Italian, French and German, is in fact a reflection of a shift in research centers; the sun of science rose from ancient eastern countries and is now in western countries.

Another problem is that while most of our scholars have enough talent for oral communication and presentation, they have trouble with writing—an unfortunate inherent characteristic among Middle Eastern societies.

One way to succeed is probably to place emphasis on geographic medicine; to stress on prevalent diseases in the region, and analyze various regional parameters such as religious beliefs and cultural habits that might modulate the incidence, course, and management of a disease and its relevant medical problems (Habibzadeh 2004 S6-7).

Another solution is to put our limited resources on only a few journals. Scientific/medical journals in the region can be united to develop a new journal with better personnel and equipment. In this way we can prevent too many journals from chasing too few funds/manuscripts. We might even think of launching regional multinational journals. Meanwhile, we can help potential authors to write their manuscripts by implementing courses on research methodology and scientific writing.

Thanks to the Internet, networking, and e-Journalism, it is now possible for any journal to become somewhat visible (Lawrence 521). Most journal Web sites can now be found through a number of well-known search engines (e.g., Google, Yahoo!, and Scirus). Also, PubMed Central (PMC), through providing free access to numerous journal articles, now plays an important role in increasing the visibility of a journal.

Development of regional associations of journal editors, such as the Eastern Mediterranean Association of Journal Editors (EMAME) (Habibzadeh Regional Conference 2003, 2005) and the Forum of African Medical Editors (FAME) (Certain S34) can certainly improve the practice of editing and journal publication in the region (Habibzadeh, Regional Association 404). Membership in these associations will allow journal editors to consider the latest editorial standards set by these associations and to learn more about their craft and about problems they once had to find solutions through trial and error. All this makes our editors better. Better editors means better journals and better flow of information that undoubtedly promotes more effective knowledge translation and better settlement of evidence-based policy and practice.

The Eastern Mediterranean region, due to its different climates, religious beliefs, cultural habits, and levels of health standards, has a somewhat different disease epidemiology and spectrum of medical practices than other parts of the world. Empowering biomedical journal publication in the region can be beneficial for the promotion of health not only here, but in the world at large.

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