- Richard H. Nicholson, M.D.
Editor, Bulletin of Medical Ethics ,
6 Gallia Road, London N51 LA, ENGLAND
I first became aware of how serious the problem is about 8 years ago. A review article on recent advances in assisted reproduction in the New England Journal of Medicine cited just over fifty papers. Only seven were by non-American authors. Yet, because of a US federal embargo on the findings of research on the embryo or foetus, all the important developments at that time were coming from Australia, France and the United Kingdom.
The problem continues. In major US medical journals. papers with a US based first author will have citations of which 85% on average were published in the US. If the first author is based in any other country, only 55% of the citations will be to US-published work. US-based authors cite more overall. so their papers on average cite twice as many US publications as papers with non-US-based first authors. This skews citation indices.
In US bioethics journals it is not uncommon to find complete issues without a single reference to work published outside the US. This helps to reinforce the erroneous belief among many academics working in bioethics in the US that the only significant work has been done in the US. While thoroughly irritating to those of us who believe that academic endeavour is only worthwhile if conducted honestly and with an open mind, it is not necessarily dangerous.
On the other hand, a recent paper, L.S. Wilsow, Current concepts: child abuse and neglect", New England Journal of Medicine 332 (1995), 1425-31; could be very dangerous. It is a review of current concepts in child abuse and neglect which makes not one reference to work published outside the US. Consequently, it omits to draw attention to two important areas of child abuse that have been the subject of much discussion in Europe and Australia in the last decade. In a section "controversies in the diagnosis of sexual abuse" the author discusses only the signs of vaginal sexual abuse in girls. Not a word is said about recent discussions of how to recognise anal sexual abuse in either boys or girls. Likewise not a word is said about the recognition of Munchausen's syndrome by proxy, in which parents fabricate the signs of serious illness in their children. Yet non-US journals have had many discussions of that problem, and of the attendant ethical issue of how much covert surveillance of parents under suspicion should be undertaken by health care workers.
So keep up the good work, and continue reminding scholars around the world that a lot of important publications do not come from the United States.