Visibility of Arab countries in the world biomedical literature

O ver the last four decades, most Arab countries have undergone considerable development and both undergraduate and postgraduate education have spread and improved. Moreover, the number of journals published in Arab countries has increased, which has provided an outlet for publishing research that is of local importance but is not of much interest to the scientific community at large and, thus, has a small chance of being accepted by well-established journals with a wide readership. However, as Arab countries are part of the developing world, their contribution to the biomedical research literature is modest (1). Measuring research output, even just quantitatively, is a complex and often controversial topic. Research articles indexed in the major databases (e.g. PubMed and Web of Science) are obvious targets when counting research publications. But what about research published in local journals, and should counts of PhD theses be given some consideration as well? Should registered patents also be taken into account? As it was not our intention to undertake research work as such, these and other questions led us to seeking a bird’s eye view not of research output but of visibility of the research to the scientific community. So we searched PubMed using the sensitive query described by Tadmouri and BissarTadmouri (2), ‘all’ articles for ‘each’ year from ‘each’ Arab country for the period from 1 January 1988 to 31 December 2007, and then we analysed the data separately for the two decades (1988 1997 and 1998 2007). The number of publications from all Arab countries combined increased from 15,868 publications in the first decade to 35,211 publications in the second decade. But by itself this does mean much because of population growth. Moreover, the total number of publications in PubMed increased by about 50% between the two decades. However, we found that the contribution of Arab countries to the worldwide PubMed literature increased from 0.38 0.6% between the two decades. Admittedly, the contribution is small, but nevertheless the progress is a positive development. The major contributors to Arab research during the second decade were clearly Saudi Arabia (one of the most affluent and the most populous in that group) and Egypt, followed by Tunisia. Together, these three countries accounted for 56% of the Arab output indexed in PubMed during the second decade (Fig. 1). We stress that these data are only absolute counts that have to be viewed with the differences in population size and economic resources in mind. Comparing countries according to their research policies was way beyond our intentions, but we took the economic factor into consideration by grouping the countries into three economic groups based on the per capita gross national product (World Bank, http://web.worldbank.org). Between the two decades, the number of PubMed-indexed publications per million population per year (which henceforth we will refer to as productivity) doubled in the lower-upper income group of countries (from 4 to 8) and tripled in the upper-middle group (from 11 to 30 publications per million population per year), which is in line with the crude notion that more money means more research. But in the upper-income group of countries it increased only slightly (from 32 to 38), which raises questions. But grouping countries and making generalisations can lead to substantial errors because not all countries within each economic group perform at the same level. So to identify the countries most responsible for substantial progress or for its lack, we went on to analyse the countries individually. Analysis of the trend between the two decades in the number of PubMed-indexed publications per million population per year for each country shows some remarkable differences (Fig. 2). In the upper income group of countries, Kuwait clearly outperformed its peers while Saudi Arabia stagnated. Productivity remained unchanged in Saudi Arabia at 30.6 and 30.7 publications per million population per year between the two decades. It might be argued that this stagnation in Saudi Arabia was caused by the Gulf War, and this might be partly true. But Kuwait, which was directly involved in the war, increased its productivity between the two decades from 75 to 107 publications per million population per year. In the group of upper-middle income countries, which includes only Lebanon and Libya, Lebanon’s improvement is impressive with productivity increasing more than threefold, while Libya did not show any progress. The international embargo that had been imposed on Libya could have been a contributing factor but it cannot explain the stagnation in full. We believe that one factor that has held back research in Libya is the pattern of frequent changes in academic and research