Representation of authors and editors from poor countries: observed publication bias may reflect who is funding research.

Editor—Despite research in tropical medicine being undertaken in countries from low human development index, authorship and editorial opinion remain with countries from higher development index. This unfair trend observed by Keiser et al demands to be addressed and overturned. This observed bias may arise because countries of high human development index fund the bulk of research in tropical medicine. 3 Authors from these countries have prepared the grant applications, taken principal investigator status, and believe that they should take primary or terminal authorship. Researchers from low human development index countries can break this cycle only if they can obtain international funding themselves or are allowed authorship by the principal investigators. It seems this is rarely extended to the collaborators in tropical countries, even though they are the ones practically conducting the study. If such generosity in authorship and mentorship were provided, this would enable researchers from low human development index countries to become successful principal investigators, obtain funding, and be invited to the editorial board of respected journals. Keiser et al could have examined the funding source of the published research articles against authorship country of origin to see if this was confounding. We are sure that these publication biases are not just restricted to tropical medicine. Consequently, we strongly advocate this approach be delivered uniformly across all clinical disciplines to support research and researchers in countries of low human development index, who are concurrently tackling substantial healthcare inequalities and unremitting disease, and deservedly need greater support.