Editor—The campaign to promote academic medicine represents an important effort to deal with the many challenges facing international clinical research.1 Particularly, since this campaign is led by a group of academic publishers, asking if or how these challenges have been reflected in the biomedical literature is worth while. To investigate this issue, we examined all 8.1 million articles indexed in Medline between 1994 and 2001, comparing three eras: 1978-85, 1986-93, and 1994-2001.
The proportion of studies including human subjects (the most common proxy for clinical research) increased significantly during the study period from 62.6% to 68.8% (P < 0.001). While absolute rates of funding rose over time for both groups, they increased more rapidly for studies not involving human subjects, leading to a widening funding gap between these papers and clinical manuscripts (table). By the final study era (1994-2001), more than two thirds of clinical publications still reported no funding source, as compared with less than one third of basic science articles. Both this absolute difference and the change over time were highly significant (P < 0.001).
Table 1.
Proportions (percentages) of unfunded clinical and basic science articles (n=8 123 392)
| 1978-85 | 1986-93 | 1994-2001 | |
|---|---|---|---|
| Human subjects (n=5 366 228) | 82.4 | 74.9 | 66.8 |
| No human subjects (n=2 757 164) | 53.1 | 40.3 | 32.1 |
| Relative risk of being unfunded | 1.55 | 1.86 | 2.08 |
This analysis provides a mixed prognosis on the health of clinical research as reflected in the biomedical literature. On the one hand, there are indications of a robust and expanding body of publications involving human subjects. On the other hand, there seems to be a large and growing funding gap between clinical and basic research. While academic medical centres have historically cross subsidised clinical research through other revenue streams, these strategies have become increasingly untenable in the current health delivery environment.2,3 If we are to preserve the vitality of the clinical research enterprise, we must work to ensure that funding keeps pace with the need for high quality clinical evidence.
Competing interests: None declared.
References
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