The Commentary assesses previous allegations of 'institutional racism' in some parts of the medical community by examining the ethnic constitution of the editorial boards and the proportion of journal content covering health from less-developed countries of the world's five leading medical journals (the Annals of Internal Medicine, the British Medical Journal, the Journal of the American Medical Association, The Lancet, and the New England Journal of Medicine).
Horton comments how the scientific, medical, and public-health priorities of the rich world are presented as the norm, adding: "We editors seek a global status for our journals, but we shut out the experiences and practices of those living in poverty by our unconscious neglect.
One group is advantaged, while the other is marginalised. Since journals collectively embody the attitudes and behaviours of researchers and practitioners, the actions of editors reflect the state of medical research itself. Racism in health has been widely debated, but similar ethnic biases in acceptance and commissioning policies at peer-reviewed medical journals have been little discussed."
Commercial factors that make medical journals profitable, together with editors desire to enhance their journal's impact factor by publishing research that has greater potential for future citations, are obvious biases that skew medical journals away from addressing the health priorities of poor countries. The Commentary continues: 'Medical research therefore becomes shaped by the commercial values and agenda of its own media. The result? That the range of public debate narrows.'
Richard Horton concludes: "…a radical cultural transformation is needed within the editorial offices of leading medical journals today to reverse a deeply embedded ethnic bias. The public-service remit of journals needs to be carefully defined and protected. Community responsibility is one of medicine's core values; medicine's global responsibilities need to be strengthened in medical journals today."
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