A more than one-hundred-fold higher per capita rate of authorship of five democratic nations versus their relatively undemocratic neighboring nations among 6,437 articles in 14 medical journals: does democracy and civil liberties promote intellectual creativity and medical research?

The aim of this work is to compare medical research productivity between democratic countries and their relatively undemocratic neighbors to identify mechanisms to promote medical research. Country of authorship was determined manually for articles published in 14 medical journals in 2005, and compared pairwise for democracies vs. relatively undemocratic nations: Israel vs. the rest of the Middle East; Japan vs. Russia; South Korea vs. North Korea; and Taiwan or Hong Kong vs. Mainland China. Democracies were quantitatively defined according to the Freedom House Index and the Economist's Index of Democracy. The frequency of publication of Israeli authors of unsolicited articles (excludes editorials) was found to be 1.08%, while its percentage of the world population is only .11% (OR = 9.97, 95%-ORCI: 4.30-23.1, P < 0.0001). This increase was invariant for more prestigious original articles (investigations) vs. less prestigious review articles or case reports, and for more prestigious high-impact factor journals vs. less prestigious low-impact factor journals. This increase was apparently not due to political favoritism: the relative frequency (RF) of Israeli authors of unsolicited articles was significantly higher than the RF of Israeli authors of solicited articles (i.e., invited editorials) (1.08% vs. 0.13%, OR = 8.38, 95%-ORCI = 1.46-48.1, P = 0.007); and was significantly higher than the RF of Israeli editorial board members (1.08% vs. 0.08%, OR = 13.0, 95%-ORCI = 2.27-74.7, P < 0.0001). Contrariwise, the frequency of publication of authors from the Middle East excluding Israel was 0.30%, while its percentage of the world population is 4.04% (OR = 0.071, 95%-ORCI = 0.04-0.12, P < 0.0001). The OR of Israeli authorship was incredibly 140.4-fold higher than the OR of the MEEI! The OR of authors of other democratic countries was also more than 100-fold the OR of authors of their undemocratic neighbors: Japan (OR = 4.93, 95%-ORCI = 3.82-6.36, P < 0.0001) vs. Russia (OR = 0.005, 95%-ORCI = 0.00-0.06, P < 0.0001); South Korea (OR = 3.48, 95%-ORCI = 2.29-5.31, P < 0.0001) vs. North Korea (OR < 0.36, 95%-ORCI = 0.00-0.35, P < 0.0001); Taiwan (OR = 5.12, 95%-ORCI = 2.85-9.19, P < 0.0001) or Hong Kong (OR = 9.21, 95%-ORCI = 3.51-24.2, P < 0.0001) vs. Mainland China (OR = 0.028, 95%-ORCI = 0.019-0.041, P < 0.0001). The OR of national authorship was closely correlated with two indices of democracy: correlation coefficient with Freedom House Index = 0.83, and correlation coefficient with the Economist's Democracy Index = 0.76. The OR of national authorship was also (mildly less) correlated with per capita income (corr. coeff. = 0.75). In conclusion, five democracies exhibit a remarkably higher relative frequency of medical publications than their relatively undemocratic neighbors. The relative frequency of authorship was, furthermore, extremely strongly correlated with democracy and political freedom. The freedom hypothesis may help explain this phenomenon: political freedom and liberty in democracies may promote intellectual creativity and medical research. This hypothesis should be tested by a multivariate analysis of univariate risk factors of medical authorship for all nations.