Article Text

Download PDFPDF
International Outsourcing of Medical Research by High-Income Countries
  1. Raquel K. Belforti, DO*†,
  2. Michal Sarah Wall, MD*†,
  3. Peter K. Lindenauer, MD, MSc†‡,
  4. Penelope S. Pekow, PhD‡§,
  5. Michael B. Rothberg, MD, MPH*†
  1. From the *Department of General Medicine and Geriatrics, Baystate Medical Center, Springfield; and †Tufts University School of Medicine, Boston; ‡Center for Quality and Safety Research, Baystate Medical Center, Springfield; and §School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA.
  1. Received July 10, 2009, and in revised form November 10, 2009.
  2. Accepted for publication November 10, 2009.
  3. Reprints: Raquel K. Belforti, DO, Division of General Medicine and Geriatrics, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199. E-mail: raquel.belforti{at}
  4. There were no funding sources for this project.
  5. None of the authors have any conflict of interest.

Changes From 1995 to 2005


Background Medical research outsourcing provides a financial benefit to those conducting research and financial incentives to the developing countries hosting the research. Little is known about how frequently outsourcing occurs or the type of research that is outsourced.

Methods To document changes in medical research outsourcing over a 10-year period, we conducted a cross-sectional comparison of 3 medical journals: Lancet, The New England Journal of Medicine, and JAMA: The Journal of the American Medical Association in the last 6 months of 1995 and 2005. The main outcome measure was the 10-year change in proportion of studies including patients from low-income countries.

Findings We reviewed 598 articles. During the 10-year period, the proportion of first authors from low-income countries increased from 3% to 6% (P = 0.21), whereas studies with participants from low-income countries increased from 8% to 22% (P = < 0.001). In 2005, compared with studies conducted exclusively in high-income countries, those including participants from low-income countries were more likely to be randomized trials (55% vs 35%, P = 0.004), to study medications (65% vs 34%, P < 0.001), to be funded by pharmaceutical companies (33% vs 21%, P = 0.05), and to involve pediatric populations (29% vs 8%, P < 0.001).

Interpretation Outsourcing of medical research seems to be increasing. Additional studies are required to know if subjects from low-income countries are being adequately protected.

Key Words
  • outsourcing
  • medical research

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.