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The tremendous economic growth of China over the past 20 years has propelled the world's most populous country to the forefront of global economy and politics. China, with its rich, unsurpassed culture and history, stands once again at the threshold of greatness in the coming decade. In virtually every human and scientific endeavor, China is becoming a force to be reckoned with and seems set to become a world leader. With such major socioeconomic impetus, marked development in science and medicine has also inevitably taken place. One of the basic tenets of scientific growth is the ability to share scientific findings with the rest of the world through publications in peer-reviewed journals. In this issue of the Journal of Gastroenterology and Hepatology (JGH), Gao et al.1 report a survey of publications in English language gastroenterology and hepatology journals from mainland China between 1996 and 2005, and compare the results over the same period with publications from Taiwan and Hong Kong. Why should this analysis be of interest to us? As the authors state so succinctly in the first line of their abstract: People of Chinese ethnicity are one of the groups at most risk of gastrointestinal and liver diseases in the world. Clearly such a huge disease burden provides the opportunity for all gastroenterologists and hepatologists, particularly colleagues and friends from the Asia–Pacific region, to learn and understand more about these diseases, from investigations conducted in and reported from China. Based on absolute figures derived from publications from 52 specialty journals during the entire study period, Gao et al. found that mainland China published almost twice the number of articles (2969) compared to Taiwan (1551), and five times that of Hong Kong (650). This certainly reflects the growth of scientific activity in gastroenterology and hepatology in China, a contention supported by the observation that a total of 30 articles was published in the top-rated gastroenterology and liver journals—Gastroenterology, Hepatology, Gut, and the American Journal of Gastroenterology. Further, the number of articles published each year appears to increase faster in China than in the other Chinese regions. However, one concern revealed by closer inspection is that the bulk of publications from mainland China was published in one single journal—the World Journal of Gastroenterology (WJG). WJG is published from China, and for this and other reasons canvassed below, the authors performed a subanalysis of productivity between these three regions of north Asia inhabited predominantly by Chinese people after WJG publications had been excluded. This showed a markedly different distribution pattern in the total number of papers as follows: mainland China 300, Taiwan 1354, and Hong Kong 613, a complete reversal of the previous order. Further, the calculated accumulated impact factor (IF) based on Journal Citation Reports, was lowest for articles from China 775, surpassed by Taiwan (3748) and Hong Kong (2273). The authors lament that the quality of papers from China and the quantity published in non-Chinese journals lags behind that of Taiwan and Hong Kong. This difference would in fact be further accentuated if gastroenterology and liver articles published in leading non-specialist medical journals, such as the New England Journal of Medicine, Lancet, and Annals of Internal Medicine, were also taken into account. What are possible reasons for this seeming discrepancy between these three regions of similar or identical ethnicity? Hong Kong and Taiwan have been for many years been at the forefront of scientific and medical research, and investigations from these regions have contributed some of the best scientific papers in gastroenterology and hepatology. Further, the high prevalence of important gastrointestinal and liver diseases—Helicobacter pylori and peptic ulcer, gastric and esophageal cancer, chronic hepatitis B, cirrhosis, and hepatocellular carcinoma––are most prevalent in these countries. This may have given a competitive "epidemiological" edge to investigators at a time when government investment in medical and health research in China was restricted by economic and political considerations. A similar argument could be mounted in terms of clinical trials of new therapeutic agents. For pharmaceutical companies, the established academic structures and clinical services in teaching hospitals in Hong Kong and Taiwan have proven unusually attractive during the decade 1996–2005, and large studies may be less expensive to conduct in Asia than in Europe or North America. Another major consideration is that publications in the medical and scientific field that reach an international audience are virtually all in the English language. This has given a major advantage to "English-speaking" countries, and during various phases of their socioeconomic development, have proven a challenge for investigators in non-English speaking countries, as recently reviewed in these columns.2 In several Asian countries (Japan, Korea, and Taiwan are noteworthy) where English is not commonly used in professional practice and education, and until recently, has only been learnt in school as an additional language, the publication of numerous high quality articles testifies to extraordinary endeavors to share and publicize important scientific findings to the world. However, this also underlines the fact that in scientific circles, the English language is indeed the lingua franca of the world. Hong Kong, like other ex-British colonies in the Asia–Pacific (Australia, New Zealand, India, Pakistan, Sri Lanka, Singapore, and Malaysia) has the advantage of a strong foundation in the written English language. Together with the required imagination, dedication, and effort, and coupled with an excellent research environment in university teaching hospitals, local investigators have been enabled to publish top-class papers in gastroenterology and hepatology. The startling fact that the overwhelming number of publications from China were in the WJG could be because it is, despite the epithet "world", in reality a "local journal" published out of Beijing. The popularity of any journal to authors ranges from the IF of the journal, ease of submission, and ease of acceptance for publication. It seems likely that these qualities have made the WJG a popular journal, not only in China, but worldwide. However, as Gao et al. point out, it is a "controversial journal", and as such, was omitted from the list of the "Science Citation Index Expanded" category of the Institute for Scientific Information in 2004. Self-citation and the easy availability of articles online have contributed to the relatively high IF of the journal. The WJG is unlikely to be representative of the quality of other medical journals published from China. For example, two journals with international stature that publish articles in gastroenterology and hepatology are the Chinese Medical Journal and our sister journal, the Journal of Digestive Diseases, both of which have wide respectability and citability. Although more constrained in their scope and citation impact at present, these more traditional journals will no doubt grow in strength in time to come. So what is the role of JGH for promoting scientific publications in the fields of gastroenterology and hepatology from "mainland China"? JGH is the first and major gastroenterology and liver journal with an Asia–Pacific focus. JGH was founded in 1984 and has an established and proud history of publishing top-class scientific articles in the field.3–5 JGH and the JGH Foundation also serve as the bed rock of unified Asia–Pacific gastroenterology and hepatology.4 Partly through JGH, the region has come together during the last quarter century, and together with the regional and national Asian professional gastroenterology and liver associations, continues to serve this important role. The owners and editors of JGH have long appreciated the importance of China in our region and the world and have been sensitive of the need to assist the development of stronger research and a professional and public health profile in these twin fields of medicine. Since its inception, JGH has followed a policy of inviting and accepting articles from throughout the region, including China, often assisting with textual improvements in English expression. The success of that policy is evident in the growing number of publication of articles from China (Fig. 1), particularly since 2004 and most impressively during the last 2 years, that is, since the period considered by Gao et al.1 Interestingly, while those from Taiwan have also increased, China has now overtaken both Taiwan and Hong Kong, while Hong Kong and other key countries, such as Japan, India, and Australia have remained relatively static by comparison (Korea is the other big "growth area", as discussed recently5,6). Number of articles published in the Journal of Gastroenterology and Hepatology between 1999 and 2007 from () Taiwan, () Hong Kong and (□) China. It has been noted anecdotally that the acceptance rates of articles submitted to JGH from China are lower than the overall 20%, and JGH aims to do more to promote the publication of high-quality original articles and important reviews of scientific developments and clinical practice. The appointment in 2001 of our first editor from mainland China, Professor Dong-Liang Yang from Wuhan, is indicative of the importance we place on soliciting and reviewing articles from China. Professor Ji-Dong Jia from Beijing, for some time a highly-active member of the Editorial Board, has recently accepted an appointment as another Hepatology editor. We have eight Editorial Board members residing in mainland China, and augmenting that number substantially is currently a priority. Suggestions from our readers of active and talented "new players" on the academic scene in Chinese gastroenterology and hepatology are now being sought and would be most welcome. As discussed before,5,6 our Editorial Board serves not only as the "nerve centre" of JGH for active and efficient reviewing, together with writing editorials and key review articles, but also as the "recruiting desk" for future editors. In the not too distant future, it would seem appropriate to have (at least) two editors from China, as we have for many years from Japan, Hong Kong, and Australia, as well as one or two from our traditional and newly-productive areas of Taiwan, India, and Korea. There are other ways in which the scientific productivity of gastroenterology and hepatology throughout the Asia–Pacific in general and China in particular can be strengthened. Participation in the major regional annual meetings (so successfully convened under the presidency of Professor Shudong Xiao in China in 2004, and the Asian Pacific Association for the Study of the Liver), leadership in clinical practice and research working parties, more effective cross-country collaborations and exchange programs for technical and professional training, as well as in research are ways to upgrade standards and academic productivity across the region. The benefits will include improved articulation and productivity of medical and scientific work in English, and networking of collaborations whereby English-fluent and experienced groups can assist in the development of those areas, should eventually yield the fruits of an improved output of high-quality articles. In our view, the study by Gao et al. should not be viewed in either a negative or elitist light. Instead, it reveals signs of a new dawn in scientific discovery and medical publications from the new China. The challenge of JGH and regional scientific and professional bodies in the specialty academic institutions in countries of the region that are currently more productive in scientific output, as well as national policy in China and investment from the private sector, is to encourage and harness all that China has to offer in the next decade. There seems little to be gained from lamenting the void of the eighties, but much to cheer from the stuttering start of the nineties. The assistance of Roisin Stewart with research for this article, and the administrative support of Jolanda tenDam are gratefully appreciated.
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