No national statistics are available for the incidence of brain tumours, and this clearly shows that this pathology has been neglected by medical research. But all Latin American countries experience this problem, as described by Contreras in 2017. This perfectly explains why the Instituto had a modest production before year 2000, and our study shows that this situation is changing, as there is a growing interest on the subject. As previously said, no Latin American country has a national registry of brain tumours, and their precise incidence is unknown and is only inferred from mortality statistics and institutional discharge numbers. Our paper is a call to action for oncologists, neurosurgeons and other stakeholders to start epidemiological studies at a regional level.
The ratio clinical versus basic is four to one in publications. According to Science , in Mexico, research and development budget accounts for 0.46% of the GDP (60% and 87% less than Brazil and Japan respectively). For experimental studies the inoculation of tumour cells into animals requires a budget and infrastructure suitable to generate original results worth being published.
Clinical studies can be performed with the patients who are being already cared for in a national referral centre such as the INNN and often require little additional budget. The value of clinical case series is unquestionable, as observational designs in our countries with limited resources, may reveal patterns not reported in the literature authored in more developed countries, due to ethnic, social or infrastructure differences. For example, Mexican patients can hardly afford chemotherapy (out of pocket expense), while in Western Europe social security grants access to this treatment. Therefore, some patients have to be treated outside the international guidelines , because they cannot afford optimal therapy or adequate molecular markers of methylation status typing. What happens to these patients, who might be underrepresented in foreign literature (European or American)? This is a pertinent question which can be answered in prospective international studies.
Archivos de Neurociencias is the institutional journal, whose first issue dates 1986 and hosts 41% of the scientific production in tumours. No clear interpretation of this can be given, as we do not have statistics about what is the normal percentage of articles that are published in domestic journals and consequently what proportion can be sent to a foreign publication with reasonable possibilities of being accepted.
But let’s stop a few moments and consider what happens to a research project not conceived in the top universities or hospitals or developed countries:
First, I conceive the idea in my mind. Second, I design the plan, carry out the experiment, analyse and interpret the data and write the manuscript. Up to this point, no else than the author and his team are aware of the results. In the third step, I want my data to become public, because I need to contribute with these findings to the global corpus of knowledge, which might improve medical care in similar patients. Not all the truth comes for perfect randomized trials where all biases are controlled. At least some knowledge comes from everyday experience of not so perfect patients treated by not so perfect doctors and published in not so perfect journals. To publish is to make public what I have done. As we already have previously written. Latin American research is often rejected from American or European journals without review. This leads many authors from our countries to publish in national journals, but this becomes a vicious circle, because other scientists cannot read Spanish and this knowledge does not really become public even after publication. In the fourth step, I want my findings to be noticed by others and receive views, likes or thumbs-up: citations! And I will be cited under two conditions: what I say is visible and what I say is interesting. We do not know the reasons behind the low proportion of Mexican papers published in foreign journals: did the authors decide to publish locally? Did they send the manuscript abroad and it was rejected? Did the prefer to publish it in a national journal because they think that foreign journals will not be interested? These are questions worth being asked but that nobody has dared to ask. Research must be published for others, not for the author.
Our study reveals that 2% of the studies were published in a journal with an unspecified JIF, 37% in journals with JIF of 1.00-1.99, 44% with JIF from 2.00 to 24.99 and none in journals with a high JIF (25.00-50.00). This confirms recent findings on the publications of Mexican spine surgeons , which shows a per capita annual index of 0.05 (one paper per author every 20 years), and that with a mean value of JIF of 0.53.
Articles are the only visible part of research, the one which precisely is public knowledge, because it has been published. Our study has three inherent weak points: 1) research that has not been published has not been considered and 2) research that is published in journals not indexed in the database are also ignored. But the situation would have been worse if we had chosen PubMed or the WoS, as the majority of Mexican medical journals are not indexed in these databases, 3) those published in minor journals were not included.
Our paper is a call for action: if we have a given proportion of patients operated at our institution, we should to transform that experience into publications.
Latin American researchers should reflect on these problems present in our countries: 1) what measures could be taken to encourage publication practices? 2) How can continuous medical education programs create numerous groups of doctors with a good command of English: most of them can read, but cannot write directly in English. They often have a manuscript in Spanish with a word for translation which poorly reflects the original idea: traduttore traditore we use to say for such situations! 3) Access to first-class journals is prohibited by the pay-for-publishing policies where publications fees are not affordable and local universities have no budget for that. 4) Which other policies might improve institutional performance?
From 2000 to 2019, we have witnessed an eight-fold increase in research publications, which is a significant sign of research productivity improvement in the country. The proportion of original research is important, which is an indirect proof of a certain maturity: Mexican researchers do not write review articles which is an easier task at the beginning of any scientific career. Now, we should focus on quality and impact.
Starting in the year 2000, a majority of clinical articles focused on the diagnosis and treatment of glioblastoma, the most common and aggressive primary CNS malignancy . Glioblastoma is one of the cancer types that require further investigation due to poor prognosis [16,17]. Our authors in molecular research on brain neoplasms have shown a preference for C6 glioma cell lines as an experimental model of glioblastoma. At the Instituto, studies with this cell line have been published primarily as a way to understand tumour growth mechanisms, as well as to test cancer therapies. International collaboration has a greater diffusion and therefore a larger number of citations. This is illustrated by this clinical paper: "Adding chloroquine to conventional treatment for glioblastoma multiforme: a randomized, double-blind, placebo-controlled" by Sotelo et al., with 297 citations, and the study on "CpG Island Hypermethylation of the DNA Repair Enzyme Methyltransferase Predicts Response to Temozolomide in Primary Gliomas" by Paz et al., with 221 citations. The first dates back to 2006 and the second to 2004. We summarize the authors on the subject in Table 3.
In the clinical field, Tena (ORCID ID: 13409398700) has authored 8% of the institutional output. In the experimental domain, López (ORCID ID: 7103066402) has authored 13% of the total production, Arrieta 6% and Sotelo 5%, whereas the main corresponding authors were Pineda, Arrieta and Sotelo with 13%, 9% and 8% of the papers, respectively; Pineda and Sotelo belong to the same research group.