Global mapping of randomised trials related articles published in high-impact-factor medical journals: a cross-sectional analysis
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Abstract
BACKGROUND: Randomised controlled trials (RCTs) provide the most reliable information to inform clinical practice and patient care. We aimed to map global clinical research publication activity through RCT-related articles in high-impact-factor medical journals over the past five decades. METHODS: We conducted a cross-sectional analysis of articles published in the highest ranked medical journals with an impact factor > 10 (according to Journal Citation Reports published in 2017). We searched PubMed/MEDLINE (from inception to December 31, 2017) for all RCT-related articles (e.g. primary RCTs, secondary analyses and methodology papers) published in high-impact-factor medical journals. For each included article, raw metadata were abstracted from the Web of Science. A process of standardization was conducted to unify the different terms and grammatical variants and to remove typographical, transcription and/or indexing errors. Descriptive analyses were conducted (including the number of articles, citations, most prolific authors, countries, journals, funding sources and keywords). Network analyses of collaborations between countries and co-words are presented. RESULTS: We included 39,305 articles (for the period 1965-2017) published in forty journals. The Lancet (n = 3593; 9.1%), the Journal of Clinical Oncology (n = 3343; 8.5%) and The New England Journal of Medicine (n = 3275 articles; 8.3%) published the largest number of RCTs. A total of 154 countries were involved in the production of articles. The global productivity ranking was led by the United States (n = 18,393 articles), followed by the United Kingdom (n = 8028 articles), Canada (n = 4548 articles) and Germany (n = 4415 articles). Seventeen authors who had published 100 or more articles were identified; the most prolific authors were affiliated with Duke University (United States), Harvard University (United States) and McMaster University (Canada). The main funding institutions were the National Institutes of Health (United States), Hoffmann-La Roche (Switzerland), Pfizer (United States), Merck Sharp & Dohme (United States) and Novartis (Switzerland). The 100 most cited RCTs were published in nine journals, led by The New England Journal of Medicine (n = 78 articles), The Lancet (n = 9 articles) and JAMA (n = 7 articles). These landmark contributions focused on novel methodological approaches (e.g. the "Bland-Altman method") and trials on the management of chronic conditions (e.g. diabetes control, hormone replacement therapy in postmenopausal women, multiple therapies for diverse cancers, cardiovascular therapies such as lipid-lowering statins, antihypertensive medications, and antiplatelet and antithrombotic therapy). CONCLUSIONS: Our analysis identified authors, countries, funding institutions, landmark contributions and high-impact-factor medical journals publishing RCTs. Over the last 50 years, publication production in leading medical journals has increased, with Western countries leading in research but with low- and middle-income countries showing very limited representation.
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Many research projects in the USA are funded by private initiatives, unlike most other countries.
“Also, many research projects in the USA are funded by private initiatives, unlike most other countries 29 , 30 , 31 .”
From Global mapping of randomized controlled trials in dentistry (2024) · cites this paper as [29]
The Results (Funding source; page not available) list several US-based industry funders associated with many RCT-related articles, supporting the point that private funding is substantial. But the table identifies funders’ countries, not where projects were conducted, and it does not establish that the USA differs from most other countries in reliance on private funding. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe USA played a central role in the collaborations identified in this study.
“The USA played a central role in the collaborations identified in this study, corroborating a previous study in the biomedical field 29 .”
From Global mapping of randomized controlled trials in dentistry (2024) · cites this paper as [29]
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Randomised Controlled Trials: A User's Guide
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Self-citation is the hallmark of productive authors, of any gender
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Sharing Clinical Trial Data: A Proposal from the International Committee of Medical Journal Editors
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Relation between burden of disease and randomised evidence in sub-Saharan Africa: survey of research
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Reporting of Results in ClinicalTrials.gov and High-Impact Journals
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Bibliometric analysis of the literature of randomized controlled trials.
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Visual insights: a practical guide to making sense of data
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“The main goal in topical analyses is to understand the topical distribution of a dataset, i.e. what topics are covered and how much of each topic is covered in a scientific discipline [32] .”
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Association of the FDA Amendment Act with trial registration, publication, and outcome reporting
Phillips, A. T., Desai, N. R., Krumholz, H. M., Zou, C. X., Miller, J. E., & Ross, J. S. (2017) · Trials · doi:10.1186/s13063-017-2068-3 · Cited by 61 · see citing works
The model underlying the measurement of the impacts of the IIC on the end-users
Goodhue, D. L. (1997) · Journal of the American Society for Information Science · doi:10.1002/(sici)1097-4571(199705)48:5 · Cited by 56 · see citing works
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Atal, I., Trinquart, L., Ravaud, P., & Porcher, R. (2018) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2018.01.006 · Cited by 48 · see citing works
Measuring Research: What Everyone Needs to Know®
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Magnitude of effects in clinical trials published in high-impact general medical journals
Siontis, K., Εvangelou, Ε., & Ioannidis, J. P. A. (2011) · International Journal of Epidemiology · doi:10.1093/ije/dyr095 · Cited by 38 · see citing works
Catalá-López, F., Alonso‐Arroyo, A., Hutton, B., Aleixandre‐Benavent, R., & Moher, D. (2014) · BMC Medicine · doi:10.1186/1741-7015-12-15 · Cited by 37 · see citing works
Self-citationCatalá-López, F., García‐Altés, A., Álvarez-Martín, E., Gènova-Maleras, R., & Morant-Ginestar, C. (2010) · Population Health Metrics · doi:10.1186/1478-7954-8-34 · Cited by 32 · see citing works
Self-citationRandomized trials are frequently fragmented in multiple secondary publications
Ebrahim, S., Montoya, L., el Din, M. K., Sohani, Z. N., Agarwal, A., Bance, S., Saquib, J., Saquib, N., & Ioannidis, J. P. A. (2016) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2016.05.016 · Cited by 32 · see citing works
Goldacre, B., Drysdale, H., Marston, C., Mahtani, K. R., Dale, A., Milosevic, I., Slade, E., Hartley, P., & Heneghan, C. (2019) · Trials · doi:10.1186/s13063-019-3172-3 · Cited by 27 · cited 2× · see citing works
“In addition, citations are also treated as equal regardless of whether research is being cited for its positive contribution to the field or because it is being criticized.”
BackgroundMethodThelwall, M. A., & Kousha, K. (2016) · Scientometrics · doi:10.1007/s11192-016-2112-1 · Cited by 26 · see citing works
Brueton, V. C., Vale, C. L., Choodari‐Oskooei, B., Jinks, R. C., & Tierney, J. F. (2014) · Trials · doi:10.1186/1745-6215-15-464 · Cited by 23 · see citing works
Large Simple Trials and Knowledge Generation in a Learning Health System
Institute of Medicine (2013) · National Academies Press eBooks · doi:10.17226/18400 · Cited by 17 · see citing works
Lundine, J., Bourgeault, I. L., Clark, J., Heidari, S., & Balabanova, D. (2019) · The Lancet · doi:10.1016/s0140-6736(19)30281-8 · Cited by 17 · see citing works
Randomised trials in developing countries
Berkley, J. A. (2014) · Archives of Disease in Childhood · doi:10.1136/archdischild-2014-306163 · Cited by 9 · see citing works
Dechartres, A., Bond, E. G., Scheer, J., Riveros, C., Atal, I., & Ravaud, P. (2016) · BMC Medicine · doi:10.1186/s12916-016-0740-1 · Cited by 6 · see citing works
Flagged first, then by citations
3 of the 131 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Self-citation is the hallmark of productive authors, of any gender
Mishra, S., Fegley, B. D., Diesner, J., & Torvik, V. I. (2018) · PLoS ONE · doi:10.1371/journal.pone.0195773 · Cited by 126 · see citing works
Language as Multi-Level Barrier in Health Research and the Way Forward
Ransing, R. S., Vadivel, R., Halabi, S. E., Jatchavala, C., Shalbafan, M., Noël, C., Noor, I. M., Yee, A. H. A., Gürcan, A., & Ramalho, R. (2021) · Indian Journal of Psychological Medicine · doi:10.1177/02537176211052071 · Cited by 48 · see citing works
Endodontic Microbiology: A Bibliometric Analysis of the Top 50 Classics
Karobari, M. I., Maqbool, M., Ahmad, P., Abdul, M. S. M., Marya, A., Venugopal, A., Shaik, G. M., Scardina, G. A., Messina, P., & Noorani, T. Y. (2021) · BioMed Research International · doi:10.1155/2021/6657167 · Cited by 48 · see citing works
“Worldwide publication activity shows that the countries having low to middle income have a lower level of scientific articles published in high impact factor medical journals [45].”
Nicholls, S. G., Carroll, K. A., Hey, S. P., Zwarenstein, M., Zhang, J. Z., Nix, H. P., Brehaut, J., McKenzie, J. E., McDonald, S. J., Weijer, C., et al. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.03.021 · Cited by 32 · see citing works
Williams, A., Lennox, L., Harris, M. J., & Antonacci, G. (2023) · Implementation Science · doi:10.1186/s13012-023-01311-1 · Cited by 28 · see citing works
“The large influx of RCT publications in recent decades [19, 20] poses challenges to healthcare systems to effectively manage the implementation of interventions at such volume [3].”
BackgroundCrowther, N. R., Holbrook, A. M., Kenwright, R., & Kenwright, M. (1997) · PubMed Central · Cited by 22 · see citing works
Lockwood, I., Walker, R., Latimer, S. L., Chaboyer, W. P., Cooke, M. L., & Gillespie, B. M. (2022) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2022.100894 · Cited by 18 · see citing works
Reuter-Selbach, M. J., Su, N., & Faggion, C. M. (2022) · Journal of Evidence Based Dental Practice · doi:10.1016/j.jebdp.2022.101793 · Cited by 17 · see citing works
Publication performance and trends in bruxism research: A bibliometric analysis
Al‐Moraissi, E. A., Ho, Y., & Christidis, N. (2023) · Journal of Oral Rehabilitation · doi:10.1111/joor.13544 · Cited by 15 · see citing works
Daltro-Oliveira, R., Quintairos, A., Santos, L. I. O., Salluh, J. I., & Nassar, A. P. (2024) · Intensive Care Medicine · doi:10.1007/s00134-024-07553-x · Cited by 15 · see citing works
“However, data on ine-quality’s impact on scientific production in medicine is scarce [1], particularly in critical care.”
Research focuses and trends in literacy within education: A bibliometric analysis
Ho, Y., Al‐Moraissi, E. A., Christidis, N., & Christidis, M. (2023) · Cogent Education · doi:10.1080/2331186x.2023.2287922 · Cited by 11 · see citing works
“These countries have a long tradition of research in professional education, have many citizens, good financial resources, and English as their main language (Ahmad et al., 2020; Catalá-López et al., 2020; Lea & Street, 1998; Leki, 1995).”
BackgroundDoulaveris, G., Vani, K., Saccone, G., Chauhan, S. P., & Berghella, V. (2021) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2021.100509 · Cited by 12 · see citing works
Charpignon, M., de Matos, J. C. R. G., Nakayama, L. F., Gallifant, J., Alfonso, P. G. I., Cobanaj, M., Fiske, A., Gates, A. J., Ho, F. D. V., Jain, U., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-086982 · Cited by 10 · see citing works
Rahman, S. M., Patel, P., Finkelstein, S., Lee, S. F., Wong, H. C. Y., Chan, A. W., Zhang, E., Kwan, J. Y. Y., Bonomo, P., Chan, R. J., et al. (2025) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2025.110846 · Cited by 9 · see citing works
Impact of medical technologies may be predicted using constructed graph bibliometrics
Jiang, L., Raza, A., Ariss, A.-B., Chen, D. J., Danaher‐Garcia, N., Lee, J., & He, S. (2024) · Scientific Reports · doi:10.1038/s41598-024-52233-x · Cited by 7 · see citing works
Ho, Y., Al‐Moraissi, E. A., Christidis, N., & Christidis, M. (2025) · Cogent Education · doi:10.1080/2331186x.2025.2453259 · Cited by 7 · see citing works
“However, all five countries have good preconditions for a production of research compared to countries with low to middle income that are shown to have fewer scientific articles published (Ahmad et al., 2020; Catal (cid:2) a-L (cid:2) opez et al., 2020).”
InfluentialNunan, D., Watts, I. V. C., Kaji, F. A., Hansjee, S., & Heneghan, C. J. (2021) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2020-111489 · Cited by 7 · see citing works
Catalá-López, F., Alonso‐Arroyo, A., Page, M. J., Castelló‐Cogollos, L., Hutton, B., Ridao-López, M., Tabarés‐Seisdedos, R., Aleixandre‐Benavent, R., & Moher, D. (2023) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2023.02.001 · Cited by 7 · see citing works
Self-citationOrduña‐Malea, E., Alonso‐Arroyo, A., Ontalba-Ruipérez, J.-A., & Catalá-López, F. (2022) · Scientometrics · doi:10.1007/s11192-022-04542-z · Cited by 7 · see citing works
Self-citationThe paucity of high-level evidence for therapy in pediatric cardiology
Littman, E., Hsiao, D., & Gautham, K. S. (2023) · Annals of Pediatric Cardiology · doi:10.4103/apc.apc_120_23 · Cited by 5 · see citing works
“[13] Catalá-López et al. have stated that this might be due to a heightened focus on scientific collaboration and biomedical investigation, increased fiscal resources, and increased scientific productivity as a result of more available intellectual capital.”
BackgroundInfluentialAdaptive clinical trials in surgery: A scoping review of methodological and reporting quality
Staibano, P., Oulousian, E., McKechnie, T., Thabane, A., Luo, S., Gupta, M. K., Zhang, H., Pasternak, J. D., Au, M., Parpia, S., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0299494 · Cited by 4 · see citing works
Importance of valid, reliable, and responsive outcome measures for lumbar spinal stenosis
Anderson, D., Mobbs, R. J., Smith, Z. A., de Luca, K. E., Sabet, T. S., & van Gelder, J. M. (2022) · The Spine Journal · doi:10.1016/j.spinee.2022.11.014 · Cited by 4 · see citing works
Charpignon, M., de Matos, J. C. R. G., Nakayama, L. F., Gallifant, J., Alfonso, P. G. I., Cobanaj, M., Fiske, A., Gates, A. J., Ho, F. D. V., Jain, U., et al. (2024) · medRxiv · doi:10.1101/2024.03.21.24304695 · Cited by 4 · see citing works
Defining Common Features in High Impact and Highly Cited Journal Articles on Pancreatic Tumors
Sugumar, K., Hue, J. J., Ahorukomeye, P., Rothermel, L. D., Ocuin, L. M., Hardacre, J. M., Ammori, J. B., & Winter, J. M. (2020) · Annals of Surgery · doi:10.1097/sla.0000000000004670 · Cited by 3 · see citing works
“This IF is based on the number of times manuscripts from a specific journal is cited within the last 2 years and the number of original manuscripts the journal publishes in the same time frame.(6) Thus, journals that are cited often and publish relatively few manuscripts per year have a high IF.”
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Randomised controlled trials in women’s health in the last two decades: A meta-review
Nielsen, J., Sleaby, R., Kumarakurusingham, E., & Mol, B. W. (2022) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2022.09.001 · Cited by 2 · see citing works
Global mapping of randomized controlled trials in dentistry
Prado, M. C., Dotto, L., Agostini, B., & Sarkis-Onofre, R. (2024) · Brazilian Dental Journal · doi:10.1590/0103-644020246233 · Cited by 1 · see citing works
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Inequalities in cardiovascular trial representation in low- and middle-income countries
Basnayake, S. K., Chapman, N., Pandita, P., Arora, A., Schutte, A. E., & Mishra, S. R. (2026) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwag162 · Cited by 1 · see citing works
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A perspective on inequities in the management of radiation dermatitis
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Cañón-Franco, W. A., García-Cardona, J. P., & López-Orozco, N. (2023) · Research Square · doi:10.21203/rs.3.rs-3133218/v1
The relationship between scientific publishing retractions and democracyPreprint
Sofi‐Mahmudi, A. (2023) · doi:10.31219/osf.io/wzehf
Larkin, J., Alanza, U., Nagarajan, V. R., Collins, M., Termanini, S., Farrington, E., Clyne, B., Fahey, T. P., & Moriarty, F. (2024) · medRxiv · doi:10.1101/2024.03.04.24303711
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Catalá-López, F., Ganuza, E., Alonso‐Arroyo, A., Perna, R., Tricco, A. C., Hutton, B., Colin, C., Tejedor-Romero, L., Ridao, M., Bautista-Puig, N., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-115612
“This includes harmonising author names, institutions, countries and journals, removing unnecessary punctuation and normalising names and capitalisation (described in previous meta-research conducted by our team 35 44 45 ).”
Self-citationTrends and gaps in obstetric RCTs: a systematic mapping review from January, 2013, to May, 2025
Li, W., Feng, Q., Spratt, W., Mol, B. W., Li, W., & Reddy, M. (2026) · The Lancet Obstetrics Gynaecology & Women s Health · doi:10.1016/s3050-5038(26)00074-9
Li, A., Javidan, A. P., Niven, D. J., Stelfox, H. T., Fergusson, D. A., Mamas, M. A., Jetty, P., de Mestral, C., Shorr, R., Verma, S., et al. (2026) · JMIR Research Protocols · doi:10.2196/93997
“Cardiovascular surgery is the second most investigated area of clinical medicine based on the volume of RCT evidence, trailing only behind interventions provided in general internal medicine [19].”
- Authors
- Catalá-López, F., Aleixandre-Benavent, R., Caulley, L., Hutton, B., Tabarés-Seisdedos, R., Moher, D., & Alonso-Arroyo, A.
- Affiliations
- Universitat de València (ES)
- Guy's Hospital (GB)
- University of Ottawa (CA)
- Corresponding author
- Catalá-López, Ferrán
- Venue
- Trials
- Published
- 2020-01-07
- Volume
- 21
- Issue
- 1
- Pages
- 34-34
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC6947860
- OpenAlex
- W3000566943
- Cited by
- 38
- References
- 131
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 8 · 2023: 7 · 2022: 6 · 2021: 5 · 2020: 1 · 2018: 1
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Trials (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- uO Research (University of Ottawa) (submittedVersion, public-domain)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion, cc-by)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Instituto de Salud Carlos III (CIBERSAM G24)
- University of Ottawa (Research Chair)
- Canadian Institutes of Health Research (New Investigator Award)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › scientometrics and bibliometrics research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Psychology Research and Bibliometrics
- Social Sciences › Decision Sciences › Information Systems and Management › Academic Publishing and Open Access
- Keywords
- randomized controlled trials, research productivity, international research collaboration, research funding sources, citation analysis, co-word network analysis, Lancet, Journal of the American Medical Association, pharmaceutical industry funding
- MeSH terms
- Cross-Sectional Studies, Humans, Periodicals as Topic, Publications, Randomized Controlled Trials as Topic, Journal Impact Factor
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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