In Reply:—

The letters by Wolfgang H. Maleck, Joachim Boldt, and John F. Nunn critically review our recently published letter in Anesthesiology about the European ranking in anesthesiology research. 1 

We agree with the statement of Drs. Maleck and Boldt that it is difficult to perform such research of the literature, especially in Germany. However, we have performed a meticulous database search.

We are aware of potential flaws which may be due to language difficulties, such as the German umlaut ä in the German version of the word anesthesiology. We strongly believe that scientists who want to compare internationally should be aware of these aspects of the English language. As we showed in several analyses, the German language has a minor role in international scientific contributions, e.g. , articles published in the German language are approximately 5% of all articles ranked in the best worldwide American biomedical database, MEDLINE. Even using the European databases PASCAL or EMBASE, the German language has a minor role. 5,6 

Possible differences in the analysis of Maleck and Boldt could be caused by using a different source. At our university hospital, we have the modern, permanent, updated version of MEDLINE on the university library server. We cannot judge the differences in using the older, CD-ROM version. We stopped using a CD-ROM version of MEDLINE approximately 9 yr ago at our university because of the more combination search strategies of the WinSPIRS version (WinSPIRS Software Version 4.0, SilverPlatter Information Inc., Norwood, MA).

We chose England instead of the United Kingdom because of the problems mentioned by Maleck and Boldt. We want to thank Drs. Maleck and Boldt for the stimulation about investigating America, where we would not have the multilingual limitations we have in Europe. Of course, there are other possibilities to compare scientific activities of countries rather than the number of medical schools. We decided to use the number of medical schools as a marker for the academic activities and believe this is better than only counting the inhabitants. The regular inhabitants of a country are not related to research. The power of a football team is better when related to the number of football teams in a high league rather than to the number of inhabitants. Comparing the states in the United States is of high interest. Currently, we are in the process of finalizing such a study, which will be presented as a full research article, allowing more space to explain our intention and to include a longer reference list.

The intention of our article was to make the reader in Europe aware of the secondary role of European research in international science and to stimulate European scientists in the future. We invite Drs. Maleck and Boldt and other interested readers to read our books about this subject for further information.

We apologize for not using German literature about this subject, but we think the language of science is English, although most members of our research group are native German speakers. We also did not cite Japanese or Chinese literature in this area, which might have interesting contributions, but we cannot presume that international researchers know the different international languages. Scientists should talk in one common language, and this is definitely English at this time. Maybe Spanish will be the dominating language in science in 50 yr, and then we will have to think about communicating in Spanish.

In response to Dr. Nunn, we are aware of the technical limits of some countries performing meta-analyses. Moreover, we are aware of the limitation on space in letters to the editor.

In our recently published book about this subject, European Countries: Biomedical Research Ranking and the New MFBP-Index  by Hofbauer et al. , 5,6we discussed the problems extensively. In this book, we state “The ranking of England in our quotation shows limitation, because England is not always indexed in the medical databases as England … Therefore we believe that England is more powerful than it might appear …”5 

We can only repeat in this reply: England is better than it appears in any database analysis. The problem is the inconsequence of listing the affiliations by scientific authors from England. Ohio is clearly listed as Ohio, and Switzerland is clearly listed as Switzerland, even though they speak four different languages. We also can only repeat our recommendations to English authors as we did in our book:“We can warmly recommend to the English researchers to appear more unique in their locations …”

The rest of the analysis is clear because of the clear expression of authors from the other countries. We would like to test our other analysis, and we do not believe that we have drawn a hasty conclusion. Database analyses have limitations due to the clearness of the authors. England is the only country where these problems occur. Scottish people want to be Scottish. Bavarian researchers from Munich publish under the country Germany, without any doubt. We think that our analysis was a high-quality analysis and was unique to the biomedical literature; we were able to publish a book and a German translation of our book about these interesting subjects.

Hofbauer R, Kaye AD, Gmeiner B, Lackner FX, Frass M: Clinical and experimental research in anesthesiology in Europe at the change of the millennium (letter). A nesthesiology 2001; 94: 183
MEDLINE [database]. Bethesda: National Institutes of Health; 2000
PASCAL [database]. Vandoeuvre-les-Nancy, France: INIST; 2000
EMBASE [database]. Amsterdam: Elsevier; 2000
Hofbauer R, Kaye AD, Gmeiner B, Frass M: European Countries: Biomedical Research Ranking and the New MFBP-Index. Vienna, VICER Publishing, 2000
Hofbauer R, Kaye AD, Gmeiner B, Frass M: Biomedizinische Forschung im Europäischen Vergleich und der neue MFBP Index (German edition). Vienna, VICER Publishing, 2000