Are We Publishing “The Right Stuff”?

T his month we publish the fi ndings of a major study estimating the likely trends in global morbidity and mortality [1]. Such a study should surely cause us, as editors, to pause and refl ect on the implications for what we should be publishing. Which medical conditions will be the major causes of death and disease, and is PLoS Medicine publishing key research studies addressing those conditions? Ideally, as a general medical journal, the proportion of research on different diseases that we publish should be roughly equivalent to their contribution to the global burden of disease. In other words, we have to ask, " Are we publishing the right stuff? " Mathers and Loncar [1] have updated the much-cited Global Burden of Disease (GBD) study published a decade ago [2]. They have produced alternative baseline, optimistic, and pessimistic projections for mortality and for the burden of disease, measured in terms of disability-adjusted life years (DALYs). Researchers, policy makers, and others will often need to consult these revised projections and we are delighted that the authors have chosen to publish them in an open-access journal. An important feature of many PLoS articles is that supplementary fi les are also freely available. The supporting documents accompanying the Mathers and Loncar article contain a wealth of detailed information and it is essential that such data is placed in the public domain. With minor modifi cations, Mathers and Loncar have adopted the same methodology as was used in the earlier GBD study. This is not a radical new " take " on the issue and we should not be surprised that no major changes in the GBD estimates have emerged. However, the fi ndings confi rm that the burden of morbidity and mortality that is due to HIV/AIDS will be substantially higher than estimated in the original GBD study. Small declines in the total burden of morbidity and mortality due to a number of other causes will result in the overall projections for mortality for 2030 remaining much the same as predicted earlier. In the baseline projection, by 2015, HIV/AIDS will be the leading cause of burden of disease in both low-and middle-income countries, but the predicted rise in tobacco-attributable deaths means that, globally, tobacco will kill 50% more people than HIV/ AIDS. The three leading causes of burden of disease in 2030 are projected to be HIV/AIDS, unipolar depressive disorders, and ischemic …