In Reply: Collaborative Initiatives in Neurosurgery Research and Publications Between High-Income and Low/Middle-Income Countries: A Bibliometric Analysis

To the Editor: We would like to express our gratitude to Dr Moshiur Rahman1 for the time and effort dedicated to deeply commenting on our recent article titled “Collaborative Initiatives in Neurosurgery Research and Publications Between High-Income and Low/Middle-Income Countries: A Bibliometric Analysis.”2 Below, we present our response to the Letter to the Editor. We would like to address several points and provide additional context to further enhance the discussion. The development and implementation of standardized protocols have been a major focus of neurosurgical societies worldwide in recent years. Numerous neurosurgical societies have dedicated substantial efforts to create and update guidelines that cater to diverse clinical settings.3 The challenge lies not in the absence of these guidelines but in their adaptation and implementation across different economic and health care environments. The suggestion to create standardized protocols for collaborations among high-income countries (HICs), while well-intentioned, overlooks the economic and practical challenges inherent in such initiatives.4 Developing countries often face significant resource constraints that make the adoption of standardized protocols difficult. The creation and adaptation of guidelines should involve local stakeholders to ensure that they are economically feasible and culturally appropriate. We have emphasized that the greater number of authors from HICs indicates the participation of experienced researchers and institutions in collaborative projects or mentorship programs with researchers from low-income countries and low-income and middle-income countries, aiding in capacity-building initiatives.5 Regarding the observation of decreased contributions from India, we believe that this decline should be viewed in a broader context. India remains one of the leading countries in neurosurgical publications.6,7 The reduction in collaborations with HICs reflects a growing scientific independence rather than a lack of engagement. Indian researchers are increasingly capable of conducting high-quality research independently, which is a positive development. Although it is true that the focus on total contributions from India may overlook significant variables such as regional disparities in economic growth, health care infrastructure, and research funding, which can greatly influence publication outputs, for no country was the analysis conducted. The results show a global view. In future studies, it would be beneficial to assess contributions using region-specific metrics, such as contributions per state or province. This approach would provide a more nuanced understanding of the disparities and highlight areas that require targeted interventions.8 In addition, similar metrics should be applied to other countries with significant internal disparities to enhance the analysis. Our analysis considered the complexities and local contexts when addressing neurosurgical collaborations and guideline implementation, merely suggesting what is applicable in the near future.