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I have edited Current Opinion in Hematology for the past decade and am increasingly pleased with its high quality. This excellence is entirely due to the efforts of the Section Editors in their selection of outstanding topics and of distinguished authors to write about them. The willingness of the editors and authors to sacrifice the time and effort to produce such wonderful articles is a tribute to the journal’s value, reflected in its high impact factor.

To determine the national origins of high-quality clinical research we looked at research articles published during the past decade in three leading general clinical-research journals, the New England Journal of Medicine, the Journal of Clinical Investigation, and the Lancet, and in a specialty journal, Blood. We found that the proportion of non-U.S. papers published annually in these journals increased between two- and almost threefold, irrespective of whether the total number published per year rose (the Journal of Clinical Investigation and Blood), fell (the Lancet), or remained constant (the New England Journal of Medicine). Most non-U.S. research published in these periodicals originated in Western Europe or Japan. The limited available data on papers sent to the journals revealed a decline in the number of U.S. papers submitted in recent years (the New England Journal of Medicine) or a slower rate of increase relative to that of non-U.S. submissions (Blood), indicating that the increase in the number of non-U.S. papers published reflects an increase in the amount of high-quality research originating abroad as compared with the amount originating in the United States. The explanation for this phenomenon is unclear, but it coincides with the slowed growth of funding from the National Institutes of Health for U.S. clinical research.