Provenance and funding of extremely cited biomedical papers published in 2003-2004, 2013-2014 and 2023-2024

ImportanceIt is important to monitor changes in biomedical literature and its funding. China has surpassed the USA in publications and, in some analyses, also in some impact indicators. ObjectiveTo evaluate changes over time in the profiles of the most highly cited biomedical papers. DesignThe 100 top-cited biomedical papers (based on Scopus) published in each of three time periods (2003-4, 2013-4, and 2023-4) were assessed for corresponding authors, types of publications represented, and funding sources, with emphasis on funding from the US National Institutes of Health (NIH) that has been traditionally considered the major funder of biomedical research. SettingGlobal. Participantsnot relevant Exposuresnot relevant Main outcome measuresProvenance and funding sources. Main findingsCorresponding authors from the USA decreased overtime (59/100 papers in 2003-4, 58/100 in 2013-4, 45/100 in 2023-4). China had corresponding authors in 0,1, and 4 top cited papers in the three time periods, respectively. There was a marked increase in consensus items (10/100 in 2003-4 versus 24/100 in 2023-4) and in reference statistics papers (1/100 in 2003-4, 10/100 in 2013-4, 11/100 in 2023-4). Reviews remained common among top cited papers, but almost always they were non-systematic. NIH funding was listed in 45/100, 50/100, and 23/100 papers in the three time periods, respectively. All other countries combined surpassed US public funding in 2023-4. Funding by NIH alone decreased sharply in the last decade (32/100, 28/100, and 2/100 in the three time periods, respectively). More commonly listed funding from non-profit organizations, societies, and institutions complemented the NIH funding decline. The first authors of 7/45 and the corresponding author(s) of 14/45 top cited USA-based papers of 2023-4 were listed as leaders of active NIH grants in RePORTER as of February 2025. Citation gaming became more obvious in 2023-4. Conclusions and relevanceOverall, the USA remains a world leader regarding the most highly cited biomedical research and NIH funding retains a substantial presence among top cited papers. However, NIH influence has shrunk overall, and top cited papers funded exclusively by NIH have almost disappeared. Strengthening public funding is essential to secure research serves the common good.