Second, there is no comparison given between respiratory medicine and other research output, so we cannot tell whether 49,382 articles in 9 years is an adequate response by researchers to the burden of respiratory disease, too little, or even too much in relation to other diseases. Canada and Oceania (what does this include other than Australia and New Zealand?) apparently perform very well in relation to their wealth. Why is this? Does it reflect the size of the challenge in these countries, top-down decision making, or bottom-up research applications? It would be useful to further analyze the factors leading to superior performance.