{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:01:25Z","timestamp":1790146885372,"version":"4.0.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Res. Metr. Anal."],"abstract":"<jats:p>East Asia is now a major center of surgical innovation. Its leading institutions have contributed to clinical care, technology adoption, and international trials. Even so, surgical research capacity, infrastructure, and academic influence remain mostly centered on major hospitals and established academic networks. Such concentration can narrow the questions asked, the methods used, and the range of people able to ask them. In this Perspective, we argue that East Asian surgical research would benefit from legitimate pathways for qualified independent researchers: professionally trained investigators who maintain substantial intellectual autonomy without holding conventional senior institutional appointments. We distinguish such researchers from amateurs by institutional affiliation, employment status, funding access, and intellectual autonomy. These dimensions, we show, operate differently in China, Japan, and South Korea, with consequences for funding eligibility, ethics review, and data access. We then outline the risks independent inquiry can carry and the safeguards that should accompany it. We propose practical measures that institutions and funders could adopt: proportionate ethics routes, transparent data-access procedures, small-grant schemes, and fairer evaluation. Our aim is to widen the pool of investigators able to meet these standards, not to lower them.<\/jats:p>","DOI":"10.3389\/frma.2026.1939323","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:17:19Z","timestamp":1790144239000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Independent researchers in east Asian surgical research: structural barriers and potential policy pathways"],"prefix":"10.3389","volume":"11","author":[{"given":"Cheng","family":"Che","sequence":"first","affiliation":[{"name":"Department of Medical Affairs and Department of General Surgery, The Third People's Hospital of Suining","place":["Suining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Gong","sequence":"additional","affiliation":[{"name":"Independent Researcher","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1111\/j.1756-5391.2011.01109.x","article-title":"The cochrane collaboration: international activity within cochrane review groups in the first decade of the twenty-first century","volume":"4","author":"Allen","year":"2011","journal-title":"J. Evid. Based Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1007\/s11883-026-01454-8","article-title":"Modernizing the Institutional review board process for implementation science\u2013a narrative review of barriers and ethical considerations","volume":"28","author":"Bazaz","year":"2026","journal-title":"Curr. Atheroscler. Rep."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1056\/NEJMsa012337","article-title":"Hospital volume and surgical mortality in the United States","volume":"346","author":"Birkmeyer","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1111\/acem.12482","article-title":"Using publication metrics to highlight academic productivity and research impact","volume":"21","author":"Carpenter","year":"2014","journal-title":"Acad. Emerg. Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"S1015","DOI":"10.1016\/j.asjsur.2024.09.176","article-title":"Surgical research trends and focus fields in China: a 2023 bibliometric analysis","volume":"4","author":"Chen","year":"2024","journal-title":"Asian J. Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"135","DOI":"10.5230\/jgc.2024.24.e19","article-title":"Precision treatment of early gastric cancer after non-curative endoscopic submucosal dissection","volume":"24","author":"Chung","year":"2024","journal-title":"J. Gastric Cancer"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e5738","DOI":"10.1371\/journal.pone.0005738","article-title":"How many scientists fabricate and falsify research? A systematic review and meta-analysis of survey data","volume":"4","author":"Fanelli","year":"2009","journal-title":"PLoS One"},{"key":"B8","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1056\/NEJMsa0810119","article-title":"A surgical safety checklist to reduce morbidity and mortality in a global population","volume":"360","author":"Haynes","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1038\/520429a","article-title":"Bibliometrics: the leiden manifesto for research metrics","volume":"520","author":"Hicks","year":"2015","journal-title":"Nat."},{"key":"B10","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/SLA.0000000000002794","article-title":"No surgical innovation without evaluation: evolution and further development of the IDEAL framework and recommendations","volume":"269","author":"Hirst","year":"2019","journal-title":"Ann. Surg."},{"key":"B11","unstructured":"Grants-in-aid for scientific research (KAKENHI) application guidelines\n          \n          2026"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1896259","DOI":"10.3389\/fpubh.2026.1896259","article-title":"Financial toxicity among patients with lung cancer: a systematic review and meta-analysis","volume":"14","author":"Jiang","year":"2026","journal-title":"Front Public Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1001\/jama.280.3.240","article-title":"Does masking author identity improve peer review quality? A randomized controlled trial. PEER investigators","volume":"280","author":"Justice","year":"1998","journal-title":"Jama"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e490","DOI":"10.1016\/j.wneu.2023.01.059","article-title":"Bibliometric analysis of the neurosurgery publication productivity of Southeast Asia in 2011\u20132020","volume":"172","author":"Kamil","year":"2023","journal-title":"World Neurosurg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e1196","DOI":"10.1016\/S2214-109X(18)30386-3","article-title":"High-quality health systems in the sustainable development goals era: time for a revolution","volume":"6","author":"Kruk","year":"2018","journal-title":"Lancet Glob Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1093\/scipol\/scu084","article-title":"International research visits and careers: an analysis of bioscience academics in Japan","volume":"42","author":"Lawson","year":"2015","journal-title":"Sci. Public Policy"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e111","DOI":"10.3346\/jkms.2025.40.e111","article-title":"Leveraging national health insurance service data for public health research in Korea: structure, applications, and future directions","volume":"40","author":"Lim","year":"2025","journal-title":"J. Korean Med. Sci."},{"key":"B18","doi-asserted-by":"publisher","first-page":"767","DOI":"10.21037\/gs-22-540","article-title":"Bibliometric analysis of robotic surgery research in breast cancer conducted between 2008 and 2022","volume":"12","author":"Ma","year":"2023","journal-title":"Gland. Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.surg.2015.02.009","article-title":"Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development","volume":"386","author":"Meara","year":"2015","journal-title":"Lancet"},{"key":"B20","unstructured":"Several opinions on standardising the use of sci-related indicators in higher education evaluation\n          \n          2020"},{"key":"B21","unstructured":"Tokyo\n          MHLW\n          National database of health insurance claims and specific health checkups (NDB): application procedures and NDB open data.\n          \n          2025"},{"key":"B22","unstructured":"2017"},{"key":"B23","unstructured":"Measures for the ethical review of research involving human life sciences and medical research\n          \n          2023"},{"key":"B24","unstructured":"Customised data sharing service (NHISS): application guide\n          \n          2026"},{"key":"B25","unstructured":"Application guide for individual basic research projects. Daejeon: NRF\n          \n          2026"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-018647","article-title":"Sharing and reuse of individual participant data from clinical trials: principles and recommendations","author":"Ohmann","year":"2017","journal-title":"BMJ Open"},{"key":"B27","doi-asserted-by":"publisher","first-page":"179","DOI":"10.5761\/atcs.ed.20-00079","article-title":"Minimally invasive surgery for esophageal cancer in Japan","volume":"26","author":"Ozawa","year":"2020","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"B28","doi-asserted-by":"publisher","first-page":"58","DOI":"10.37737\/ace.23008","article-title":"Review of studies using japanese nationwide administrative claims databases","volume":"5","author":"Sato","year":"2023","journal-title":"Ann. Clin. Epidemiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1583","DOI":"10.1001\/jama.2012.500","article-title":"The patient-centered outcomes research institute (PCORI) national priorities for research and initial research agenda","volume":"307","author":"Selby","year":"2012","journal-title":"Jama"},{"key":"B30","unstructured":"State Council Decree No. 796, revised 2024\n          Regulations of the national natural science foundation of China\n          \n          2024"},{"key":"B31","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"Declaration of helsinki: ethical principles for medical research involving human subjects","volume":"310","year":"2013","journal-title":"Jama"}],"container-title":["Frontiers in Research Metrics and Analytics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frma.2026.1939323\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:17:24Z","timestamp":1790144244000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frma.2026.1939323\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":31,"alternative-id":["10.3389\/frma.2026.1939323"],"URL":"https:\/\/doi.org\/10.3389\/frma.2026.1939323","relation":{},"ISSN":["2504-0537"],"issn-type":[{"value":"2504-0537","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"article-number":"1939323"}}