Asia Produces the Research. The World Doesn't Hear It Presented.

Asia now conducts roughly half of the world's clinical trials. It is one of the largest engines of clinical research on the planet, and growing faster than Europe, North America, or Australia.

Now look at who gets the microphone.

A 2025 study in the Journal of Clinical Oncology reviewed every oral presentation at the ASCO Annual Meeting from 2021 to 2024 — 1,563 presentations in total. North America accounted for 69.7% of presenters. Europe and the UK, 17.6%. Asia, home to more than 60% of the world's population and an enormous share of global trial activity, accounted for just 10.2%.

It isn't only oncology. A 2023 review in JACC: Asia examined 656 cardiovascular, diabetes, and obesity trials published in the New England Journal of Medicine, The Lancet, and JAMA between 2011 and 2020 — the three journals most likely to set global treatment guidelines. Only 7.9% of trial lead authors were based in the Asia-Pacific region, despite the region carrying an estimated 60% of the world's cardiometabolic disease burden.

The pattern holds across specialties. The research is there. The stage time isn't. The question is why the gap opens at the podium and not in the literature.

Where the gap actually shows up

A 2023 study in PLOS Biology offers a clue. Researchers surveyed more than 900 scientists across eight countries with varying levels of English proficiency, all of whom had at least one first-authored paper published in an English-language journal — so the sample was already publishing at an international standard. The findings: non-native English speakers needed 94% more time to prepare a conference presentation than native speakers. One in three avoided attending international conferences altogether. Roughly half who did attend avoided presenting, specifically citing low confidence in their English communication, not their data.

That last detail is worth pausing on. These were not junior researchers unsure of their science. They were published authors, already vetted by peer review, describing hesitation rooted in delivery rather than competence.

A separate line of research, presented at the 2025 CHI Conference on Human Factors in Computing, looked specifically at live Q&A sessions — widely reported by non-native English-speaking presenters as the most stressful part of conference presenting, more so than the prepared talk itself. Several participants in that study made a point of distinguishing the two: their research was solid; the live, unscripted exchange in a second language was where the pressure concentrated.

What the numbers add up to

Put together, the picture is fairly specific. Asia is not underproducing research — by volume, it's arguably overproducing relative to its podium time. And the physicians most affected by that gap are not, by and large, ones whose science is in question. They are researchers who have already cleared peer review, already built a body of work strong enough to be invited to speak, and who then, at a measurably higher rate than their peers, hesitate at the exact moment the room is watching.

Medical Affairs teams and pharma organizations invest heavily in the research itself — trial design, KOL relationships, years of data. Far less is known about what happens, organizationally, in the weeks between an abstract's acceptance and the physician walking on stage. The literature above suggests that gap is where a meaningful part of the story is being decided.

Whether the industry treats that period as seriously as it treats the science that gets a physician invited to present it in the first place is, at this point, an open question.

Sources

Journal of Clinical Oncology (2025), analysis of ASCO oral presentations 2021–2024.

Azzopardi R, Nicholls SJ, Nerlekar N, et al., "Asia-Pacific Investigators and Asian Enrollment in Cardiometabolic Trials," JACC: Asia, 2023.

Amano T, González-Varo JP, Sutherland WJ, "Languages Are Still a Major Barrier to Global Science," PLOS Biology, 2023.

"It's about Research. It's Not about Language": Understanding and Designing for Mitigating Non-Native English-Speaking Presenters' Challenges in Live Q&A Sessions at Academic Conferences, Proceedings of the 2025 CHI Conference on Human Factors in Computing Systems.

The BECC Consulting Group has spent over twenty years working with Medical Affairs teams and physicians across Asia and the United States, preparing them for the international stage. Learn more at beccconsulting.com.