It 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. The present analysis evaluates the 100 top-cited biomedical papers (based on Scopus) published in each of three time periods (2003-4, 2013-4, and 2023-4). Corresponding 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. Overall, USA remains a world leader in biomedical research and NIH funding retains 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.

My work is currently supported in part by an R01 grant unrelated to the current work. I am a co-author in 2 of the 300 analyzed papers and in an update of a third paper.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Funding: The work of John Ioannidis is supported by an unrestricted gift from Sue and Bob O’Donnell to Stanford.

Disclosures: My work is currently supported in part by an R01 grant unrelated to the current work. I am a co-author in 2 of the 300 analyzed papers and in an update of a third paper.

Data statement: All data are in the manuscript and in the supplementary tables.

Contributions: JPAI had the idea, collected the data, analyzed the data, and wrote the paper.

All data are in the manuscript and in the supplementary tables