To participate in any international study will depend on the study group and the population to be investigated. One needs to select the population group carefully. For example, Dupuytren Disease is rare in Asia, so that population group may not be suitable. Melanoma is common in tropical Australia, but much rarer in a northern European nation. If an association with an international group or country is to be considered, the relative incidence of the disease to be investigated should be considered.

With international involvement, case numbers multiply, enabling a large series to be investigated. For example, in one multinational study over a 5-year period, it was possible to follow up 950 Dupuytren subjects injected with collagenase in 1081 treated joints.

By working in differing countries, a variation in population subjects can be expected. This may reduce genetic/country/external influences and give a more balanced population study group. The cost can be spread by working in differing countries. Industries, research foundations and charities have different rules in varying countries which may allow more opportunities.

The type of research study needs to be carefully considered. Data collection is relatively straightforward, but tissue collection may be difficult if it requires transfer from one country to another, especially if refrigeration/liquid nitrogen is required. The cost may become prohibitive. Blood, urine or tissue samples are difficult to transport internationally. There is a risk of sample loss over such large distances. Customs may block the import of human tissues or fluids and needs to be confirmed before international transfers. Monitoring of surgical techniques may not be comparable between countries.

A major advantage of the digital age is that it has made the world smaller. Although Australia is on the opposite side of the world to Europe and the Americas, it is readily accessible via the Internet. Facilities such as Skype may allow videoconferencing, and electronic case report forms (eCRF) make transfer of information and data simpler and instant. Teleconferencing is a possibility, although additional costs may result.