04/01/2013 12:20 pm ET Updated Jun 01, 2013

The Ephemeral Fugitives of Global Health Research

This week I went to the launch of a brand new journal, Global Health: Science and Practice. Funded by USAID, and supported by Johns Hopkins School of Public Health, George Washington University and Knowledge for Health, it hits all the buzzwords of the global health and development zeitgeist: open access, diplomacy, scaling up, multidisciplinary, local solutions, experiential knowledge, lessons learned, and of course -- game changer.

But will GHSP be a game changer? This journal is interesting because it also wants to be a manual. Not that there's anything too unusual about that -- most journals have extensive methods sections that describe exactly how the experiment was done. A good methods section would ideally enable anyone to replicate it. But GHSP seems to want more than this: it wants very detailed methods that don't just tell its readers how to do an experiment --they tell us how to deliver and scale up a program. This is usually the sort of information that lurks in the far reaches of the back offices and esoteric webpages of NGOs and multilateral agencies, receding into a shady, chaotic world known as 'grey literature', a place where those seeking to implement similar programs may never come across it.

And yet, it seems to be true: at the journal launch (a swank affair at Washington's National Press Club, complete with sculptured fruit and some excellent granola for breakfast) Ron Waldman, co-editor of the journal, announced that GHSP specifically aims to bring important learnings out of the grey literature and into the light.

Quick pause for definitions, and I very much like how Alberani defines grey literature: "In general, grey literature publications are non-conventional, fugitive, and sometimes ephemeral publications". Nice. The Fourth International Conference on Grey Literature in Washington, DC, October 1999 is somewhat more prosaic: "That which is produced on all levels of government, academics, business and industry in print and electronic formats, but which is not controlled by commercial publishers." (I'd venture to add multilateral and civil society organizations to that list.)

Waldman's comments on grey literature took me back to the days of undertaking my first major systematic review -- a beast of a search about which I still sometimes have nightmares. It encompassed all the literature about scaling up mental health programs in low and middle income countries over four years. Until that moment, I'd mostly done nice, contained literature reviews -- searching conventional databases to find everything published on a topic. In other words, hopping blithely onto Pubmed and the like, typing in a few choice keywords, and being presented with a beautiful, neat, finite digital list of all the relevant papers. And that is indeed how I started with this systematic review. Holed up in the rather delightfully academic, polished wood and dusty tome-lined library of London School of Hygiene and Tropical Medicine, I retrieved all the relevant conventionally published papers. Done. Beautiful. And then it was time for the grey literature.

Conducting a search in the grey literature, I found, is another beast entirely. I devised a protocol, and duly toiled for hours and hours and hours through the internet and random publications. Wading through websites where links lead to links lead to links, I was left with the disorientating knowledge that not only was I not ever going to find everything relevant that lurked in the abandoned, distant corners of Google, but that I hadn't even ventured out of the English language yet. And furthermore, for every fascinating, highly relevant paper I found lurking in cyberspace, I shuddered to wonder how many more might be secretly taunting me from their shadowy place on the shelves of government, NGO, business, and academic offices. The knowledge that I would never know -- that it was not possible to ever know - jarred unacceptably with my bright eyed OCD-style zeal to do this systematic review properly. I cowered, rocking gently, as I described my angst to colleagues. The advice was unanimous: vigorous parameters.

And so I duly imposed vigorous parameters. I survived, The Lancet liked it, and I learned four things: 1. Papers in the grey literature are often the most useful, important papers you can find; 2. You will never find them all; 3. You have to be a combination of very determined and very serendipitous to find the best ones; and 4. You will probably never know if you have.

So will Global Health: Science and Practice change that? Well, it doesn't promise to find them all. It would like, I'm sure, to find the best ones, but even that's unlikely, because it isn't actively mining the grey literature. Rather, it's encouraging grey literature producers to actively divert their papers from that niche on a shadowy shelf or esoteric website to a sunnier spot in the annals of global health, to be validated through peer review, published for all to see, and then easily identified, systematically retrieved, and used in practical ways that move beyond academia to real world implementation.

And what of those non-conventional, fugitive, ephemeral papers that might hold the key to scaling up global health programs on a practical level but never really fit into the conventional world of academic journals? If their producers are paying attention, feeling motivated, and are willing to bend their epistles to convention, Global Health: Science and Practice is a chance to shine. It isn't a magic bullet, of course. Shelves across the world will continue to heave with untapped gems (amid mountains of tangentially relevant rocks). But there will be a few gaps on the shelves: spaces from which high quality, practical reports on scaling up global health interventions have been diverted to shine on the global stage, where people in the real world of implementation will benefit from their sparkle. It's a bold ambition. It's exciting. And yes, this could, perhaps, start to be a game changer in global health.

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