S C H O L A R LY P U B L I S H I N G A S A M E A N S O F M E A S U R I N G A N D P R O M O T I N G C L I N I C A L R E S E A R C H
in this chapter, we engage with the following questions:
1. What key problems with South African clinical research can be identified by an analysis of published outputs?
2. What specific interventions will best promote the overall productivity of clinical research in terms of both quality and quantity?
INTRODUCTION
clinical research in a developing country has more than one purpose. It seeks
to contribute to health care at all levels by identifying the causes of health problems, facilitating diagnosis, improving the efficiency and effectiveness of care, and promoting good policy-making. It supports the training of health professionals of all kinds, and contributes to global knowledge about the prevention and treatment disease. Scholarly publication and the
accompanying targeted dissemination of new information is a key process
in achieving these multiple functions, and is simultaneously an important, measurable indicator of its success in doing so (Gevers et al., 2006). It must be remembered, however, that different functions require the use of available indicators in different, even if sometimes interdependent ways, and misleading impressions can be created if one publication indicator is applied to the exclusion of others.
Considerable importance is currently attached to international publication of local research. International publication has come to mean the placement of original articles in the relatively small number of journals selected to be indexed in international periodical databases. The most well-known and frequently analysed of these is the Thomson Reuters Institute of Scientific Information (ISI) database. With the enormous recent growth of publications (most of it in the developed countries), specialisation within the main clinical sub-disciplines, not to mention sub-sub-disciplines, has spawned in each of them a limited set of (mostly US and European) journals regarded as the most desirable and rewarding targets of researchers in that area. Thus, publishing ‘internationally’
REVITALISING CLINICAL RESEARCH IN SOUTH AFRICA 123
A STUDY ON CLINICAL RESEARCH AND RELATED TRAINING IN SOUTH AFRICA
has come to mean publishing in the (usually voluminous) leading journals of each sub-discipline or sub-sub-discipline, achieving connectivity and reputation within the global community of other researchers working in a focused field, and satisfying the demands of funders and local policy-making for ‘significant research outputs of high impact’ (see below).
With this kind of publication, specialisation has given rise to a general migration of attention from the few remaining, still highly competitive multidisciplinary
clinical journals to the many more and consequently larger-capacity specialty journals in the international indexes. If one considers the fabled categorisation
of scholars into ‘foxes’ and ‘hedgehogs’ (the former constantly moving from one field to another, and the latter burrowing ever more deeply into one topic), the system has become much more friendly to hedgehogs than to foxes.
It is clear that the ability of researchers to publish articles arising from their clinical research in leading international speciality journals generally reflects high standards of design and execution of research projects, and promotes international collaborations, facilitates the acquisition of international grants and provides solid evidence for a variety of rewards in career development. It is generally considered that such publishing is a kind of visible iceberg or
proxy of general bottom-up excellence in research groups, centres and
institutions, in which in-house and local conferences provide opportunities for pre-publication presentation and concomitant peer review of productive work, apprentice-type development of younger staff and postgraduate students, and enhancement by collaboration (Mode 2 research) (Gibbons et
al., 1994). But the following questions can reasonably be asked: Are there are
down sides to the prevailing system of formal publication almost exclusively in international speciality journals in a developing country such as South Africa? Do high-quality local journals, successfully completed postgraduate
studies, effective research-based teaching and training, innovation in drug development, etc., also have specific roles and functions, other than being
poorly visible components of the metaphoric ‘iceberg of excellence’ indicated by international publications? Is the scientific community too fragmented
S C H O L A R LY P U B L I S H I N G A S A M E A N S O F M E A S U R I N G A N D P R O M O T I N G C L I N I C A L R E S E A R C H to foster cross-field insights and collaboration? Can our young researchers develop into the leaders of tomorrow when they are located in isolated groups whose main scientific contacts and focus are outside the country? Can the core values of clinical research be acquired without community of purpose and enquiry?
We will accordingly examine whether and how the worldwide trend of
international specialty publishing is reflected in South African clinical research,
and how this affects the fact that clinical research has many important functions besides achieving recognition in the ways described above. We will look at the question of how analysis of published outputs helps us to assess whether and how the different functions are being met in an optimal and balanced manner. Specifically, we will endeavour to answer the question of how a health sector can be built that sees research as an essential element of improved health care. We will also address the question of how research
communities can best be created, as part of a vibrant culture of clinical
research, both for established practitioners and for new entrants to the field. Finally, this will connect to the matter of public engagement with clinical research.
While much of the information presented will be drawn from a commissioned
study done for the Panel by the Centre for Research in Science and Technology
(CREST) at Stellenbosch University (covering the ten-year period from 1996 to 2005), other published sources will also be extensively used.