Dear Joanna and all,
Thank you for your message a few days ago. [ https://www.hifa.org/dgroups-rss/open-access-9-introduction-joanna-donne... ]
You wrote: "Open access publishing ensures that the highest quality peer-reviewed evidence is available to anyone who needs it, anywhere in the world. This has the potential to improve transparency, advance medical science and, we believe, improve patient care."
I would like to invite us all to develop this further. With regards to the first sentence:
1. If 'high-quality evidence' is open access, then I agree it is available to anyone who has an internet connection and, because open access allows reuse, it is also potentially available to those without an internet connection (for example as print copies). Open access also delivers 'low-quality evidence' (and lots of it).
2. What do we mean by 'high-quality evidence'? Back in 2004, the GRADE working group suggested the following definitions in grading the quality of the evidence:
'High = Further research is very unlikely to change our confidence in the estimate of effect.
Moderate = Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low = Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low = Any estimate of effect is very uncertain.'
https://pmc.ncbi.nlm.nih.gov/articles/PMC428525/
Then in 2008 the same group proposed a different approach to the definition:
'In the GRADE approach to quality of evidence, randomised trials without important limitations constitute high quality evidence. Observational studies without special strengths or important limitations constitute low quality evidence. Limitations or special strengths can, however, modify the quality of the evidence.'
https://pmc.ncbi.nlm.nih.gov/articles/PMC2364804/#:~:text=In%20the%20GRA....
The 2008 approach is arguably in contradiction with the 2004 approach, because it is very unusual for a single randomised controlled trial ('high quality' 2008) to be so conclusive that 'further research is very unlikely to change our confidence in the estimate of effect' ('high quality' 2004).
We have several HIFA members with expertise in this area, including a few on the GRADE group, and we would welcome their inputs and perspectives on the impact of open access on the availability of high-quality evidence.
3. What evidence do health workers need to guide their decision-making? Arguably, they do not generally need access to original primary research as this is almost always inconclusive. What is most useful and most reliable for health workers is repackaged information (such as clinical guidelines, formularies, educational resources, textbooks) that are rigorously developed (which normally means they are based on cumulative evidence synthesis such as systematic reviews).
This week we are looking at the impact of open access to research on health, with a particular focus on peer-reviewed research. Can anyone provide an example where open access to research (as opposed to repackaged information) has informed (or frustrated) clinical decision-making?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org