Limited Access to Information

Evidence-based practice, including access to medical research, improves patient outcomes – such a statement seems like a no-brainer. I remember a particular case that I think was my proudest moment as a librarian in a clinical setting. As a medical student, I was involved in the management of a particularly aggressive form of cancer. The patient had contracted a rare infection due to being immunocompromised – fusariosis. Such an uncommon infection did not have easily accessible treatment protocol and guidelines. The internal medicine residents were stumped, and yet, I saw clearly that this was a dilemma fit for a health sciences librarian. Offering my skills, and applying what I learned in library school, I managed to find an experimental protocol for the drug Voriconazole. The patient underwent treatment, and the infection resolved after a few weeks of intensive treatment, enough for the patient to be discharged. A proud moment, as a librarian.

Despite the anecdotal, and evidence-based support for the need of healthcare workers to access timely information, paywalls and article access fees still plague the research landscape, as profits are prioritized over access to lifesaving research. For my particular experience, I only managed to find the information through the use of “unconventional” resources such as Sci-Hub (much to the chagrin of greedy, for-profit publishers). But what of the majority of cases, where healthcare workers may not have access to a librarian, or even the information itself in articles? What happens, when a lone doctor in a poor village does not have the resources to look up treatment for Neglected Tropical Diseases?

The COVID-19 pandemic brought about something unprecedented: almost all research related to the disease had, at one point, become open access. This proves that publishers implicitly agree with the fact that Open Access to research saves lives and improves healthcare, and yet, academic publishing still continues to reap record profits via paywalls, despite token efforts at pushing “Open Access” to appease critics. This great disparity in information privilege, between resource rich (the Global North), and resource poor (the Global South) countries, have real, measurable impact in terms of human lives, all in the name of profit.

Limited Dissemination of Research

The other side of this problem lies in research dissemination. Access is already problematic for healthcare workers due to costs, but disseminating research, especially when unaffiliated with academia, is an entirely different headache. Firstly, to disseminate research, one must actually be aware, and have the proper foundation for research – this is a problem of education, and is another can of worms beyond the scope of this discussion.

Surmounting the barriers of research education, a prospective researcher wishing to disseminate their findings face red tape, further paywalls, and administrative roadblocks. Ethics review, while not inherently bad, already cost a hefty chunk, and often takes a very long time to resolve. Then come the actual data gathering, which is plagued with inefficiencies and unreasonable budgetary requirements, as lamented by this researcher. Finally, where you publish also matters, as the Philippines, like most countries, has been taken over with the madness over metrics and world rankings – Scopus-centrism, as coined by San Juan. These indexed journals often have paywalls, or if open access, “Article Processing Charges” (despite reviewers being unpaid).

These barriers have produced the sad reality that a majority of healthcare research in the Philippines remains unpublished. Information on local contexts, and solutions to local problems that may be useful in other similarly resource disadvantaged areas never see the light of day. When you do want to publish, you must publish only in pre-approved, often paywalled journals – destroying the chance for local journals and avenues of research dissemination to flourish.

The Vantage Point: What Must Be Done? 

With all that being said, healthcare workers need advocates and activists, a role well-fulfilled by librarians and information professionals that staff our knowledge-producing institutions. Projects such as the creation of local journals, and local databases like Herdin, are welcome efforts that try to reclaim some semblance of autonomy in scholarly communication, and reduce the disparity in information privilege. But the buck does not stop here.

There are multiple ways of forwarding the agenda of reducing information privilege inequity, and improving scholarly communication practice in healthcare. Those in healthcare research (including physicians who opted for a research career), librarians, and members of the academe must organize to resist administrative pressure to comply with oppressive forms of scholarly communication. Promoting alternative methods of measuring research impact on how it actually affects native communities, instead of fulfilling an externally imposed checklist, is another way of resistance. Researchers outside academia also need a voice, and must be represented in conversations around research policy. Most importantly of all, these actions must be concerted, and realized on a scale larger than just one or two universities; it must enter the mainstream of global academic (and non-academic) discourse, so that resistance may be felt around the world.