Paediatric research in Canada: What else can we do?

Dr Ron Gold has once again provided Canadian paediatricians and readers of the current issue of Paediatrics & Child Health with a useful snapshot of the state of research published by authors with a Canadian connection. The challenge posed by such an inventory is, of course, how best to interpret it. What value should be placed on these data? How are we doing? Is the glass partly full or partly empty? What ‘should’ the picture look like? To some extent, these are empirical questions, and in this respect, very difficult to answer clearly. It must, of course, be recognized that what is actually published in peer-reviewed journals reflects the end result of many interlocking processes over many years that led to the work being conceived, undertaken, prepared as a manuscript, submitted to a journal, deemed by the editors to reflect a contribution to the field, reviewed ‘positively’, and so on. Thus, what we read about published research in the Gold review (pages 317–321) (dare we call this second annual report “Gold's standard review”?) is part of a bigger story, presumably drawn from a larger body of research and scholarly work underway by Canadian clinicians and scientists both in this country and elsewhere. It is also important to remember that the methodology used by Gold was not designed to detect published basic science research (which might be relevant to child and youth health) and, thus, primarily reflects the ‘clinical’ research being done by Canadians. There is, of course, a considerable body of clinical and health services research constantly underway in this country that is as yet unknown (ie, unpublished). What do we not know about this work that might enhance our collective ability to improve child and youth health in Canada? In an era of instant global communication, with the Web only a keystroke away, it is relatively easy to find information when one is specifically looking for it. Thus, for example, one can search the Canadian Institute of Health Research or the Canadian Paediatric Society Web sites to look at what research has been funded or presented in any particular year. This tactic will certainly work for the dedicated and task-oriented searcher, who is likely to have a specific goal in mind in undertaking such an inquiry in the first place. Suppose, however, that a database of this and related information were available? Imagine a central database that compiled and regularly updated all child health research supported by, at a minimum, all of Canada's public funding agencies, and that included the titles and authors of all papers and posters presented on child and youth health by Canadian (clinical) scientists, whether the work was published or not. If such a database were cross-referenced by topics (presumably using standard nomenclature for ease of searching) and were available to anyone looking for investigators currently exploring topics in which they were interested, that interest might be spurred on by other researchers wanting to ‘connect’ with like-minded colleagues. Such connections might be initiated by a researcher seeking the latest ideas from people whose contributions to the database indicated their particular familiarity with the issues. Perhaps an eager student has ideas for a thesis and wants to contact people who might provide help and advice. Clinicians might wish to use such a resource to search for the latest in emerging information on a clinical question posed by a patient. As researchers and academics hoping to impact our fields, the authors of this editorial are always delighted to be contacted by colleagues or students asking questions. In the process, connections may be made, ideas exchanged, advice given (and often received as well!) and duplication of effort potentially avoided. We can certainly attest to the exciting ways in which these connections can become collaborations virtually (and ‘virtually’) anywhere in the world. The starting point of these connections is, of course, the availability of the types of information to which we have alluded to here. An additional value of such a registry would be to enable people to get a sense of what topics are (and are not) the focus of systematic inquiry in this country. This information could be used by all of us, from novice student researcher to research institute director, to identify areas of child and youth health that beg for attention or represent unmet academic needs. This information, in turn, could be used as a ‘grantsmanship’ element in making the case in support of research in areas of child and youth health that remain, by this evidence, underserved. Is this an original idea? Not really. Many readers of this editorial will be aware that as of July 1, 2005, there is an expectation internationally that all randomized clinical trials be registered at a central site before they begin. In fact, the editors of many of the world's leading medical journals will refuse to accept any manuscripts reporting the results of trials that are not publicly registered in this way. This tactic has been designed to encourage transparency in the nature, design and implementation of randomized controlled trials, and to ensure that the methods and results that are published match the planned design. There are, of course, challenges to creating databases –databases need energy, commitment, human and financial resources, and upkeep. On the other hand, as an experiment in creating connectedness among researchers and the rest of the world, such a project could possibly be developed with specific goals in mind, evaluated annually (to count ‘hits’ and other potential measures of impact) and assessed empirically after 24 to 36 months of operation. The authors of this editorial do not speak on behalf of the Canadian Paediatric Society. However, perhaps the Canadian Paediatric Society might wish to consider the ideas presented here as an additional element of its educational role, and as an opportunity to help forge connections among people who publish research, people who present their work and who may need encouragement to publish, and people doing original work that hopefully will be published in the future. Perhaps we do not need to wait to make the ‘Gold’ standard before sharing our research information with others. Perhaps a broader and more inclusive inventory of research activities in Canada would serve us better.

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