“[H]ow should global health researchers approach the task of documenting and disseminating their impact in what are these days termed resource-poor settings? What role does a journal have in fostering that process?” Paul Farmer, chief strategist and co-founder of Partners In Health, asks in The Lancet’s “Global Health” blog. “It has long been the case that randomized clinical trials have been held up as the gold standard of clinical research,” he writes, noting, “This kind of study can only be carried out ethically if the intervention being assessed is in equipoise, meaning that the medical community is in genuine doubt about its clinical merits.” He adds, “It is troubling, then, that clinical trials have so dominated outcomes research when observational studies of interventions like those cited above, [such as immunizations among children,] which are clearly not in equipoise, are discredited to the point that they are difficult to publish.” He continues, “Stripping away context, both local and translocal, creates the illusion of equipoise in a world riven by poverty and social disparities,” and asks, “How, then, do we have a body of research where such context matters?”

“All aspects of the research — from prioritizing research questions to interpretation and dissemination of results — must have local involvement and promote a sense of ownership” and “should strive to address two disparities if it is to be regarded as in equipoise: first, the disparities of risk (of both disease and poor outcomes due to lack of access to proven therapies) that constitute the backdrop of global health; and, second, the disparities of training and opportunity that explain why research capacity is heavily concentrated far from the settings in which the burden of these pathologies is concentrated,” Farmer continues. “So what then is the charge of a global health journal?” he asks, and writes, “First, to recognize that the information gleaned from a rigorous observational study may be more useful to program implementation than information derived from what are now reified as clinical trials. … Second, journal editors can help ensure that results are presented in such a way that any study’s methods can be understood and assessed by implementers and by those setting and revising health policy regarding life-and-death matters, including those mentioned above and many others now emerging.” Finally, he adds, “the challenge and promise of a journal dedicated to global health research [is] to value equity over reified notions of equipoise, to insist on intelligibility over arcana, and to pose questions about plans for dissemination of information that is indisputably of relevance to the wellbeing and very survival of many millions who do not yet benefit from already proven interventions” (7/8).