Open Access to Health Care Research: Good Intention, Bad Idea? Thoughts from an Industry Insider

Readers interested in the $25 billion economics of peer-reviewed published research may have seen this article posted in the March 30 issue of The Wall Street Journal. Author Richard Aslin argues that the discoveries from federally supported medical research shouldn't be hidden behind the paywalls or subscription fees of scientific publishers. 

As the volume and scope of funded research has grown, says Dr. Aslin, libraries, medical schools and hospitals are paying more and more for access to study results that are ultimately the property of the U.S. taxpayer. He argues for versions of an "open access" model, in which the authors - and not the taxpayer - ultimately bear the cost of getting their findings into the public domain.
 
The Population Health Blog contacted a colleague in the medical-scientific publishing industry and asked her for her reaction.  Here's her reply:
 
Interesting, but frustratingly one-sided.  It leaves out the critical point that someone has to pay for a CRUCIAL service that the publisher is providing - peer-review, editorial expertise, and career-making reputations for authors after the published results appear in a trustworthy, sound, and respected journal.
 
This is also fueled by complaints from researchers who have benefited for decades from federal subsidies (most notably student loans) who have suddenly found their inner-Reagan and cry foul when the system doesn't suit their needs.
 
Without the publishing industry to ensure that the science those taxpayers paid for is sound, we'd probably all be drinking Gatorade to cure Alzheimer's, because the incentives would ultimately award sponsorship to the highest bidder. Research misconduct would likely be rampant.

To me this argument sounds like being angry that you pay taxes that the government puts towards highways and then you still have to buy a car from a reputable manufacturer.
 
Lots of medical journals are Open Access and the publishing industry supports it. But we're also not just slapping it on the internet. Researchers are welcome to do that with their own work, free of charge. And I wish them luck with that. I'm sure they'll need it.

Coda: The PHB - who has authored approximately 50 peer-reviewed publications - tongue-in-cheek offers another potential upside to the status quo: because the ability of mainsteam news media to truthfully and objectively report research findings is highly questionable, lack of open access offers added consumer protections from spin, bias and innumeracy.  If you think it's bad now..... 

But seriously, it's also not unusual for authors to share a copy of manuscript to individual colleagues who, in the interest of advancing scientific knowledge, request it.

Image from Wikipedia

Scientific Info and Policy Making: Print vs. the Web

The Disease Management Care Blog also recommends the Health Affairs Blog, where you’ll find top caliber thinking from the wisest of the healthcare Brahmins. Speaking of which, that’s where you’ll find an announcement that James Robinson is stepping down from the editor-in-chief post. In the interim, the highly regarded John Iglehart will return to his old post and look hard for a replacement.

Here’s an unsolicited opinion for Dr. Inglehart and his colleagues: the prognosis for scientific and policy web publishing using blog and wiki formats is much ultimately brighter than staid print journals like Health Affairs. Their exclusive web-based articles in addition to the paper-medium journal are a step in the right direction, but it’s not enough.

As someone who has had both peer-reviewed manuscripts make it to print and has also gotten a case of blog-fever, my impression is that blogging is a better deal for the writer and the reader.

Why is that you ask?

I'm still writing and submitting manuscripts to journals, but I've begun to notice that more and more of the useful references I quote are web-based.

In a blog, everything is really mine. In print, I have to assign copyright to the journal. It's theirs.

In a blog, I write, I post and *click!*, it’s up. In print, it typically takes months to make it through the peer reviewers and, if I’m lucky enough to get accepted, additional months before it’s published and mailed bulk rate. It’s not very satisfying to the writer and the topic can quickly turn obsolete.

In a blog, I’m completely responsible for the content. In print, I am at the mercy of space constraints and the peer reviewers. They are very smart, very dedicated and have helped me polish all my manuscripts, but I think they can also be biased with viewpoints that may not necessarily be perfectly aligned with the intended audience. Who knows, they know their readers but those biases can shape the final product that appears in print.

In a blog, the reader can comment immediately. In print, it’s a letter to the editor.

You may think the delay, process and peer review is worth it since that gives traditional journals the safeguards necessary to protect the reader from wrong information. While true, that assurance has become dented. Check out this review from the American Journal of Psychiatry that demonstrates how vulnerable the peer-review process is to intentionally and unintentionally contrived studies. Even the luster of New England Fortress of Medicine has been victimized by under-reporting of side effects, having its reviewers be vulnerable to allegations of misconduct and authors neglecting to report conflicts of interest.

This is why I predict some academic institutions and/or researchers will eventually start posting/blogging/wiki-ing their reports directly on the internet. Readers need to judge for themselves anyway and have the smarts to do it. No need for scientists and policy makers to worry about criteria for tenure, because their academic success will be measured not in the stature of the journal or the number of reprint requests, but by the number of “hits” or “comments” from members of the medical community. In the meantime, print will remain important but could fast become a medium that is used by fewer and fewer to write about less and less.

Remind you of the disintermediation going on in the music industry? It should.

Should the disease management industry take note? It should.

I’m sorry Health Affairs, but your business model is destined to change and soon. I’m sure you guys have already been thinking about this and may be already planning to have your blog eventually become the chief source of revenue. I hope Dr. Iglehart’s replacement finds a way to manage it, because I think it’s likely to happen soon.