Paying for access to medical journals

I’m not sure about the validity of this study: Free Access to U.S. Research Papers Could Yield $1 Billion in Benefits.

Quantifying how much money will be saved by increased efficiency due to open access seems like fuzzy math at best.  However, we do need better access to medical journal articles.  As a researcher, I’ve constantly fought the battle against firewalled journals.  I am fortunate to be part of a university that has excellent access to most of the published medical research I need.  But I still come across what is the researchers’ equivalent of the “blue screen of death”:  the “login or purchase this individual article for $30″ screen.

Before I go on, why do I have to pay $30 (or more) for a single article?  Isn’t that a bit excessive?  I would consider paying $2 or $3, but $30?!  Do you realize I would pretty much have to write a separate grant just to gather the background research I need at that price?

Fundamentally, the publishers must realize they need to adapt.  Just like the music industry and now the newspapers and magazines, medical journals must figure out how to leverage technology to deliver their content more efficiently.  They also need to understand their customers better.

I am a relatively large consumer of published medical research.  I use it for writing research articles, researching topics for clinical application, keeping up with the latest developments in certain fields and, occasionally, blogging.  Do you know what happens when I come up against a login screen that wants to charge me $30 for a single article?  I find another article (from another journal) to use in its place.  And smaller journals, this is where you are really losing–most medical institutions buy subscriptions to the major journals.  Since I’m more likely to have access to these big journals and they are more likely to carry the most important published research on any given topic, I do cite them more often (regardless of whether or not they are open access).

So, small journal, when you are lucky enough to publish a major paper and I go to your website to find it — running up against the inevitable login screen asking for $30 — I don’t end up reading it, which means it doesn’t get cited.  And the major factor in determining a journal’s impact factor? Citations.

So, what should the publishers do?

  1. Stop printing journals!  Is this not obvious?  It’s expensive, labor-intensive, not environmentally friendly and inefficient (both in delivering content and for consumers to manage content; stacks of journals are not searchable).  Some people will still want to hold print copies in their hands.  Charge them the equivalent of $30 an article!  A “print” subscription should be at least 20 times more expensive than an “online only” subscription.
  2. Get together and form a consortium to deliver content electronically over a unified platform.  The goal here is to create the medical journal equivalent of iTunes.  This platform must have the following functionality: (1) the ability to search all participating journals and save searches (think the ease of Google with the comprehensiveness and functionality of PubMed); (2) the ability to purchase (or activate) subscriptions and individual articles (like purchasing albums and songs on iTunes); (3) a research library management system that integrates with Microsoft Word to build bibliographies (EndNote is what you’re aiming for here); (4) a PDF reader that will allow you to highlight and annotate articles within the program; (5) the ability to share research libraries with colleagues easily; (6) an RSS feed reader (the goal is to have a simple way to view Tables of Contents from the user’s selected journals each time new content is added, RSS feeds are the easiest way to currently do this); (7) a way to flip through content as though it was an actual electronic copy of the physical journal (people who like traditional journals will appreciate this); (8) cross platform development so that content can be properly viewed from computers, smartphones, iPads and other tablet devices (the key word here is “properly”).  A good start for accomplishing this goal would be to buy up Mendeley; these guys have the right idea.
  3. Make content open access after a given period of time.  It seems the government may be moving towards a 6 month embargo (from the current 12 months) for NIH funded research.  If you implement the changes above and make individual articles cheaper (which will be possible under a unified platform), the government may be more likely to leave it at 12 months.
  4. Become leaner.  It’s a reality for all media companies.  In the era of shrinking budgets, you will lose subscriptions if you can’t increase your value.

Dealing with subscriptions and firewalls only creates inefficiency.  Total open access is the dream.  However, we live in a real world where things need to be paid for.  Journals are not compiled, peer-reviewed and edited by volunteers.  Medical journals need to be more proactive in their approaches to making access more open.  Having a completely closed system is not forcing researchers to sign-up for subscriptions or pay $30 for a single article.  It’s forcing them to be inefficient and use other sources.

Josh Herigon is a medical student who blogs a Number Needed to Treat.

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  • Jenny Reiswig

    I know it’s not as convenient as “right now” access, but that same library that gets you all the nice subscriptions probably also has an interlibrary loan service that will get you articles from those non-subscribed journals for free or almost free. It’s not instant, but if it’s something you really want to read and you can wait a few days… just sayin. With our service you can send in your requests right from PubMed. No muss no fuss. (OK, a little muss and a little fuss but… still.. free!)

  • Edward Stevenson

    couldn’t agree more. journal access is a joke especially in a clinical sense. As a student I pay tuition to fund journal access and despite having an athens account I can only access content like up-to-date on library computers. which is of no use at the out patient clinic when a patient asks a question. Often finding an answer to a clinical question is a needle in a haystack task to begin with without the $30 to access a journal that most likely won’t have the information you are looking for. Does anyone really pay the $30 bucks? I have had plenty of professors say they never do they just call around to their colleagues at other institutions to see if one can access it and email them a copy. in the end it hurts patients, it slows research, and acts a means of censorship of research.

  • Kenneth L. Ripley

    I would like to take Ms. Reiswig’s comments a bit further. As “a relatively large consumer of published medical research,” I think Mr. Herigon can definitely benefit from LoansomeDoc. This facility is easily and directly accessible through PubMed and allows you to purchase medical articles for considerably less than the quoted $30, which no one need pay. Under PubMed, check the articles you wish, and then click on “Send to:” in the upper right of the screen. Then select “Order” and “Order Article” to get to the LoansomeDoc entry screen. First time, you will have to create an account for yourself. During the registration process, you will have to select one or more library sources – shop for price. After that, order your articles and have them delivered to your email address in 1 to 5 days, depending on the obscurity of the journal. You will be billed monthly by the selected source library.

  • Eric widera

    I think your looking at the wrong audience for the $30 a reprint. Reprints of articles are a substantial source of income for medical journals thanks to big pharma. It has bee estimated to account for 23% of the Massachusetts Medical Society, 41% for The Lancet, 53% for the American Medical Association. A single Drug company article may bring in more than a million dollars in reprints from pharma.

  • ninguem

    Uh oh………..

    The academcs meant for socialism to be applied to the private sector, not th themselves.

    This could be trouble.

  • Dave Leader, DMD

    I do not begin to understand or even care about the economics of reprints and online viewing. However, I have all the access I need through my university.

  • Janice Flahiff

    Interlibrary Loan (Jenny Reiswig) and LoansomeDoc (Kenneth Ripley) are great avenues for free/low cost access to medical articles.
    For other suggestions, please go to one of my blog items “How to obtain free/low cost medical articles in medical and scientific journals”

    Also, please follow Dr. Leader’s advice…and, email, or otherwise contact a medical librarian with those stumper medical literature questions…They collaborate with colleagues within the institution…and outside the institution via a medical librarian listserv..the medical librarian community is amazing, believe me

  • Ben

    YUCK! I-tunes for scholarly articles?!?! Integration with Microsoft Word? That conjures up ideas of DRM, trying to move articles from one computer to another and not being able to read them, and an archaic, plastic-looking interface.

    Other than that, I agree completely. We need better access to scholarly articles, but we certainly don’t need the complexity of a unified searching system. Google scholar, PubMed, etc. do that very well for us already.

  • Matt Hodgkinson

    “Do you know what happens when I come up against a login screen that wants to charge me $30 for a single article? I find another article (from another journal) to use in its place.”

    That’s pretty scary, as research articles are not interchangeable. Finding a replacement article won’t give you the same research or evidence. This is just one example of why we need open access. Much of Josh’s suggestions to publishers are already being done by open access publishers like PLoS (I work for PLoS ONE) and BioMed Central.

    There is a low-tech solution – email the authors to ask them to send you a copy.

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