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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