NEJM and other journals allow public (non-subscriber) access to the full text of articles of general public interest. JAMA has steadfastly refused to do so. Why? As the others have shown, it results in no financial loss. And, it enhances the position of the journal among the public and decision-makers.
Examples are here and here. The second one was a 2010 article by Peter Pronovost, entitled, "Learning Accountability for Patient Outcomes," where only an excerpt was provided to the public. As I stated at the time, "Wouldn't you love to read the whole thing? Maybe, someday this influential journal will understand that it would be still more influential if it permitted free access to articles of public import like this."
Before being presented with this question, in response to another question, Dr. DeAngelis talked about how much JAMA wants to get accurate exposure for its articles:
We spend lots of money getting our articles out to the media. We give it to them early. We write up the ones that we think are important. Every week we put out a video news release. The one bug I have a about the media is when . . . a headline is absolutely wrong, opposite of what the article says.
So, you would think that the best way to get accurate, accountable exposure for articles of general interest would be to permit anyone to read them.
On my question, I am sorry to say she gave a misleading answer. Here are excerpts I was able to pick up:
This is discussed constantly. If it is an article of great public interest, we make it free immediately [for a short period of time]. We make all studies free after six months. I would love to make everything we do free. The problem is that it takes money to run a journal.
Actually, all those articles are not made freely available after six months. This is the message you get if you want to look at that Pronovost article from 2010:
To play back something Dr. DeAngelis said:
We are not a guild. We have an MD, not an MDeity. The patient is always the top priority.
So, let us allow patients to get access to these important articles.
16 comments:
Excellent question and poor answer, Paul. You just gave me an idea - what if those of us that were subscribers to medical journals (I subscribe to NEJM) published our usernames and passwords on Facebook or somewhere for anyone to use?? If I'm paying the $$ anyway, then other people may as well get the benefit. And maybe 'massive resistance' of this sort will challenge the journals to rethink their policies.
I challenge other MD's to do this. I think I will do it right now.
nonlocal MD
What's more, I receive a challenge to enter subscriber information or purchase the article for the 1997 article "Thyroid Storm," mentioned in today's WIHI talk by Dr. DeAngelis. Hard to believe JAMA does not provide the full text of an article 14 years old to the general public!
A Medical Writer
The excuses of Dr. DeAngelis do not withstand any reasonable criticism. Patients and other need to have timely access to recent research. MDs should, by themselves, free the access to their articles by publishing them in blogs, websites, anywhere or as suggested above by publishing user name/password.
As far as I am concerned, if an article I need is blocked by publishers, I write to the authors and ask for a copy. No one has so far refused.... It does take time but it's a solution to the problem...
The model of charging for access to works of interest does not seem unusual. For example, the Harvard Business Review continues to ask for payment to read the "Nut Island Effect" an article you penned over 10 years ago and have referred to in this blog. Certainly that piece has generalizable interest. What framework should be used in deciding which writings should be freely available?
Hmm, maybe I should ask for royalties! I wonder if they have sold any copies.
The answer is that if JAMA wants to have more of an influence on public policy matters, it would do better to make some articles public. That's what NEJM does.
It is all a matter of degree, right?
Is it possible that there is a way to get it for free after six months, but they make that less apparent than the subscription request? A well known IT site does something like this, www.experts-exchange.com, where they make it *look* like you need to sign up, but if you scroll down far enough, the answers are present for free. Not saying JAMA does that, but maybe there's a link that's not obvious somewhere that leads to the article, making her statements technically true, but unintuitive?
Maybe Jon, but if we take her at her word, why wouldn't you want to make it easy?
Another thing they could do is make their journal available to patients at a discount, like $25 per year. The old way cannot persist; access to life saving information is too critical. Visit e-patients.net to see a post about a patient whose physician was 10 years behind on the link between Parkinson's disease and melanoma. Patients now have to protect themselves. Why defend the status quo?
nonlocal
So, perhaps the moral decision remains in the hands of the professionals: Do patients come first? First do no harm?
As it becomes apparent that public access does not contraindicate business survival, and the strictures on information pose increasing costs for patients and progress in science, scientists and physicians should boycott such publications. There is plenty of great competition out there, and in 2011 there is no excuse for secrecy in science.
Dear Anon 10:21;
I like your idea of a boycott, but I also like my idea of giving out the logon information to patients. While one involves no one reading the publication, the other permits all to read it - and simultaneously subjects the articles to the wisdom of the greater crowd. There are some very smart scientists out there who do not have MD after their name, who I bet could make some very cogent criticisms in letters to the editor.....
nonlocal
Given that not all wisdom lies in the guild, public access provides a very important layer of review as well. Consider the excruciatingly limited percentage of health scientists who get funding (%NIH grants), the high percentage of repeat big ticket winners of this lottery, and the nearly incestuous pattern of citations within disciplines. Peer review is like the clinical trial. It is a gold standard only as good as gold can be. Nice to have in your pocket, but put to better use with alloy, contextualization, and the testing of other knowledge.
A great tool would be a network map of journals (e.g. Katy Borner's Atlas of Science, MIT) indicating levels of public access. If you get the game, you get citation rates. But what if we value transparency as the ultimate peer review?
You can have my copy - I don't have time to read it anyway! (a copy a week)
There is real movement for information transparency:
http://www.openaccessweek.org/
October 24-30, 2011 | Everwhere
"Open Access Week, a global event now entering its fourth year, is an opportunity for the academic and research community to continue to learn about the potential benefits of Open Access, to share what they’ve learned with colleagues, and to help inspire wider participation in helping to make Open Access a new norm in scholarship and research.
“Open Access” to information – the free, immediate, online access to the results of scholarly research, and the right to use and re-use those results as you need – has the power to transform the way research and scientific inquiry are conducted. It has direct and widespread implications for academia, medicine, science, industry, and for society as a whole."
I was just made aware of a stopgap measure allowing patients temporary access to journal information, found at the website below:
http://www.cautiouspatient.org/blog/item/47-realities-of-medical-care-series-45-of-patients-get-only-partially-treated.html
With thanks to Fred Trotter at e-patients.net
Another way to say "We make all studies free after six months" would be 'we adhere to the Federal Research Public Access Act of 2006,' which mandates that any study funded by NIH be submitted to the open-access PubMed Central. Non-NIH-funded research and older research does not have to be submitted. From this it sounds to me like they are hitting the minimum legal requirement.
Veteran of several surgeries, wary of medical industry, glad to belatedly discover your journal. Just wanted to point out that AMA journal articles are STILL not made available to the public. Perhaps $30/article is considered the same as "free" to the medical profession, but it just isn't.
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