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You can take your $15 fee and … ! by Paul Levy

In the past, I have sometimes used this blog to refer to articles
from medical journals when I felt they had broad public interest.
Sometimes, those articles have not been available to the general public
because they were only available by subscription. From time to time,
commentors to this blog have complained about this. I have let those
comments go by without reply.

But, finally, I have had enough. I
want to state this clearly and directly: When a respected medical
journal issues a press release about a given article that has important
public policy ramifications but does not make available the full text
of the article, it is a bad thing. It inhibits full public
understanding of the issue and makes us beholden to other people’s
interpretation of the article. It is inconsistent with the general
principle of academic discourse and also is counterproductive in
facilitating an informed debate on issues.Here is today’s example, from the Journal of the American Medical Association ("JAMA").  Last week, I received the following email from the AAMC (Association of American Medical Colleges):

The
Feb. 13 issue of JAMA will include an article on a new study examining
the status of institutional conflicts of interest policies at U.S.
medical schools. The study was undertaken by the AAMC and Massachusetts
General Hospital, and provides the first national data on medical
school policies and practices for dealing with institutional financial
conflicts of interest. Susan Ehringhaus, associate general counsel for
regulatory affairs in AAMC’s division of biomedical and health sciences
research, is the lead author on the artic
le.

This topic
is clearly of great public interest and import, and so I asked the
question of whether the full article would be available for reading
upon publication. The answer I received today was, "No." Checking the
JAMA website, I confirmed this.  I can read the titles, the authors, and a short abstract.
But I can’t read the article and reach my own conclusions about the
methodology employed, the assumptions made, and the results.

I can even read a press release
issued by the AAMC about the article. But I can’t read the article and
reach my own conclusions about the methodology employed, the
assumptions made, and the results.

Tomorrow, I may be able to
read newspaper reports about the article. But I can’t read the article
and reach my own conclusions about the methodology employed, the
assumptions made, and the results.

Oh wait, I can, if I pay $15 (plus tax) for the privilege of having 24 hours of access to the article, and only from the computer I am currently using.

Please
understand that I do not begrudge journals that need to charge
subscriptions to stay in business. But I find it upsetting when a
respected journal issues an occasional article about an important
public policy issue and does not allow wide and unhampered circulation.
Surely, allowing open access on such a matter can only enhance the
reputation of the journal. Restricting it is totally unnecessary and,
beyond the mercenary aspects, feels elitist and condescending, a
reputation the medical profession does not need to reinforce.

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RonJanice McCallumrbaerShelleyLex Recent comment authors
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Ron
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Ron

All articles from JAMA and usually NEJM are typically available at most public libraries. You remember libraries, don’t you? No? They were those brick and mortar repositories of information where you used to check out books when you had term papers back in high school. Anyway, if you need an article, you can always go there and look at it for absolutely free.

Janice McCallum
Guest

I outline some reasons why publishers of medical journals would benefit from increasing free access to articles that have broad public interest in a post on my blog at: http://www.healthcontentadvisors.com/blog. Using the analogy of the Wall St. Journal, I think it is likely that much of the news content with broad appeal will be made free and ad-supported, facilitated by the larger audience it attracts. The challenge to the publisher will be to continually create value-added content (and features, such as analytic tools) for which a select number of core readers will pay a premium.

rbaer
Guest
rbaer

I am certainly no friend of the AMA and of corporate interests, but to my understanding, the online versions of papers get most of their money from online ad revenues. I don’t see that happening with JAMA articles – the medical students, physicians and researchers reading the bulk of the articles are not a good advertising target since they are already inundated with pharma advertising.
However, one could certainly make the point making the “public-interest” articles available online for free, like Lex did … and I’d agree.

rbaer
Guest
rbaer

I am certainly no friend of the AMA and of corporate interests, but to my understanding, the online versions of papers get most of their money from online ad revenues. I don’t see that happening with JAMA articles – the medical students, physicians and researchers reading the bulk of the articles are not a good advertising target since they are already inundated with pharma advertising.
However, one could certainly make the point making the “public-interest” articles available online for free, like Lex did … and I’d agree.

rbaer
Guest
rbaer

I am certainly no friend of the AMA and of corporate interests, but to my understanding, the online versions of papers get most of their money from online ad revenues. I don’t see that happening with JAMA articles – the medical students, physicians and researchers reading the bulk of the articles are not a good advertising target since they are already inundated with pharma advertising.
However, one could certainly make the point making the “public-interest” articles available online for free, like Lex did … and I’d agree.

Shelley
Guest

Hi Paul,
For some innovative cheap ideas on fixing health care check out my blog:
http://diybaby.blogspot.com/2008/02/fixing-health-care.html
Dr. Shelley

Lex
Guest

As a writer (and apparently not a publisher or business person), maybe you need to be reminded … This is the ONLY way that journals will be able to survive in the future. I’m not arguing that JAMA should give everything away online, just the articles with the most general interest AND with significant public-policy implications. As it happens, my publication publishes most of its stories online for free. Doing so enables more people to link to us, which enhances our online authority and drives up page views. There are solid business reasons for taking this approach (search revenue, for… Read more »

Chris
Guest
Chris

Ahem … PLoS journals seem to be doing just fine, without charging for access to their articles. And a lot of scientists and physicians seem happy to contribute and share their hard work.

Peter
Guest
Peter

So who gets the $15? JAMA, the writer of the article of the new study or maybe the AAMC and Massachusetts General Hospital who actually did the study?

Michael Breen M.D.
Guest

I’m a physician who was a TV medical journalist (CBS-Chicago)for many years. (Now I run a large medical marketing company.) I can give you a little insight into this process. JAMA cares about one thing…beating the NEJM in mass media exposure week after week. That’s why we used to receive abstracts several days before each issue literally “pitching” that issue’s stories to us. Their abstracts were no different than our TV stories….hyperbolic and designed to get attention. The docs I called to be interviewed hadn’t even seen these studies…often I had to fax them to the docs before they’d agree… Read more »

john
Guest

Frank .. I think that’s exactly the point that’s being discussed here. Why does the Wall Street Journal allow some of their content to live outside of their firewall? While charging for the rest of it?
I don’t think anybody is suggesting that the JAMA should adopt the Napster business model. As somebody on the business side I can tell you it’s a trade off and by no means as clear cut as you suggest.

Frank
Guest
Frank

As a writer (and apparently not a publisher or business person), maybe you need to be reminded …
This is the ONLY way that journals will be able to survive in the future. Without getting actual money in exchange for your seing their hard work, they will not exist.
Please explain, because I don’t understand – Why would you be willing to pay for a daily newspaper delivered to your front door or on the newstand, and not be willing to pay for it online? Unless, of course, you feel entitled to getting someone else’s hard work for free.

Lex Alexander
Guest

This drives me up a tree, as well. If The Wall Street Journal can make some of its good stuff available free and stay in business, JAMA can, too. The people who would want to read only the articles with important public-health or public-policy implications generally are never going to subscribe to the print edition anyway, and JAMA is missing an important opportunity to expand its authority online. I’m a newspaper medical writer, new to this blog and find it both useful and enjoyable. One minor quibble: Is there a way to link from one individual post page to those… Read more »