Open Access: The Next Steps

A useful and well-written summary of open access to publications in the medical field triggered some thoughts I’d like to share. The thrust of the article was that doctors need more access to a wide range of journal publications in order to make better decisions. The article also praises NIH’s open access policy, which has inspired the NSF and many journals.

My additional points are:

  • Open publication adds to the flood of information already available to most doctors, placing a burden on them to search and filter it. IBM’s Watson is one famous attempt to approach the ideal where the doctor would be presented right at the point of care with exactly the information he or she needs to make a better decision. Elsewhere, I have reported on a proposal to help experts doctors filter and select the important information and provide it to their peers upon demand–a social networking approach to evidence-based medicine.
  • Not only published papers, but the data that led to those research results should be published online, to help researchers reproduce the results and build on them to make new discoveries. I report in an earlier article on this site about the work of Sage Bionetworks to get researchers to open their data. Of course, putting up raw data leaves many challenges: one has to be careful to deidentify it according to accepted standards. One has to explain the provenance of the data carefully: how it was collected and massaged (because data sets always require some culling and error-correction) so it can be understood and properly reused. Finally, combining different data sets is always difficult because they are collected under different conditions and with different assumptions.

  • The biggest hurdle ahead may be a psychological and cultural one: persuading doctors to accept evidence-based medicine. They tend to trust their own intuition, which is a reasonable position to take given that so many studies are flawed and that each patient is unique. However, the field cannot cope with the expanding range of complex conditions doctors have to deal with unless doctors learn to ground their decisions on the best practices discovered by others.

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. His work for O’Reilly includes the influential 2001 title Peer-to-Peer, the 2005 ground-breaking book Running Linux, and the 2007 best-seller Beautiful Code.

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Shirie Lengjohn Recent comment authors
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Shirie Leng

Nothing is more frustrating than finding articles on a search engine that you can’t access. I have a couple opinions on your points: the first, about filtering provided expert information; we actually do this already – it’s called curbsiding. Secondly, I suspect fewer doctors than you think can really parse the data and run the statistics. Most people just read the results section. For researchers it would be great. Thirdly, EBM was the big thing when I was in med school in the 1990s. In real life, it turns out, doctors do what everybody else does. It’s called standard of… Read more »


Andy For a lot of people – particularly publishers and other content creators – the issue here is not cultural, it is economic. I hear you loud and clear on the greater common good and the various benefits of opening access. Would like to know about how the economics of this are supposed to work for journal publishers? Others with economic interest involved? Are we basically saying wake up – figure out a new business model that doesn’t shut down progress? if that’s what we’re saying, that’s totally fine, that may be inevitable – but I think it would help… Read more »