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 article.

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.