A Fight for Free Access To Medical Research
Online Plan Challenges Publishers' Dominance
By Rick Weiss
Washington Post Staff Writer
Tuesday, August 5, 2003; Page A01
The family was poor, living on the Great Plains, and the child had a rare medical condition.
"Here's what we can do," the family doctor told them. But it didn't work, recalled Michael Keller, who oversees the libraries at Stanford University. "So the family went to the Internet."
Soon they were back at the doctor's office with a report of a new therapy. "They plunked it down and said, 'Hey, can we try this?' And guess what? It worked."
Such tales are becoming increasingly common, but the happy endings come at a cost -- literally. That is because the vast majority of the 50,000 to 60,000 research articles published each year as a result of federally funded science ends up in the hands of for-profit publishers -- the largest of them based overseas -- that charge as much as $50 to view the results of a single study online. The child's parents, Keller said, paid for several papers before finding the one that led them to the cure.
Why is it, a growing number of people are asking, that anyone can download medical nonsense from the Web for free, but citizens must pay to see the results of carefully conducted biomedical research that was financed by their taxes?
The Public Library of Science aims to change that. The organization, founded by a Nobel Prize-winning biologist and two colleagues, is plotting the overthrow of the system by which scientific results are made known to the world -- a $9 billion publishing juggernaut with subscription charges that range into thousands of dollars per year.
In its place the organization is constructing a system that would put scientific findings on the Web -- for free.
Scientists and budget-squeezed librarians have long railed against publishers' stranglehold on scientific literature, to little avail. But with surprising political acumen, the Public Library of Science -- or PLoS -- has begun to make "open access" scientific publication an issue for everyday citizens, emphasizing that taxpayers fund the lion's share of biomedical research and deserve access to the results.
"It is wrong when a breast cancer patient cannot access federally funded research data paid for by her hard-earned taxes," Rep. Martin O. Sabo (D-Minn.) said recently as he introduced legislation that would give PLoS a boost by loosening copyright restrictions on publicly funded research. "It is wrong when the family whose child has a rare disease must pay again for research data their tax dollars already paid for."
It remains to be seen whether the newly bubbling discontent among citizens and politicians will boil over into a full-blown coup, fulfilling scientists' longstanding goal of democratizing the scientific publication enterprise. But whether it succeeds or fails, historians of science say, the effort is a remarkable social experiment in itself. After all, publication is at the heart of the scientific system of rank, respect and power. So the movement to dissect and rewrite the rules of that system is, in effect, a rare opportunity to watch scientists experiment on themselves.
Research as Moneymaker
Historians peg the birth of scientific publication to 1665, when England's Royal Society began publishing its Philosophical Transactions -- the same journal that would later announce key discoveries by Isaac Newton, Charles Darwin and other icons of science.
Today the universe of scientific journals includes about 28,000 titles, but they fulfill the same four basic needs: communicating findings; controlling quality by "peer review," in which scientists check one another's work; creating a historical record; and documenting authorship for personal credit and professional recognition.
In recent decades, however, journals have found that scientific communication can be not only a service but also a potent moneymaker. Central to their success is that each journal publishes original research that appears nowhere else, so each is necessary for scientists in a given field.
"Scientific journals are monopolies in that there's the Journal of Artificial Intelligence, for example, and the Journal of Artificial Intelligence Research, and as long as they're both good there's no way a library can just say, 'We'll take the one that's most cost-effective.' They have to have both," said John McCarthy, a Stanford University professor emeritus of computer science and an authority on scientific publication. "And when there's a monopoly there's always the opportunity for extra profit."
Indeed, said Stanford's Keller, "over the course of the years several of these companies have become giants. And some of their price increases have been horrendous, sometimes 25 to 35 percent per year. It's been unbelievable."
Many commercial publishers -- the biggest include Elsevier and Wolters Kluwer, both of Amsterdam; Blackwell Publishers of England, and BertelsmannSpringer of Germany -- charge between $1,000 and $5,000 for a one-year subscription to their journals. One prestigious collection of journals called Brain Research costs subscribers about $20,000 a year.
Publishers defend their prices largely by pointing to the extra services they provide. Not only must they pay for publication and mailing, they say, but they also hire peer reviewers, editors and contributors to write commentaries and review articles. Some, including the premier journals Nature and Science, also have writers who produce news articles and scientific perspectives.
"We believe we add value to the research," said Jayne Marks, publishing director for Nature Publishing Group in London, a closely held company that publishes about 50 journals, including Nature.
Nature does not reveal financial details, but figures released by the largest publisher of scientific journals -- Amsterdam-based Elsevier -- help explain why many scientists and others are frustrated. Its 1,700 journals, which produce $1.6 billion in revenue, garner a remarkable 30 percent profit margin.
"I do realize that the 30 percent sticks out," Elsevier Vice President Pieter Bolman said. "But what we still do feel -- and this is, I think, where the real measure is -- we're still very much in the top of author satisfaction and reader satisfaction."
In October, critics say, the real test of that will begin, as PLoS begins the first of a series of journals dedicated to the free sharing of results. The aim is to get the world's best scientists to submit their best work to PLoS -- and force change by starving profit-oriented publishers of their earnings and prestige.
"Our goal," said PLoS's executive director Vivian Siegel, "is to transform the landscape completely."
Shift to Open Access
The PLoS plan is simple in concept: Instead of having readers pay for scientific results through subscriptions or other charges, costs would be borne by the scientists who are having their work published -- or, practically speaking, by the government agencies or other groups that funded the scientists -- through upfront charges of about $1,500 an article.
The shift is not as radical as it sounds, the library's founders argue. That is because government agencies and other science funders are already paying for a huge share of the world's journal subscriptions through "indirect cost" grants to university libraries, which are the biggest subscribers. The new system would radically increase the number of people who would have access to published findings, though, because results would be freely available on the Internet. By contrast, people today who do not subscribe to these journals must pay charges, typically $15 to $50, to get a reprint of -- or online access to -- a single article.
Those charges can add up quickly.
"When my father was diagnosed with multiple myeloma, for example, I must have glanced through 50-100 articles almost immediately" while searching for treatment information, Siegel wrote via e-mail. Physicians, professors, graduate students and others, including science journalists, face the same problem daily.
Some journals have already made the leap to open-access publishing. But for the most part they have not attracted the best science -- a key to success. Now, with a $9 million grant from the Gordon and Betty Moore Foundation, the PLoS hopes to lift open-access publishing into the scientific stratosphere, in part through the personal gravitas of its founders and friends.
In terms of scientific stardom, the critical mass is there. PLoS was founded by three highly respected scientists: Harold Varmus, who won a Nobel Prize in 1989 for his work with cancer viruses, headed the National Institutes of Health from 1993 to 1999 and is now president of Memorial Sloan-Kettering Cancer Center in New York; Patrick O. Brown, a renowned genomics expert at Stanford University School of Medicine and the Howard Hughes Medical Institute; and Michael Eisen, a computational and evolutionary biologist at the Lawrence Berkeley National Laboratory and the University of California at Berkeley.
Having hired a team of hotshot editors and reviewers -- in some instances wooing them away from prestigious journals -- the group will begin its first monthly open-access journal, PLoS Biology, in October. It plans to launch PLoS Medicine in 2004. Others may follow, but the group hopes that the need to keep creating journals will drop off as existing journals see how successful the model is and shift to the open-access system themselves.
For scientists, the benefits would extend well beyond being able to read scientific papers for free. Unlike their ink-on-paper counterparts, scientific papers that are maintained in open electronic databases can have their data tables downloaded, massaged and interlinked with databases from other papers, allowing scientists to compare and build more easily on one another's findings.
"In epidemiology and public health it would be an enormous leap forward," said Christopher Murray, a World Health Organization epidemiologist and health economist. "You can't imagine how much time researchers spend trying to get access even to old data sets to do new things or make new connections."
But pressure from consumers, whose taxes provide about $45 billion in federal research funding each year and who are increasingly asked to take on a larger role in their own care, may be the force that finally tips the balance.
"They've paid for the research," Eisen said. "And the fact that the primary results are not available to them is really crazy and grossly unfair and completely unnecessary."
Publishers Raise Red Flags
The bigger for-profit publishers say advocates of open access exaggerate the benefits.
"This is, in general, very esoteric material . . . not written for the public," said Elsevier's Bolman, adding that he doubts the business model will work. "Everybody is getting onto the open-access bandwagon. It reminds me of the enthusiasm and mania of the dot-com explosion, and it will pop, too."
But what Bolman and other publishers object to most of all are budding congressional efforts to force publishers to adopt open-access principles. The latest House appropriations report instructs the National Library of Medicine to look into ways to make federally funded research more available to the public. And Sabo's bill would require research "substantially funded" by the federal government to be in the public domain.
That is especially worrisome to the smaller, not-for-profit publishers -- most of them affiliated with scientific societies -- that say they are sympathetic to open-access principles but fear that the system will not work for them, with their tighter margins.
"Saying you're for free access is like motherhood and apple pie," said Ira Mellman, chairman of Yale's Department of Cell Biology and editor in chief of the highly cited but inexpensive and nonprofit Journal of Cell Biology. "But you have to recognize that this is an experiment in publishing, and the legislation seems to be trying to enforce one model before the conclusion of the experiment."
Several journal editors noted that they have moved in recent years to widen access. Many have agreed to make their papers available for free to scientists in developing countries, for example, and some release results freely to anyone six to 12 months after publication. But critics say that is not enough, arguing that even a six-month delay deprives scientists and others of the latest and best information.
Ironically, several observers said, the fate of open-access science publication may ultimately depend on something highly unscientific: the enigmatic quality of prestige. With scientists' professional standing still intimately linked to their latest paper in journals such as Science and Nature, will the best of them step up to the plate and start sending their hottest papers to open-access journals such as PLoS?
"With scientific journals, competition is not so much on the reader end but on the author's end," Bolman said. "When you get the best authors, then other authors tend to follow, and then you have an exciting journal, which really is your objective."
PLoS Biology started accepting its first submissions for its premiere issue last month, and Varmus said he is pleased with the quality of the work the journal is attracting.
One thing is certain: Among the countless scientists and others who will read PLoS Biology for free in October will be Bolman and other publishing executives, who will be looking for the first hints of an exodus.
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