The joys and challenges of being an open-access medical journal

"For supporters of open access publishing, these are heady times," wrote the editors of the BMJ in 2004, reflecting on an extraordinary revolution taking place in the world of medical and scientific publishing.¹ The pace of progress since then has been astonishing, with an explosion of new open-access journals and growing support for open-access world wide from, among others, research funding agencies, universities, governments, publishers, physicians, and patients.² Open Medicine is joining a revolution that now seems unstoppable.

One of Open Medicine's editors referred to PLoS Medicine, the international open-access journal published by the Public Library of Science, as its "older sister." As the editors of PLoS Medicine, we take that as a great compliment — although, at the tender age of just two years, we feel as if the CMAJ's description of us when we launched as "the boldest new kid on the block" still holds true.³ What lessons might there be from our experiences so far that can be passed on to our newest sibling?

Open-access journals, unlike subscription journals, have the potential to reach a broad audience and not just the traditional readers of medical journals (those wealthy enough to afford access). We have a tremendous opportunity to disseminate research to a diverse readership in developed and developing countries, from clinicians and clinical researchers to health policy makers, teachers, students, non-governmental organizations and patients. But along with this opportunity comes a responsibility to help non-expert readers make sense of the research. Open-access journals have begun to experiment with reaching out to the broader public — for example, by publishing plain-language summaries of each research article — but this experimentation is still in its infancy and is likely to evolve in creative ways.

Because online open-access journals are free from the space constraints imposed by print, they are able to publish more articles at a fraction of what it would cost to publish them on paper. The result, say Elizabeth Slade and Pritpal Tamber of the open-access publisher BioMed Central, is that open-access journals can "choose a greater range of topics that would appeal to a broader base of readers."⁴ The most obvious benefit of this freedom is that open-access journals can be more international in their content. In contrast, subscription-based health journals tend to neglect the problems of the developing world. One recent study found that a mere 3% of articles in the New England Journal of Medicine address the health problems of the developing world,⁵ problems that constitute 90% of the world's disease burden.⁶ This neglect is no surprise, given the business model of subscription-based journals: in order to remain profitable, they must publish materials that will appeal to readers in the rich world who can purchase the content (typically US$30 for a single article or several hundred US dollars for an annual subscription).

Another benefit of the freedom of open-access publishing is that there is greater scope to be inclusive with respect to authorship. We believe that open access should not just mean greater access for readers, but also greater access for contributors.⁷ Authors from low-income countries have been marginalized by subscription-based journals; for example, a survey of six leading "international" medical journals found that only 6.5% of papers were authored by researchers from the developing world.⁸ Yet health problems are "no longer just local, national or regional, they are global."⁹ And so a truly international journal would give authors from all countries the opportunity to discuss national problems that are of relevance to the global health community.⁷

Many open-access journals are funded by levying an author charge that aims to cover the costs of publishing the research paper and that is usually paid for by the author's research funding agency or institution. One of the most common criticisms of this business model is that author charges prevent researchers in the developing world from contributing to open-access journals. Addressing this criticism is crucial to the success of the open-access movement, which will be deemed a failure if it simply replaces one barrier (a fee to read the literature) with another (a fee to contribute to the literature). Many open-access journals, including the PLoS and BioMed Central journals, are tackling this criticism by simply waiving author fees for poorly funded researchers. Editors are blinded to an author's ability to pay; therefore, ability to pay can never influence editorial decisions on which papers to publish. In addition, the Open Society Institute has created a fund that authors in developing countries can use to pay author charges (see link).

Including more authors from the developing world is just one of the ways that open-access journals are changing the status quo of medical publishing. These journals are also beginning to use the functionality of the Internet to allow readers to participate more directly in the publishing process, for example by annotating online articles (see link), starting discussion threads and blogs, and ranking the quality of published research. We are witnessing a new form of scientific discourse, "open access 2.0," which maintains those elements of traditional journals that benefit the scientific and medical community but also embraces the potential of the Internet to create a more interactive, community-driven literature. "The more we use, share, and exchange information on the web in a continual loop of analysis and refinement," says Dean Giustini, medical librarian at the University of British Columbia and associate editor of Open Medicine, "the more open and creative the platform becomes; hence, the more useful it is in our work."¹⁰

One of the most important ways in which PLoS Medicine and Open Medicine are kindred spirits is that both journals have adopted a progressive copyright license, the Creative Commons Attribution License. Unlike traditional copyright, which severely restricts the potential uses of an article, the Creative Commons license allows readers to reuse the articles for any legal purpose — reproduction, distribution, translation, and the creation of derivative works — provided proper attribution is given. The result, says Jan Velterop, Director of Open Access at Springer, is that "copyright can be used for what it is meant to in science, not to make the articles artificially scarce and in the process restrict their distribution, but instead, to ensure that their potential for maximum possible dissemination can be realised."¹¹

If PLoS Medicine's experience is anything to go by, it will undoubtedly take some time before readers of Open Medicine use the Creative Commons license to its full potential. We still regularly receive requests asking for permission to reuse our materials, suggesting that our audience remains unfamiliar with progressive copyright. As more and more journals join Open Medicine, PLoS Medicine, and BioMed Central in adopting the Creative Commons license, perhaps we will reach a "tipping point" at which the power of knowledge in the public domain becomes more obvious. Searching and mining the literature, for example, will become exponentially easier. The Wellcome Trust, the world's second largest charitable funder of medical research and a major supporter of open access, argues that "as the tools for such mining become more sophisticated, we will see new knowledge being created by the linking of research papers that previously had not been seen as relevant to each other." Crucially, they note that "for this to happen, however, papers must be held in an open access repository and not remain hidden behind publishers' authentication systems."¹²

Open Medicine and PLoS Medicine were both launched in the spirit of reinventing the modern medical journal by doing things rather differently. Both journals eschew drug advertising, out of a desire to break the unhealthy cycle of financial dependency that has grown between journals and drug companies.¹³ We also feel sure, given the circumstances that gave rise to the creation of Open Medicine, that the journal will join us in taking risks and publishing provocative articles that stimulate debate about improving the health of individuals and populations. "In a world where political correctness obfuscates and public discussions are managed by public-relations firms and paid experts," said John Hoey, former editor of the CMAJ, "there is a desperate need in medicine for open, plain-spoken discourse."¹⁴Open Medicine, born in a spirit of fierce editorial independence, will undoubtedly help to meet that need. We are proud to be allies in the enterprise of disseminating knowledge freely to all.

Biographies

Gavin Yamey is Magazine Editor, PLoS Medicine and Consulting Editor, PloS Neglected Tropical Diseases.

Virginia Barbour is a Senior Editor of PLoS Medicine.

Barbara Cohen is a Senior Editor of PLoS Medicine.

Larry Peiperl is a Senior Editor of PLoS Medicine.

Paul Chinnock is a Senior Editor of PLoS Medicine.