Editorial: Is Open Access for You? It Depends Who “You” Are

Open-access (OA) publication was supposed to transform scholarly publishing. As a potentially transformative force, it’s often described in terms I associate more with populism and overthrow than science [3]. And yet despite being around for 25 years, only 15% of articles are published OA [18]. That proportion in first-tier journals of our specialty like Clinical Orthopaedics and Related Research® likely is much smaller.

So rather than arguing about market share or transformation, it may instead be more productive to ask this simple question: Is OA for you?

Of course, whether and how OA publication meets your needs depends critically on who “you” are. In particular, it depends on whether you are mainly a content consumer or a content producer. But even then, it quickly gets complicated. The needs of content consumers may vary widely, since their circumstances are so diverse: Medical librarians, practicing surgeons in developing countries with little infrastructure (beyond perhaps access to the internet), and orthopaedic surgeons in more-affluent countries (who may have greater or less institutional support in terms of subscriptions) all are content consumers. The needs of content producers also differ, on one extreme from clinician and laboratory scientists with large federal grants that mandate OA publication, to orthopaedic surgeons who seldom publish, are self-funded or unfunded, and certainly don’t have USD 2700 [11] laying around to pay OA article-processing charges for a case report.

Regardless, all of those individuals should share a desire for quality: Quality of the content they read vis-à-vis scientific reporting (completeness, accuracy, modesty, context), and quality of the publication process, for those who do research (partnership from thoughtful reviewers, editors, and effective distribution of the work to the largest relevant audiences possible after publication). The journals people trust are the journals that consistently meet or exceed those expectations.

But First, Tell Me Again What Is OA?

It can be confusing, but in broad terms, a paper that has been published OA is freely available to any reader who has access to the internet. OA publication models vary, and some of them allow the author of a manuscript to retain copyright on his or her work, rather than transferring it to a publisher. As one can easily surmise, if authors retain copyright and can distribute papers freely, a publisher cannot monetize that work through subscriptions. Since publishing costs money, and biomedical publishing is a business not a social service, the margin must be achieved another way.

To cover their costs, publishers of papers on which authors retain copyright and that are OA as of the moment of publication (so-called OA “Gold”) generally charge authors or their institutions article-processing charges (APCs). These APCs typically run several thousand dollars [11], though some publishers forgive these charges in certain circumstances; for example, many publishers don’t charge APCs if the research was performed in a resource-constrained country. Under an OA “Green” model, the publisher can monetize content by keeping it behind a subscription paywall for a period of time before making it freely available in one or more repositories, such as PubMed Central; under an OA Green model, authors generally do not retain copyright.

(By way of disclosure, CORR®, as do most journals, derives at least some benefit from OA fees. In the case of CORR, these fees do not accrue to the journal or its owner, The Association of Bone and Joint Surgeons®, but rather to its publisher, Wolters Kluwer. Publishing OA in CORR is always an option—CORR authors can pay an OA article-processing charge to Wolters Kluwer and publish OA Gold—but it is never is required, and since we don’t ask authors for their choice until after an initial disposition has been made on their work, this cannot and does not influence the manuscript-decision process. Authors who opt not to publish OA Gold in CORR pay no charges at all, and the full-text content of their work is available only to subscribers for the first year after publication. One year after print publication, all manuscripts are freely available in full-text form through PubMed Central.)

As I’ve written before [17], there are both philosophical and practical advantages to OA publication (Table 1). However, OA also has its shortcomings, and it has enabled a set of incentives that did not exist before. Not all authors have the resources to pay APCs, particularly in a specialty like orthopaedic surgery, in which so few investigators are extramurally funded. And in terms of incentives, in a fully OA Gold publishing model, the more a journal publishes, the more income it generates for itself or its publisher; this may influence what and how much it publishes. Under that model, it seems intuitive to surmise that fully OA journals may “lower the bar” for close-call papers. This has become a point of embarrassment for many OA journals that have been hit by a number of very-public “sting” operations (Table 2) as well as mass retractions in the wake of inattentive review processes [12, 20].

Table 1.

Philosophical and practical rationales favoring open-access publication

Table 2.

Selected list of “stings” of OA and predatory journals suggesting lax review and editorial practices

The extreme case of OA incentives run amok is the predatory journal. A predatory journal is one that “actively solicits manuscripts and charges publication fees without providing robust peer review and/or editorial services” [25]. Prior to the advent of OA publication, there were no predatory journals, because incentives for subscription journals run contrary to the pay-to-play ecosystem in which predatory journals exist. In fact, before the Impact Factor gained traction as a surrogate metric for journal quality, subscription journals used the percentage of manuscripts they rejected for that purpose (with higher rejection percentages considered to be a marker of higher-quality journals).

This doesn’t mean that OA and predatory are synonymous. There are many high-quality OA journals. But it does mean that without OA, there would be no predatory journals. Predatory journals are the parasites of an OA publishing ecosystem, and as long as OA journals derive revenue from APCs (as opposed to some newer models like “publish and read”, “read and publish” [22], and “subscribe to open” [1] that strike me as unlikely to gain universal acceptance) that ecosystem will continue to host predatory journals.

With all this as (important) background, I’ll ask once again: Is OA for you?

If You Are A Content Consumer

In fact, we’re all content consumers. Even individuals who make a living hunting big-dollar grants and publishing high-impact papers must read many more articles than they write. All the same, my suggestions for content consumers vary according to the elements that most-fundamentally define their jobs.

If you are a practicing surgeon, scientist, or clinician-scientist and you have the means to subscribe (or have institutional access to subscription-model journals), then you have the full range of choices in terms of what you can read. I’d suggest you be choosy. Focus your reading on the journals that have earned your confidence over decades of consistent, balanced, thoughtful approaches to scientific reporting [16]. Since one doesn’t need to subscribe to OA journals to access them, your opportunity to read from them likely will arise in the course of literature searches. To avoid inadvertently consuming content from predatory journals, try to limit your OA reading to OA journals that have developed strong reputations for attentive scientific reporting over a long span of time; unfortunately, as of now, there are few such titles in our specialty.

Choices for surgeons in the developing world may be much more constrained. As I mentioned, some high-quality, branded orthopaedic journals, including this one, make their content freely available on PubMed Central in full-text form after an embargo period (often one year). Fortunately, few things in orthopaedic surgery evolve faster than that, so surgeons without access to subscriptions may wish to focus on content from trustworthy journals placed in repositories like PubMed Central, supplemented by as-needed searches of the better OA titles.

Medical librarians are, in large measure, driving these phenomena rather than following them. My only recommendation for that group—which is more like a plea—is that they recognize that not all biomedical disciplines are the same. The overwhelming majority of orthopaedic research is self-funded or unfunded, and to the individuals doing that work, APCs represent a substantial impediment to dissemination of their research. As such, recommending that authors publish only OA as some have [23] will result only in cost-shifting from libraries to departments and individuals, who—at least in this surgical specialty—generally are unable to bear them. And suggesting (as some have) that an OA publishing model will arise that has “no fees for authors or readers” yet still will allow authors to “always retain copyright” [29] and have publishers and high-quality journals continue to deliver the large number of expensive, value-adding functions they provide [2], is beyond fanciful. I don’t buy it.

If You are a Content Producer

Your world is changing. One thoughtful observer suggested you base your choice of where to publish on visibility, cost, prestige, and speed [8]. For authors who are free to choose, this is not a bad set of standards to apply, though I personally would add “quality of publication process” to that list, and I’d put it first.

But the choice may not be yours to make, and soon some funders’ publishing mandates may become far more restrictive than they are now. Currently, some grant-funding agencies require that the research they support be made freely available in a content repository like PubMed Central after some embargo period under an OA Green arrangement (the period mandated by the NIH for this is 12 months [28]); many journals accommodate this. Others even require immediate (Gold) OA from the moment a work is published [4].

But some funders have gone a large step further, and signed on to something called Plan S, which will require as of 2021 that the research they underwrite be published in fully OA journals (publishing OA in a hybrid journal will not meet this standard) [7]. This gets back to the “movement” quality of OA publishing I mentioned at the outset; the goal here is not merely to have the research they funded be disseminated without cost to readers, but actually to eliminate alternative publishing models with which they have philosophical disagreements.

Plan S as currently drafted does not suit the needs of all content producers, and if you are a content producer and you’ve not heard of Plan S, this is something you will want to read up on. Currently, for example, there are no first-tier fully OA (that is, Plan-S compliant) journals in orthopaedic surgery, there are no OA journals in medicine that match the quality of the New England Journal of Medicine or JAMA, and there are no OA biomedical research journals anywhere near as good as Nature or Science. That being so, Plan S would restrict many leading researchers from publishing their best work in the places their peers are looking to find it. Plan S proposes to restrict prices that publishers can charge; this is likely to favor large publishers, which have economies of scale, and is hardly in line with the democratizing principles Plan S articulates. Perhaps more importantly, it will create further incentives for all in that publishing ecosystem to cut corners. My feeling is that we don’t need more articles that are poorly reviewed and cursorily edited, and that researchers should have the liberty to decide where to publish their work, since they know which audiences will benefit most better than funders or governments do.

But tackling this in depth is more than I need do here, since the many serious controversies currently swirling around Plan S (and its parent, cOAlition S) [13, 21] affect only a small number of CORR’s content producers, and even a smaller proportion of our readers. This topic is acrimonious [3] because there are billions of dollars in play here, and many conflicted interests on both sides. As of the writing of this editorial, it’s impossible to know whether Plan S will gain traction by bringing more funders under its umbrella.

If it does, it stands to transform medical publication in fundamental ways, though I think the changes will not be for the better. If this happens, it will affect you regardless of whether you are a reader or a researcher.