Among the four major medical journals, The British Medical Journal is my favorite. It has the most extensive news coverage of the fight against the infectious diseases that are ravaging the developing world, a subject in which I take a keen interest. And it consistently prints iconoclastic studies that take on the medical establishment.
And, until this year, it was entirely free on the web. That made it distinct from the other big-time journals (The New England Journal of Medicine, The Lancet, and The Journal of the American Medical Association), which charged hefty fees to view individual articles of interest if you weren’t a subscriber. But, alas, _BMJ_’s open access policy went the way of the dodo bird this January, leaving medical consumers locked out of all the major journals. Accessing some of BMJ’s original research articles and all of its news section now require a subscription to the journal.
It’s testimony to the poverty of the public policy debate in this country that no one in the mainstream media has yet raised this issue – access to cutting edge medical information – in response to the Bush administration’s push for “consumer-driven health care” through individual health savings accounts. How are consumers to choose wisely when and where to get health care if they are cut off from key sources of information? It’s like sending car buyers to the used-car lot while denying them access to the Kelley Blue Book.
I’m a skeptic when it comes to consumer-driven medicine anyway. Buying health care isn’t like buying a house or car or even legal services. The vast majority of expenditures occur in either emergencies or when the patient, i.e., the consumer, is under the duress of ill-health. If I find myself in that situation, I want a doctor who can quickly guide me to the most effective care and give me carefully thought-out options that hopefully are not based on some drug industry-funded study published in a second-tier medical journal and dropped off in his or her office the day before yesterday by a drug industry salesman (these reprints are a major source of medical journal publishing revenue, by the way).
Though I’m not a doctor, my research and writing over the past five years has probably made me one of the better-educated medical consumers in the country – I venture to say at least in the top five percent. But if I were to get deathly ill, I wouldn’t trust myself for a minute to have figured out all the options for speeding recovery. Even in routine care, I need professional help to sort out the issues. I had a colonoscopy three years ago and got a clean bill of health. I’m in my mid-50s. Do I need another one? Do I want to make that determination based on the size of my health savings account or some uninformed speculation evaluating my need to save that cash for a rainy day versus preventive medicine?
Of course, I could go to the internet for advice. But if I search “colonoscopy frequency” on Google, I find a similar set of unspecific advisories on for-profit and non-profit websites: have one every 3-5 years but more often if you’re at risk or if there is a family history of colon cancer; get one every ten years if you’re over 65. My brother had polyps removed after his last colonoscopy. Is that a family history? I’m lost already. And how about evaluating risk? What exactly are the risk factors? My diet? My weight? My propensity for flatulence, diarrhea or constipation? Hmmm. If I have to make this decision on my own, this is going to take some time. And what am I to think about this article from the National Cancer Institute (the third listing) that reports on a study showing that doctors over-prescribe colonoscopies?
Before I trusted the internet to help me make this decision, I would prefer to read a solid review of all the most recent studies printed in a well-respected, peer-reviewed journal like the BMJ. But the change in policy doesn’t allow me that option anymore.
But in true BMJ fashion, the latest issue contains a survey of BMJ authors on their response to closing off free access. Sara Schroter, a senior researcher at the journal, reported that 75 percent of 211 authors surveyed considered it “very important” or “important” that articles be freely available to the public when considering where they would publish their studies. A majority said it would make them “slightly” less likely to submit articles to BMJ because of the change, while another 14 percent said it would make them “much less likely” to publish there.
As I suggested at the top, physicians and researchers who publish in BMJ tend to be a more progressive bunch than the profession as a whole. But this strong endorsement of open-source publishing is heartening news. It suggests broad support within the ranks of medical researchers for opening up the medical literature to the consuming public along the lines of the Public Library of Science, the Moore Foundation-funded suite of journals launched a few years ago for the expressed purpose of making them freely available on the web. Here’s hoping the ill-conceived push for health savings accounts furthers the cause of open access to medical information – and nothing else.