Transcript The Good, the Bad, and the Ugly Rethinking where you

Open Medicine:
New Standards of Access and
Independence
Anita Palepu1,2,3
1Co-Editor, Open Medicine
2Scientist,
CHEOS and Associate Professor of
Medicine, UBC; 3Michael Smith Foundation for Health
Research Senior Scholar
The Good, the Bad, and the Ugly
• The Good: Open Access
 A healthier publishing model
 Open Medicine
• The Bad: The current biomedical publishing
model
 Impeding scientific progress and global public health
• The Ugly: The resultant lack of knowledge
dissemination
The Ugly
Conflict between publisher and editor is a recurring theme
1992
Robert Fletcher : “The pharmaceutical industry
showed us that the advertising dollar could be a twoedged sword, a carrot or a stick. If you ever wondered
whether they play hardball, that was a pretty good
demonstration that they do”
1999
• Editor George Lundberg
fired by the AMA for fast
tracking a report describing
what college students
considered "having sex“
• Coincided with President
Clinton's assertions that he
“did not have sex with that
woman”
• Justification: Lundberg
“Swayed from science and
medicine into politics.”
1999
Editor Jerry Kassirer
forced out because
he objected to
publisher’s use of
editors’ credibility to
market content
editors hadn’t
reviewed
2006
Plan B
• Canadian Pharmacists Association
complained to CMA about a news article on
Plan B
• Publisher instructed editors to withhold article
on grounds that investigative reporting isn’t
scientific research
• Clear interference with editorial autonomy
• Prioritized relationship with a collegial
professional body over best interests of
patients
http://www.cmaj.ca/cgi/content/full/174/7/945
Honourable Tony Clement
• News report about "two-tier
Tony” published online
• Ordered off website by
publisher, who published more
supportive revision after firing
editors
• Prioritized political relationship
over fair reporting of Minister’s
record
• Original and revised versions at
http://www.cmaj.ca/cgi/content/full/174/7/945
Reasons for firing editors
“Need for a fresh
approach”
Reasons for firing editors
“Irreconcilable
differences”
Bottom line
• Publisher-editor relations often turn on
differences in priorities and values
• When the publisher’s priority is to serve
the advertisers, to maximize profit, or to
serve the financial or political interests of
its members, editorial autonomy can be
compromised
Lessons Learned
• Effective governance depends on the
integrity of both parties (publisher/editor)
• An editor who doesn't share the values of the
association/publisher is vulnerable to loss of
autonomy
• A truly independent journal cannot exist
within traditional publisher-editor relationship
Our Values
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Open access
Author retains copyright
Publishing excellence
Editorial autonomy
Financial independence
Political independence
Local community and international engagement
Technological innovation
Current model of publishing
Current model restricts access
• Medical knowledge is privately
owned and available in a
timely way only to those who
can pay
• Billions of dollars of taxpayer
research funding research
seen by small fraction of the
intended audience
 Cost of annual subscription to
Brain Research is $20,000
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Restricted access drives big profits
• High profile drug trial can earn $1m in
reprint sales
• Market leader Elsevier earns profits of
US$290m/yr with margins of 40% on its
core journal business
• Medical publishing the fastest growing
sub-sector of media industry for past 15
years
Restricted access does harm
• Impedes global research
• Contributes to knowledge gap in
developing countries
• Hampers capacity building and
collaboration
• Clinicians, patients and health
policymakers can’t make decisions based
on all the available information
Their goal is to fool most of the doctors most of the
time – should we help them do it?
• PLoS Medicine June 2006
Pharmaceutical Ads
• Driving a $9 billion/year drug industry
• Accounted for US$448 million of medical
journal revenue in 2003
• Medical journals are now dependent on
revenue from pharmaceutical and medical
device advertising
Ads in Association Journals
• In 1996, 5 of 6 physician organizations raised
10% or more of their total annual revenue from
pharmaceutical advertising in affiliated medical
journals
• In 2004, advertising in AMA publications
constituted 15.1% of total AMA revenues
 AMA generated US$40.7 million from advertising, more than
twice the US$17.5 million from subscriptions
Ads in Association Journals
In 1995, 12% of journal
editors reported
conflicts between
advertisers’ wishes and
editorial decisions, and
21% reported that they
had no control over
advertisements
Courting Pharmaceutical Advertisers
• "You'll be amazed at what a week in
New England can do"
• "Once a week, your advertising message
is delivered to physicians who make
decisions and influence the decisions of
others"
• "The place to be for important news,
important readers, important prescribers”
• "Place your ad in the New England
Journal of Medicine and make our
relationship with the medical community
yours.”
Medical Marketing and Media (MMM) October 2000 and November 2003
Courting Pharmaceutical Advertisers
"The highly cited articles published in JCE&M
discuss the application of your company's
therapeutic products in the treatment of various
endocrine disorders.”
Medical Marketing and Media (MMM) May 2002 a four-page advertisement for the
Endocrine Society, which publishes the Journal of Endocrinology and Metabolism
Reader Surveys
NEJM 2007 advertising rate card: "To help
you determine physicians’ reading and
prescribing habits, NEJM conducts
independent market research and
subscribes to PERQ/HCI Focus. To learn
how this research can benefit your
product’s marketing efforts, please contact
your Regional Sales Director or visit our
website,www.nejmadsales.org."
Who do our journals serve?
• No requirements to demonstrate greater efficacy
as condition of advertising
• As a service to advertisers, side-by-side
advertising of competing drugs is avoided:
“Competitive products are separated by no fewer than
four pages for primary indication only, as reflected in the
ad content.” (Annals of Internal Medicine)
Access and dissemination
The goal of a medical
journal should be to
put as much useful
medical information
into as many hands
as can use it to
improve human
health.
Current model driven by profit motive
• Little space devoted to covering health
issues of developing world
 Editors must prioritize what will sell ads
and reprints
 Editors must prioritize audiences who
can afford to buy:
 Pharmaceutical and medical device advertisers
 Physicians in wealthy nations
Current model creates conflict
• Revenue from pharmaceutical “clients” vs.
research-based best medical practice
• Political and collegial relationships vs. best
interests of patients and health policy
• Profit from publications vs. best interests of
progress in global health
A healthier publishing model
for medicine
• Our first responsibility is to do no harm
• Irresponsible not to build a medical
publishing model that will serve Canadians
with greater integrity
Public Knowledge Project
“How are we to
ensure the
university’s
contribution to a fairer
world if access to the
research it produces
about the world is
itself a source of
inequality?”
Qu i c k T i m e ™ a n d a
T I F F (Un c o m p re s s e d ) d e c o m p re s s o r
a re n e e d e d t o s e e t h i s p i c tu re .
Open access publishing
• Subscription fees made sense before
Internet
• Printing, binding, and mailing each
additional paper copy cost additional
amount
• Online publishers have one-time fixed cost
 Cost of 2 readers = cost of 2000 readers
 Why charge all 2000 readers?
Impact
• Impact factor =
citations in given year
to all articles/number
of articles deemed to
be "citable"
• PLoS’ first impact
factor was 8.4
• 2006 IF is 13.5
Open Medicine
Mission
With the understanding that the science and
practice of medicine are global endeavors for
the benefit of humanity, the mission of Open
Medicine is:
 To facilitate the dissemination of high-quality health
research
 To promote international dialogue and collaboration
on health issues
 To improve clinical practice
 To expand and deepen the understanding of health
and health care
Open Medicine
Advertising Policy
• No ads from any business or organization
whose activities are inconsistent with our
mission
 No pharmaceutical or medical device ads
 No ads for CME that is funded by
pharmaceutical or medical device companies
Open Medicine
Reader Survey Policy
• We will not sell information about our
readers’ reading or prescribing habits to
pharmaceutical or medical device
companies
 We’re not about the money
 We’re about the science and practice of
medicine
Publish with Open Medicine
1. If your purpose is to advance science
and improve health
 Science and medicine will advance more
quickly when knowledge is freely available
and widely disseminated
Publish with Open Medicine
2. If you believe publishing in a closed
venue is inconsistent with the spirit of
science or the goals of medicine
“Faced with the option of submitting to an open-access or closedaccess journal, we now wonder whether it is ethical for us to opt
for closed access….”
Anthony Costello & David Osrin,
Institute of Child Health, London
Publish with Open Medicine
3. If you want to publish in a medical journal
that will enhance your work
 Peer-reviewed
 Experienced editorial team with a proven
track record
 Prominent Editorial Board
 Broad scope, internationalist
 Current acceptance rate is 17%
Publish with Open Medicine
4. If you want to retain ownership of your
work
 Creative commons license
 No need to order reprints
 Anyone can reprint and distribute content
with attribution to the author and the source
Creative Commons
Publish with Open Medicine
5. If you want technological innovation to enhance your
publication and maximize post-publication discourse on
your research
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Collaborative online Reading tools
Rapid Response
Open Medicine Blog by Dean Giustini
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Enhanced interactivity and context
Remix, Re-use content of articles through the creative
commons license
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Translation
Additional information-creating added value for your
readership
Figure from a PLoS Medicine article depicting the Drug Development Pipeline
Re-mix of the PLoS article in the Drugs in Neglected Diseases Initiative newsletter
Publish with Open Medicine
6. If you believe – as we do – that
Canadians have a perspective on health
care and health care values that need to
be shared and promoted
•
•
Link to our Associate Editor’s blog by Dr James
Maskalyk Suddenly Sudan
http://www.msf.ca/blogs/JamesM.php
Publish with Open Medicine
7. If you believe independence is essential
to restoring and maintaining the integrity
of medical publishing
 Pharma money creates editorial bias
 Pharma ads undermine good practice
 Commercial and association publishers
interfere when it suits their political or
commercial needs
Technological Innovation
• Open source software
 Development of ideas and code
 Drupal to manage to OM Blog
 XML conversion to allow indexing
 Publicly available resource
 Improves the global circulation of knowledge
Making it viable
• Open access is a
publishing platform,
not a business model
• Editing, producing,
hosting and
promoting cost money
Making it viable
• What are the options for funding?
 Subsidy from host university (Faculties of Medicine or
Health Sciences) and other scholarly institutions
 Fees to institutions
 Author processing fees
 Usually paid by author-sponsors, not out of pocket
 Charged by 47% of OA journals to offset costs
 Waived for economic hardship
Making it viable
• Funding options:
 Foundations/Philanthropy
 Research libraries co-operative
 In-kind contributions:
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Legal incorporation - David Fewer, University of Ottawa
Website design - University of Ottawa e-medicine
Website hosting and tech support – Simon Fraser University
Editorial Wiki hosting and website development - Tarek
Lubani
 All of the editors have contributed their time and money to
launch this project
Making it viable
• Non-pharma advertising
• Sponsorship
 BC Centre for Excellence HIV/AIDS
 CHEOS
 CLARITY
• Donations from individual readers
 Through the PKP, UBC (Faculty of Education)
is serving as our fiscal sponsor and can issue
charitable receipts
Open Medicine Editorial Team
Co-editors: Stephen Choi and Anita Palepu
Deputy Editors: Claire Kendall and Sally Murray
Associate Editors:
Jay Brophy
Bill Ghali
Dean Giustini
John Hoey
James Maskalyk
David Moher
Anne Marie Todkill
Publisher: John Willinsky, PKP
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Open Medicine BoD
• Timothy Evans, WHO Assistant Director General
• Aaron Freeman, Policy Director, Environmental Defence
• Kathryn O’Hara, Professor of Journalism, Carleton
University
• Robert Madden, Tax lawyer
• Leslie Weir, Chief Research Librarian, University of
Ottawa
• Jerome Kassirer, Editor Emeritus, NEJM and Professor
of Medicine, Tufts University