Does Pay-to-Publish Threaten Health Science Integrity?

3694454531_4f4ce520d02A couple of recent postings, about Tracking Disease with Twitter and a review showing that there’s no evidence that electronic medical records improve health quality or value have quietly raised an under-discussed part of health care, wellness and the research base that (a least in theory) underpins our knowledge of those domains.

This is the world of professional health publication, aka academic publishing, peer reviewed publications, the health literature. Basically it’s the jargon rich, hardly intelligible home to such hallowed names as The New England Journal of Medicine, Journal of the American Medical Association (sometimes referred to as JAMA), the British Medical Journal, and about 100,000 other titles (I’m making that number up, not sure how many health journals are out there, since it matters little to this story).

In most cases, journals get a sweet deal. Researchers, often at some of the world’s most prominent institutions, get funded by a third party to produce research, then submit the findings to be published, generally because their career and reputation depend on it. Journals review the submissions, send them out to volunteer peer reviewers (if it’s a peer reviewed publication), then publish the resulting studies if they meet appropriate criteria.

The findings are now part of a larger body of knowledge, accessible to all, right? Well not exactly. Most journals are profit centers. This may not be a bad thing, but it could have unintended consequences. Material that is published is free to the journal, but the journal is not free to its readers. In some cases there are open access provisions, but in most cases a subscription is necessary to access the full text of a study (or they become free, but only after a certain time period). So you either pay anywhere from $25 to $50 to purchase a single study, or you trudge on down to your local library to see if they are subscribers. But there’s a catch here too: Libraries are no longer able to subscribe to individual journals, as massive publishers such as Blackwell Synergy, and Elsevier bundle subscriptions together (similar to cable TV). This drives up the costs to libraries considerably. Remember, these are publications that may cost $300 to $2000 per year to subscribe to. Imagine what a subscription to a bundle of 100 titles must cost.

Some journals won’t even send a published author a free copy of his/her own study.

There are exceptions:

Some federally funded research is published with the understanding that it be freely available to the public. In some cases authors can pay a fee to have their publication freely available. Many journals have at least a few teasers accessible to the non-paying. And there are an increasing number of “open access” publications. These are collections such as PLoS (Public Library of Science) and BMC (Bio Med Central) that publish a host of titles that are freely available to anyone with an internet connection. In addition to being convenient for health writers and other researchers, it nestles nicely with the social media values of transparency and open access to information, especially to a public increasingly empowered by Google to become their own health information resource.

The catch?

Authors submitting manuscripts have to pay a publication fee, something that folks such as Justmeans reader Ron Wolf calls “pay-to-publish.” These are significant fees, in the $2000-$3000 range, even if you want to publish a lowly letter to the editor that points out a potential flaw in a previous publication. This could be viewed as a conflict of interest masquerading as a business plan, or possibly worse a means for utilizing the good name of "open access" to turn a profit. If I'm paying you publish my material, will you be motivated to publish based on fees earned rather than the objective merits of my submission? But PLoS would counter that they are dedicated to publishing methodologically sound research that may not be considered interesting or relevant by other journals. This is especially important in an error when "publication bias" leads to many more positive studies being published showing when a drug works, for example, than negative studies showing when a drug doesn't work. This also frees them from many of the business decisions that no doubt shape what types of research are published by more traditional publications.

This raises several questions, including:

--Does the “publication fee” or “pay-to-publish” model reduce the validity of the research it publishes?

--Is it truly “open access” since unfunded researchers, myself included, cannot afford the cost of submitting to these publications?

--Are they any better or any worse, in terms of access and smacking somewhat of profiteering, than the publishing giants such as Elsevier?

--Is this new model a net-gain or net-loss for information quality and access?

Incidentally, if you are a patient, consumer or writer and need access to a publication, try emailing the author and asking if he/she can send you a PDF of their study. Many are perfectly willing to do so. To find their email, try search for the article either in Google Scholar, or

Photo credit: The author, via Flickr