Onyx Health Insights: Should medical journals be free to access?

After years, and sometimes decades, of ground-breaking research, scientists may think that upon study completion they have finally reached the end of an often arduous journey. In actual fact, the final barrier is simply getting their research published. 

Paywalls remain common in medical research.¹  Many journals have a subscription-based publishing model, whereby research papers are only available to paying readers. For those without a subscription, downloading a single journal article costs around £30, a high price to pay when a single narrow search can return hundreds of relevant papers.  

There have been growing calls among the industry for a full open-access revolution since the advent of the internet. Many universities and research centres do not want scientific knowledge locked behind paywalls. In 2019 University of California dropped its annual subscription to Elsevier, the world’s largest publisher of academic journals. Additionally, open-access crusaders, including science pirates, have created alternatives that free up journal articles and pressure publishers to expand access.

Is the industry due a change, in the same way the industry for recorded music and movies has changed? At Onyx Health, we’ve weighed up the pros and cons of a fully open-access publishing world.  

Would open-access benefit science authors? 

With the current publishing model, it takes an average of 15 clicks for a researcher to find and access a journal article.²  

Studies have shown that open-access articles are viewed and cited more often than articles behind a paywall ³, meaning open-access may speed medical progress and impact. Furthermore, open-access papers that cross multiple disciplines may increase interdisciplinary conversation and collaborative research.  

Open-access enables the commercialisation of the results of scientific research via the exchange of ideas between the scientific, academic and commercial industries.  

Would open-access benefit the public? 

Patients have expressed a need for better communication between academic research and the community it serves.¹ The open-access revolution would enable a broader audience, beyond the core scientific community, to read research findings. 

In addition, clinical research participants generously give their time and energy to research studies often with the assumption that the results will be broadly disseminated. By making such research freely available, public and patient engagement in science could increase.  

This is critical at a time when patient and public engagement is of upmost importance to the World Health Organization, National Health Service and pharma providers alike. Patient engagement involves encouraging patients to make informed decisions about their own health. Without accurate, factual information, how can patients be expected to be involved in such decisions? Open-access would mean that taxpayers who have funded scientific research have greater transparency on the outputs of their investments. 

What are the barriers to open-access? 

• Reputation – Currently, the prestige of having publications in high-profile journals is what guides researchers’ careers, in terms of the promotions and grants. Many well-considered scientists will, rightly so, not be prepared to let go of this reputation. Many academics still refuse to publish in open-access journals for fear that they are less prestigious and lower quality.    

• Cost – While open-access papers are free to read, they are not free to produce. The cost is simply shifted to researchers who pay money up front to publish. If scientists do want to make their work open-access, they’re charged an additional fee. The average fee for publishing in an open-access journal is £563⁴ which may not be affordable for smaller research groups or those in developing countries. On top of this, academic publishing is a highly profitable business, hence there is always going to be lingering resistance to full open-access.  

• Review processes – High quality information comes with a price. Full open-access could lead to the traditional peer-review process being abandoned. Scientists may start to upload their results directly, without being subjected to any quality control or review process. As with anything, you get what you pay for.  

• Health literacy – Often, scientific papers are highly technical, narrowly focused, and may be misunderstood by anyone without the required specialised training. As discussed in our previous blog on health literacy, the health literacy of adults varies drastically, which could lead to dissemination of misinterpreted scientific information. If all papers were open access, there would be a requirement for authors to add, at the minimum, a layperson’s summary.  

Improving medical literacy is part of the answer 

While making medical journals free to access has potential benefits for scientists and the public, overcoming the barriers is no mean feat. Increasing access won’t necessarily benefit the public, without a wider increase in medical literacy.  

Morever, increasing access to medical information must be balanced against the requirement to uphold high standards and the costs of production. Improving free access to medical literacy resources would be an important first step in bridging the information gap in this area. Its time we all got more medically literate.

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