Open Access and the Public Good: A Physician’s Perspective

Leave a comment

July 27, 2017 by Brian Rosenblum

We are pleased to introduce as a guest blogger, Matthew N. Stein, MD, who responds from a physician’s perspective to issues of open access (OA) of scientific literature both in a general sense and specifically in the area of health care. Dr. Stein served as a practicing oncologist/hematologist for 34 years. During that time he also volunteered as an instructor in the Humanities and Western Civilization program (1990–2010) and offered courses in American Health Care Policy (2006–10 and 2014–17) in the Honors Division of the College of Liberal Arts & Sciences at the University of Kansas in Lawrence, Kansas.

Introduction
The remarks that follow are my response to the discussion between Dr. H. Charles Romesburg (Utah State University, Logan) from 2016 and 2017 and faculty from the University of Kansas involved with the analysis and implications of OA of scientific literature (see references below).

Romesburg’s objections (input-process-output, advancement of science, peer review quality and quality of debate, etc.) attempt to keep information “in-house” (within the learned society). They strike me as, at best, elitist (he argues that the poor countries must find an economy and then they can worry about science later) and at worst intended to maintain exclusivity of knowledge. This would seem to be at best exclusionary and probably (in my world of medicine) a product of market forces. His claim that about 75% of the University of California investigators refuse to make their work available smacks of the most prolific current influence in the world of research and academic medicine. (I am thinking of exclusive patents, “shops,” and the licensing of extraordinarily lucrative creative rights to the product and process innovation that limit availability of information). The question for Romesburg, scientific investigators as a group, and specifically to many of my medical colleagues becomes “what is the purpose and goal of academic pursuits” particularly medical ones which directly affect the lives and outcomes of all of us, (more on that and Bayh-Dole below).

Secondly direct OA to academic journals and their findings (medical and otherwise) is predominantly an academic and educated/professional class issue at the outset….aimed at the sharing of knowledge and insight into a world of sophisticated disciplines. Researchers write as if their readers are other researchers. It may be argued that readers most likely to be seeking the type of information contained in journals and research articles are for the most part academics, professionals, entrepreneurs and other highly educated individuals or groups. As such the scholarly work available in journals whether they come from societies, commercial producers, or OA should be:

a) available without undue hassle or expense to those who need it, wish to use it, and are capable of understanding it at the professional or scholarly level. As a practicing physician (outside of an academic medical center) unless I subscribe to a commercial information service (e.g., http://www.uptodate.com), the particular journal in question, or wish to pay full fare for an individual article that I desire to examine in depth, it is not readily or easily available.

b) available and understandable to the general public seeking additional information necessary to help them make health care decisions. The latter issue (taken from practical experience in medicine) is of equal or greater importance for our general population. Some popular venues exist (Web MD, Medline Plus, Google), but usually the path to adequate understanding is clouded with commercial and medical jargon that make accessibility and understanding at times very difficult for those seeking insight. We often utilize the term health care “consumers” to depict the relationship that should exist between those in need of health care and the information that should guide the decision-making. At times that can be true (elective procedures, non-acute and chronic illness issues), however the asymmetry of information and understanding that exists between provider and patient (a term I will choose to use) in more acute scenarios needs to be narrowed in a reasonable and understandable fashion so that understanding and decision-making can be enhanced.

Following from my initial comments using the health care model, there are two levels to this problem:  making the information available to those who can use it without the roadblocks which currently exist, but realizing that accomplishing that goal is (in my mind) only the halfway point. Health care and medicine are probably the predominant example of the issues of research/science and its purposes gone astray from original intent. We have come a long way from Salk “neglecting” to patent his vaccine (a bit of an oversimplification) to Genentech trying to patent the BRCA gene (genetic breast cancer syndrome gene). The Bayh-Dole Act of 1980 was intended to provide avenues for more readily accomplishing technology transfer, giving research institutions and individuals the rights to invent, hold patents, and lease/sell the rights to those discoveries. The Act has triggered an incredible upswing in the innovations available across a wide range of disciplines, including my own, which is intrinsically and potentially of great benefit to many. However, it has also (in the world of medicine and health care in particular) caused a progressive commodification of the profession (from academic medical centers to “non-profits” to physicians to PHARMA to insurance “medical loss-ratios” to a host of other examples). The net result has been an emphasis first on bottom-line financial outcomes where the research is often aimed at initial profitability and secondarily at utility for those affected. Our current health care expenditures (18.2 % of GDP and $3.2 trillion) provide some of the world’s greatest innovations, but I dare say at a “market cost” that is both unsustainable and indefensible.

Ultimately it becomes a question of purpose, intent, and I dare say professionalism (dedication to a greater purpose than one’s personal gain). It has become commonplace to assume that one requires exclusively financial  incentives to achieve anything productive; yet our national measures of “productivity” continue to stagnate. Ultimately what do we see as the purpose and goal of academic research whether that be the basic sciences, the humanities, etc.? From my perspective it is an obvious answer that requires ethical action and response from the professionals who manage this information and knowledge. Ask any one of my former cancer patients what they think our job and responsibilities to them ought to be.

We do these things and share this knowledge to improve the plight of everyone (ourselves, our families, our professions, our nation and our world) and build a better place in which to live and prosper. Sharing that knowledge at all levels (academically, professionally, and to the rest of the world) would seem the proper and laudable goal for the common good; ultimately that is what professionals are supposed to do.

References

Bolick, J., Emmett, A., Greenberg, M. L., Rosenblum, B. and Peterson, A. T. (2017), How open access is crucial to the future of science. Journal of Wildlife Management 81: 564–566. doi:10.1002/jwmg.21216. Open version available, http://hdl.handle.net/1808/22672.

Peterson, A.T. (April 20, 2017), Moving from Colonialism and Paternalism to Equity and Cooperation in Scholarly Communication. Blog post on OAnarchy, https://oanarchy.wordpress.com/2017/04/20/moving-from-colonialism-and-paternalism-to-equity-and-cooperation-in-scholarly-communication/

Romesburg, H. C. (2016), How publishing in open access journals threatens science and what we can do about it. Journal of Wildlife Management 80: 1145–1151. doi:10.1002/jwmg.21111

Romesburg, H. C. (2017), How Open Access is Crucial to the Future of Science: A Reply. The Journal of Wildlife Management 81(4):567–571; 2017. doi:10.1002/jwmg.21244