For Medical Journals, a New World Online

March 20, 2001 - There was a time when the University of Zimbabwe could
boast of subscribing to more than 600 different medical journals, a
collection that made it a standout among sub-Saharan institutions.

Over the years, though, as resources shrank and the journals raised their
rates with disheartening regularity, that changed.

At the university's library in Harare, there are now subscriptions to about
170 medical journals. Librarians there have even taken away the racks on a
wall where journals used to be placed.

That is not all bad news for this university and for countless other
medical institutions and providers in developing countries.

The racks on the wall have been replaced by computer terminals, and
students and teachers have begun to use the Internet to gain access to the
medical journals that gradually are making their way online.

"The B.M.J. has won our hearts because it's free," said Helga Patrikios,
the medical librarian at the University of Zimbabwe.

The decision of the B.M.J. — as the well-regarded British Medical Journal
is known — to make itself available at no charge on the Web is but one
manifestation of the way the Internet is changing the multibillion- dollar
medical journal business.

The Internet has already altered how many journals operate, forcing most of
them to put articles online.

In the coming years, this could fundamentally change the face of the
industry, with some midlevel publications facing the threat of extinction
if they fail to adapt.

On another level — and to the pleasure of many researchers, practitioners
and medical schools in developing countries — the democratizing effect of
the Web has already had at least one benefit: the flow of valuable
information making its way to poorer regions, once a trickle, is now a
steady if still limited stream.

"It's what they call a disruptive technology — it does sort of change all
of the opportunities within the market," said Richard K. Johnson,
enterprise editor of the Scholarly Publishing and Academic Resources
Coalition.

The group was founded in 1997 by representatives of North American research
libraries to try to break what they see as a stranglehold by the
scientific, technical and medical journal industry.

For academics, publication in the "right" journals (think The New England
Journal of Medicine or The Annals of Internal Medicine) can do much to
assure tenure, and so they have abided by many publications' insistence
that they say little or nothing about their work before it appears (lest
the journal be scooped) and that they relinquish their rights to the material.

For doctors, the journals have generally been the only means to keep
abreast of new developments in the field.

And for libraries, journals have been the only game in town, so there has
been little choice but to pay the $15,000 a year or more that some of them
charge, to say nothing about paying for individual articles from past
issues that they do not own.

But the Internet may undo in less than a decade what took three centuries
to evolve. The talk among researchers these days is of e-prints, preprints
and postprints — all ways for researchers to make their own material widely
available, at no charge, before or after it appears in a journal.

Researchers also speak of PubMed Central and Biomed Central, potentially
vast electronic archives of new and previously published articles
available, again, at no charge.

And, there is talk of boycotts of journals by researchers disturbed that
the journals refuse to make the work freely available after a certain
amount of time.

Few predict that any of the top-tier journals face a serious threat. But
some believe that trouble lies ahead for many of the highly specialized
midlevel publications with big price tags and small audiences.

And virtually every journal, from the most obscure to the most prestigious,
is being forced to create an online presence and to reconsider whether to
make some or all of their material available at no charge.

Much of the pressure is coming from outlets like PubMed Central, a new
archive created by the National Institutes of Health.

While the institute, a government agency, had long maintained a vast
archive of journal abstracts that helped steer researchers to articles of
interest, the goal of PubMed Central is to persuade medical publishers to
post full-text archives on the site, where they will be made available
worldwide at no charge.

The publications decide how long to wait before turning the material over.

Some have rushed to do so; most have not.

In either case, said Nicholas Cozzarelli, editor of The Proceedings of the
National Academy of Sciences, "It has forced the whole field, the whole
publishing community, to move in that direction."

The Proceedings was one of the first journals to join the initiative.

PubMed Central, the brainchild of Dr. Harold Varmus, the former director of
the health institute, has provoked criticism in the medical- journal world.

Dr. Marcia Angell, for one, former editor of The New England Journal of
Medicine, has objected to early plans for the archives to print primary
research that has not been reviewed by peers — the cornerstone of any
serious medical journal.

Others have protested that they cannot afford to turn over material without
compensation.

"The main issue is that content is our livelihood," said Dr. Margaret A.
Winker, deputy editor of The Journal of the American Medical Association,
"and so to provide content free of charge can undermine the financial
viability of the publications."

JAMA refuses to discuss its revenues, and The New England Journal of
Medicine stopped divulging revenue figures two decades ago.

But by some estimates, its owner, the Massachusetts Medical Society, pulls
in at least $20 million a year from the journal.

Dr. David Lipman, the director of the N.I.H.'s Center for Biotechnology
Information, which operates PubMed, said medical journals should consider
the archives an opportunity, not a threat.

"What we're basically saying here is, We're creating an archive if you want
to give us your content," Dr. Lipman said. "Put it here and we will make it
available and safe."

The goal, he said, is to get medical information to the places where it
will do the most good, and to preserve it in a form that will make it
readily available in the years to come.

"It's a very simple thing we want to accomplish," Dr. Lipman said.

"We want to make sure that this incredibly precious information is as
available as widely as possible to everyone in the world."

While PubMed Central is gradually winning over some journals, others are
unconvinced. JAMA, which in the mid-1990's experimented with providing its
articles free on its own Web site, now makes only part of its material
available at no charge.

It is about to start its own fee-based electronic archive service.

The New England Journal of Medicine is also considering making its archives
available online.

And some major journals have already decided to make themselves entirely
available online at no charge, among them the British Medical Journal.

This has been a welcome development at places like the University of
Zimbabwe, although Mrs. Patrikios is among the many people to lament the
"digital divide" that separates developing countries from the rest of the
world.

Dr. Klara Tisocki, a professor of pharmacology at the university, said the
Web had already made it easier to do her job, allowing her, for example, to
get the latest information on administering drugs against the AIDS virus.

Still, while some major journals make themselves available selectively to
developing countries, and say they are moving to increase those efforts,
Mrs. Patrikios and Dr. Tisocki said much more needed to be done to make
studies available.

"Important information on human health," Dr. Tisocki said, "is like a
right, a human right."


By ERIC NAGOURNEY
Copyright 2001 The New York Times Company
http://www.nytimes.com/2001/03/20/health/20JOUR.html

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