APPENDIX 8
Memorandum from Dr Virginia Barbour
1. I am writing in a purely personal capacity
as a scientific and medical editor employed for the past four
and a half years at The Lancet, a leading general medical
journal. I trained as a medical haematologist in the UK, and as
a scientist in both the UK and the USA. I then became an editor
at The Lancet. My reasons for becoming an editor were similar
to the reasons that I went into medicine and science; because
I am interested in understanding the causes of diseases, and applying
this understanding to the ultimate aim of improving health. For
this aim, I believe that the free flow of scientific information
is essential; not only to other researchers and physicians, but
also to an increasing medically sophisticated public.
2. I am shortly to leave The Lancet
for a job at the Public Library of Science, a not-for-profit organisation
that is committed to open access (ie, free to the reader). By
contrast, The Lancet is owned by Reed Elsevier, a large
for-profit publisher. The Lancet is available as an individual
subscription, but is more often sold to institutions as part of
a bundle of journals; I understand the committee will be investigating
this practice.
3. The main reason for my move is that I
am not convinced that the current user-pays model of publishing,
to which The Lancet's editors are bound by Elsevier's management,
is in the best interests of either the medical or scientific communities,
or the general public. Although scientific and medical editors
and publishers have an important role in making scientific data
available in a useful format, the access restrictions of some
publishers do not serve the medical or scientific communities,
or the general public well. Making information available only
for a high fee at the point of access has the most severe repercussions
for one particular group of end-users; patients. I can illustrate
best the issues that can arise from the current policy of restricting
access using a few recent examples of papers published in The
Lancet.
4. On 29 November 2003, The Lancet
published an article entitled "Caesarean section and risk
of unexplained stillbirth in subsequent pregnancy".[1]
This article reported that the absolute risk of unexplained stillbirth
in a pregnancy following a caesarean section at or after 39 weeks'
gestation was 1.1 per 1,000 women who had had a previous caesarean
section and 0.5 per 1,000 in those who had not. Reading such a
result should allow a doctor or a patient to understand that although
the chances of having a stillbirth increased, they were still
low. Unfortunately several newspapers chose to report simply that
the "risk" doubled. In The Guardian on 28 November,
this was the full text of their report on the article:
5. "Risk posed by C-section birth
Women whose first child is born by caesarean
section double their risk of having a subsequent stillbirth, according
to a Cambridge University research in The Lancet. The caesarean
rate has doubled in 10 years."
6. This report, although technically accurate,
is misleading because of what it omitsthe absolute risk
as well as than the relative riskand suggests that the
writer either did not appreciate the importance of reporting the
absolute risk, or chose to selectively report the more sensational
relative risk. The misleading report would not be so important
if it were not that case that the original article is only available
to non-subscribers for $30, which is likely to deter most patients
from obtaining it.
So this work, which was funded entirely by public
agenciesCambridge University, Greater Glasgow NHS Board,
and the Common Services Agency, Edinburgh, is not available to
the public except for a substantial fee. Incidentally, journalists
are allowed full free access to any article that they want in
advance of publication. What does such an embargo achieve, apart
from publicity for the journal? Advance notice should allow journalists
to interpret the work accurately for the public. However, as shown
by the reporting of this and many other articles, newspapers and
news outlets are primarily interested in attracting readers; even
more serious broadsheet newspapers tend to prefer sensational
news rather than dull but worthy research. [2]
7. A second example of an article where
access to the original report would have been in the public interest
was the Million Women Study[3],
published on the 9 August 2003, of the risks of breast cancer
associated with hormone replacement therapy. This study, along
with a commentary[4]
has generated huge public interest, led to changes in prescribing
guidelines and in the day to day practice of physicians, but again
is only available for a fee. Again it is funded by public agencies;
Cancer Research UK, the NHS Breast Screening Programme, and the
Medical Research Council.
8. Editors have become increasingly aware
of the desire of both authors and users for the free flow of information.
I am a member of the advisory board of the Microarray Gene Expression
Data Society, an organisation of scientists and editors that has
worked to promote the free access to the scientific data that
underlies microarray experiments. Although The Lancet,
along with many other journals, has signed up to this principle,
they often do not make the final papers available freea
clear contradiction of intent. Authors realise the absurdity of
this situation, and are beginning to request that such papers
are made available for free, ie, on an open-access basis.
9. The final issue that I want to raise
is copyright. At the moment Elsevier insists on authors signing
a rather restrictive copyright agreement that limits or requires
substantial fees for reproduction of the data. This restriction
can have severe repercussions for end-users. I was recently told
by a publicly-funded scientist that to make 30 copies of an article
(of publicly-funded research, although from another country) for
teaching purposes Elsevier required several hundred pounds in
fees.
10. The Lancet's editors work around
some of these policies. For example, we make some content free
to all. This policy was implemented for all papers relating to
the SARS epidemic; it is widely acknowledged that the daily free
exchange of information was pivotal in the rapid progress towards
determining the cause of this disease. At The Lancet, editors
and managers seem to have different aims; the former to promote
the free flow of information; the latter to generate revenue.
11. In summary, I believe that unrestricted
access to information contained within primary research is essential.
Physicians and scientists rely on this flow of information for
their work and practice. The public should not have to rely solely
on journalists to interpret research, since journalists have different
priorities to scientists and scientific editors. Instead, everyone
should be able to read freely the primary research (often funded
by public agencies) upon which decisions concerning their health
care are made.
January 2004
1 Smith GC, Pell JP, Dobbie R. Caesarean section
and risk of unexplained stillbirth in subsequent pregnancy.
Lancet 2003; 362: 1779-84. Back
2
Harrabin R, Coote A, Allen J. Health in the News: Risk, reporting
and media influence, King's Fund 2003. Back
3
Beral V, Million Women Study Collaborators. Breast cancer
and hormone-replacement therapy in the Million Women Study. Lancet
2003;362:419-27. Back
4
Lagro-Janssen T, Rosser WW, van Weel C. Breast cancer and
hormone-replacement therapy: up to general practice to pick up
the pieces. Lancet 2003;362: 414-15. Back
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