BMJ and open access

Merrill Goozner laments the end of the British Medical Journal's open access policy.

"Among the four major medical journals, the British Medical Journal is my favorite. It has the most extensive news coverage of the fight against the infectious diseases that are ravaging the developing world, a subject in which I take a keen interest. And it consistently prints iconoclastic studies that take on the medical establishment.

And, until this year, it was entirely free on the web. That made it distinct from the other big-time journals (the New England Journal of Medicine, The Lancet, and the Journal of the American Medical Association), which charged hefty fees to view individual articles of interest if you weren’t a subscriber. But, alas, BMJ’s open access policy went the way of the dodo bird this January, leaving medical consumers locked out of all the major journals. Accessing some of BMJ’s original research articles and all of its news section now require a subscription to the journal.

It’s testimony to the poverty of the public policy debate in this country that no one in the mainstream media has yet raised this issue – access to cutting edge medical information – in response to the Bush administration’s push for “consumer-driven health care” through individual health savings accounts. How are consumers to choose wisely when and where to get health care if they are cut off from key sources of information? It’s like sending car buyers to the used-car lot while denying them access to the Kelley Blue Book.

I’m a skeptic when it comes to consumer-driven medicine anyway. Buying health care isn’t like buying a house or car or even legal services. The vast majority of expenditures occur in either emergencies or when the patient, i.e., the consumer, is under the duress of ill-health. If I find myself in that situation, I want a doctor who can quickly guide me to the most effective care and give me carefully thought-out options that hopefully are not based on some drug industry-funded study published in a second-tier medical journal and dropped off in his or her office the day before yesterday by a drug industry salesman (these reprints are a major source of medical journal publishing revenue, by the way)."