Open Access

Medicine lives in the shadows of vulnerability. The granite conformity that exists if peeled would reveal the distortions and countless contrary opinions. Each layer has been imbued with the color of discord.

The medical venue is rich in its diversity in spite of the outward image of uniformity. For so long the shroud that has covered - protected that image, is finally being swept away. The hidden knowledge up until now available to a select few is falling in the hands of all. No longer does one have to find and comb through the journals stored away on shelves of a hard to access medical library. The written word once ensconced in the hallowed halls is at the fingertip of anyone with access to a computer jacked into the Net. This medium not only allows the ability of fast access but also allows those hitherto with dissenting voices to express their rants to merge with the raves.

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The tedium of the glacial paced written word on a journal’s page is now available instantly and open to question. The richness of differing opinions prevents a well-articulated -but minimally reviewed article, to become the hard currency of thought. Previously this currency, could lay its foundation into the minds of many scientists and physicians and become permanently inked. It would become the style of thought and the mode of action. But that is a-changing.

The past although rejoiced for its many advances has also been the historical review of too long entrenched a thought that went unquestioned for too long. The promoters of such thought for whatever reason, either drenched in egotism or delusional perceptions, failed to call their own data into question. Now change is afoot; the thousands of pairs of eyes that review such information are armed with easily available broad spectrum of knowledge that can critique any potential error before it gains semi-permanence.

Open access is ready to revolutionize the science and soon in the near future, the art of medicine. But there are flies in the ointment; if the finder of the research pays for the online publication for open access then one might consider a conflict of interest, or if the peer evaluation process is based on "single blind" analytical review then bias can creep in. Here lies the broadened knowledge base of the reader, who, given this open access can now make a critical and qualified evaluation of the study for all to consider. The process does and will on a rapid basis weed out the charlatans. The written publication which, moves at a glacial pace from completion of the study to information dissemination for consumption, equally hampers the flow of criticisms in letters to the editors taking even larger parcels of time to get through to the authors, makes the old printed publication process archaic.

Dr. Anil Potti

History has taught us that a published journal article without the applied criticism can become ingrained into the minds of the scientists especially the physicians and thereby can alter patient care and management. Equally this sluggish pace leads others to using the "published article" as a reference in future studies thus contaminating and obfuscating the truth. A recent case of a Duke University scientist, Dr. Anil Potti grabbed headlines when his study could not be reproduced by others but at time of discovery, Dr. Potti's article had been cited 100 times in the scientific literature- the contamination had gone "viral." The drama has ended with his resignation from the university. Other notables of ill-repute in the recent past include; Maria Carmen Palazzo, a psychiatrist on the payroll of GlaxoSmithKline has been sentenced to 13 months in prison after pleading guilty to committing research fraud in trials of the company’s antidepressant Paxil on children. Dr. Scott Reuben, a Massachusetts anesthesiologist with several hundred papers to his name, 21 of which were found to be pure fiction pleaded guilty to charges of research fraud in 2010.

Dr. Scott Reuben

The dilemma of fraudulent research is significant; Dr. R. Grant Steen in the Journal of Medical Ethics reported that 788 retracted papers from 2000 to 2010. Steen's research found that U.S. scientists were lead authors on 169 of the papers retracted for serious errors, as well as 84 retracted for outright fraud. This practice, although rare in overall terms (1 in 6109 published paper is retracted or 0-0164 retraction rate) is also prevalent in other countries: China with 89 retractions, Japan with 60 followed by India and the United Kingdom.

Additionally there is monetary cost associated with this fraudulence. Researchers from the Roswell Park Cancer Institute in New York has developed a model that estimates the monetary costs of scientific misconduct cases placing a direct cost of investigation for each case at $525,000.00 or $110 million for 217 cases of alleged misconduct in 2009.

Today's headlines are tomorrow's footnotes and day after tomorrow's retractions. The open access process would, given a wide net of critical thought, clear the cobwebs of improper technique, observer, selection and a whole host of biases with quick dispatch. Although hoped but improbable, it certainly will not weed out all bias or errors and in fact it might add unneeded and questionable comments, but on the whole it will purge the unnecessary, the delusional, the slipshod- intentional or otherwise, the dogmatic and the unexamined axioms of scientific arguments. The discordant clamor and exposed inattention from diverse viewpoints will loosen the grip of firm misconceptions revealing a better reality.

Medicine is at the threshold of a transformative change. Open access will enable a larger number of researchers and would-be researchers to have access to information that might lead to new ideas. Each new idea can generate a new hypothesis and thus a new scientific breakthrough. This arborized venous knowledge base will herald a new era in understanding. A minority opinion based on legitimate scientific research can call to question the stranglehold of the conforming thought. The partitioned cells of knowledge will coalesce into an amalgam of rich diversity easily harvested for use.

Suppose you want information about a specific gene function and related research, it will be a click away. The isolation between scientists will end and even though the desire to compete for the top prize will always linger, as it should- since we are humans, the shared information will give others in the field help with their own research. More importantly it will bring the breakthroughs closer and faster to the practicing clinician who can formulate the best plan for his or her patient.

Where does one go today in search of this scientific grail?

There are easy search engines that provide free information backed by peer-reviewed scholarly information. The list by no means is complete but serves as a starting point.

Tim Wu, author

There is a vast growing library that can be freely accessed today:

Among the many other free access areas, included below are a few that can be accessed via computer or through iPad apps:

PubMed. This excellent resource gives abstracts of all available information in its database. There are free full text articles also available. Those that are in abstract form can be purchased through a separate online source. But the diversity of the information available makes the search more productive for a specified query. An app for the iPad is also available.

Medscape: This resource is an excellent collation of recent scientific data well referenced by peer-reviewed scholarly articles. An app for the iPad is also available.
Google Scholar: The references mentioned here are similar with an as yet smaller database than that which is available in Pub Med. But it is growing rapidly.

PLoS (Public Library of Science): This online service has scholarly peer-reviewed new articles unpublished elsewhere open access for all. The references are excellent and an app for the iPad is also available.

PNAS or Proceedings of the National Academy of Sciences is considering online publishing (PNAS Plus) as a major format starting in 2011. Other major leading widely read scientific journals including Science, Nature, JAMA and Cell amongst others are also online bringing abstracts and an occasional full text article to the public for free. Times-are-a-changing when 20% of all peer-reviewed scientific articles are available through open access!

These examples are heralding a future of intellectual properties freely available to all. Some are free and some tease with abstracts only, hoping to sell entire articles for a price, I believe time will dispel such pecuniary limits.

And although open access is the wave of the future, just like any other new paradigm its control has to remain with the users. A worrisome historical record encountered in the book “The Master Switch” by Tim Wu suggests that when a technological breakthrough paradigm sprouts its wings, there is a desire by some elite to control and manipulate it. Vigilance, in a dialogue for openness will always be a prerequisite for open access survival.

Parvez Dara, MD FACP

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