E-drug: Free access to medical journals
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Free Access to Medical Journals To Be Given to Poor Countries
By David Brown
Washington Post Staff Writer
Monday, July 9, 2001; Page A12
Six giant publishing houses will announce today that they will
provide free electronic access to about 1,000 medical journals to
medical schools, research laboratories and government health
departments in poor countries.
Piloted by the World Health Organization, the program will benefit
about 600 institutions, principally in Africa. It will also include
training in techniques for researching the vast amount of medical
literature by computer.
The initiative is the publishing world's counterpart to the drug
industry's newfound commitment to make medicines for AIDS,
malaria and tuberculosis more widely available to Third World
countries. The democratization of medical information, however, is
likely to be far easier and cheaper than the democratization of
pharmaceutical therapy.
In addition to aiding research scientists in the developing world, the
program may help spread the "evidence-based medicine" revolution,
in which doctors are increasingly expected to search medical
literature to answer their questions and help them make decisions,
rather than relying on memory, customary practice or the advice of
authority figures.
"It is perhaps the biggest step ever taken towards reducing the
health information gap between rich and poor countries," Gro
Harlem Brundtland, director general of the WHO, said of the
agreement.
Although journals have been the main outlets for medical research
for more than 50 years, many institutions in poor countries have
little access to them. The average specialty publication costs about
$1,500 a year, but popular, clinically-oriented journals are often
available for less than $200. Even when subscriptions are
affordable, the copies often arrive months late. Because of that,
researchers and practitioners in the poorest countries often must
rely on librarians elsewhere to cull the scientific literature for them
and forward photocopied articles.
"This is wonderful news," said Vinand Nantulya, a Ugandan
physician and researcher who is a visiting scholar at the Harvard
School of Public Health. "The scarcity of journals in educational
institutions is a big issue."
Nantulya, 55, paid for subscriptions to six journals for the library at
Makerere University Medical School, in Kampala, in the late 1970s
when the Ugandan economy was in a state of near collapse and the
library was getting no current journals.
Barbara Aronson, a librarian at the WHO's Geneva headquarters and
a prime mover behind the program, said most medical schools in
developing countries get fewer than 100 journals, and many only a
few dozen, compared with 1,000 or more in most American
medical schools.
Libraries and research institutions often must pay a higher price for
a subscription than individuals. The Lancet, a popular weekly
European journal, costs a person $134 a year, while a library is
charged $495. Some subscriptions are significantly more expensive.
The most extreme example is Brain Research, which is published
three times a week by Elsevier Science, headquartered in
Amsterdam. Each issue contains about 200 pages, and about 2,700
research articles appear between its covers annually. The journal
costs $17,000 -- and will be among the hundreds of journals
Elsevier is making available.
"The developing countries are going to be getting something that a
top university in the United States would be happy to have,"
Aronson said of the total package.
The cost to the publishers is likely to be minimal, as they won't
have to print or mail more copies than they do now. (The press run
for many highly technical journals is fewer than 1,000 copies.) But
the value of the material is high. Elsevier's package is worth "at
least $500,000" in terms of what electronic subscriptions for all the
titles would cost, said Karen Hunter, an executive of the company.
Under the proposed rules, institutions in countries where the per
capita gross national product (GNP) is less than $1,000 a year
would get the journals free. In countries where the per capita GNP
is $1,000 to $3,000, there would be a minimal charge. Companies
do not have to agree to give away electronic subscriptions in
countries where they have substantial sales now, although some
have indicated they may be willing to.
"This is a way of getting to parts of the world where otherwise
there would really be no possibility," said Margaret Becker, an
executive with Wolters Kluwer, a European company that includes
the Lippincott Williams & Wilkins imprint in the United States and
that publishes such titles as AIDS, Annals of Surgery and the
Pediatric Infectious Disease Journal.
Besides Elsevier and Wolters Kluwer, the participating publishers are
Blackwell, Harcourt General, Springer-Verlag and John Wiley &
Sons.
The idea for the initiative, which will be announced today in
London, arose in part from a meeting the WHO convened in April
last year at which researchers from the developing world were
asked how the organization could help them. Aronson said their
first request was: "We have information problems. Help us get
access to primary information."
The initiative fits with a program launched last fall by the United
Nations called the Health InterNetwork, which seeks to make
statistical data, peer-reviewed scientific publications, clinical
guidelines and health-policy recommendations, software packages
that help researchers make statistical and mathematical calculations
and online training electronically available to resource-poor
countries.
The medical journals will be available through an Internet portal the
WHO is creating as part of the Health InterNetwork. The portal will
both guarantee security and provide necessary tools, such as
engines for searching the journals, said Joan Dzenowagis, the WHO
project manager for the Health InterNetwork.
The Open Society Institute, part of the charitable foundation
directed by George Soros, the billionaire currency trader, in recent
years has provided electronic journal access to 2,100 institutions in
39 countries, most of them in the former Soviet bloc. That program
has concentrated on social science, economics, business and law
publications. It will make its network of contacts available to the six
publishers and the WHO, a foundation official said.
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