Power to the people!
Medical education is virtually just a click away these days. The Internet has become a vast sea of medical information, providing basic facts and the latest research. Whether it's for a woman diagnosed with breast cancer or for a child with cystic fibrosis, it's there 24-7. Indeed, for many, online medical information is a lifeline.
But the hunt for such information can be daunting. Sometimes access to a key study is denied, but not because it isn't out there, floating in the ether. Consumers are required to fill out an online form and cough up their credit cards--often to the tune of $25 or even $50. That's not the public library we grew up with. It sounds more like a medical cartel.
That common and frustrating scenario has incited a small group of prominent scientists, led by Nobel laureate Harold Varmus, to create journals called the Public Library of Science, or PLoS. PLoS will publish online research articles paid for by authors, not readers--a novel approach. Their populist agenda is to make all knowledge free, pressuring others to follow suit. After all, they reason, taxpayers foot the bill for about half of all published research. The first issue of this effort, PLoS Biology, will hit the screens in October.
Guardians. Here's the argument against PLoS. First, it's unlikely scientists will pay a "publishing tax." But even more, scientific publishing is a huge business, simply because of the productivity of science itself. Someone needs to police the quality of all this new knowledge. Historically, that's been the job of specialty journals. The journal system has an especially esteemed role in clinical medicine, where it, in effect, certifies work that influences patient care. Furthermore, there's already lots of that kind of work available free online from prestigious medical journals. So what's the fuss?
In a word, cash. Marquee journals support themselves with advertising, but smaller niche journals cannot. So they charge higher subscription fees, and, indeed, many have become part of a highly profitable commercial publishing apparatus to survive. These conglomerates, mostly based in Europe, are the real target of PLoS's and others' ire. So dominant have they become that the normally meek librarian community recently appealed to the Justice Department to block a merger of two European giants.
But there is a middle ground here. And in fact there is no need to toss the current system overboard in a medical Boston Tea Party. Knowledge is already open and free and more accessible to the medical consumer than ever before in the history of medicine. You just have to know where to click.
The true liberator of medical knowledge is the National Library of Medicine, the real public library. The NLM is no stuffy ivory tower for doctors, though. Under almost 20 years of physician Donald Lindberg's leadership, the NLM has zealously pursued the goal of making medical information free, open, and easily tapped. The crown jewel of this quiet revolution is the modestly named PubMed (www.pubmed.gov). Virtually all published medical articles from the thousands of professionally recognized and peer-reviewed journals are archived on that site in summary form. I encourage you to learn how to access this public treasure.
PubMed comes with a powerful search engine that will quickly identify by topic virtually all research reports from accredited peer-reviewed journals. One extra click leads you either to the full article posted free or to the journal's Web site, where it can be purchased.
Here's the trick, though. Sometimes the fees are reasonable, but sometimes they're astronomical. If the fee is prohibitive, take this next step: Call either the public information office or the scientist directly. The PubMed summary provides the names of the researchers, their institutions and location, sometimes even an E-mail address. They can freely provide the article to you as long as the request is for your personal use or for scholarship and teaching. What's more, major research institutions are increasingly putting their published work on internal Web sites, making their response to you easier. Most of these publicly supported institutions desire public interest in their work and will welcome you, once you become a habit. Have problems? Let me know.
This story appears in the September 8, 2003 print edition of U.S. News & World Report.