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Paper Cuts

By Jennifer Durgin

The pages of peer-reviewed scientific journals may not be very colorful, but they're the lifeblood of an academic medical center. The information in journals is essential to clinicians and researchers alike, and journals are the medium through which discoveries made at Dartmouth are spread around the world. That's why both librarians and academics are worried about changes in scientific publishing.

It's a double whammy," says William Garrity, director of Dartmouth's Biomedical Libraries. It's the libraries' job to supply clinicians and researchers in the Dartmouth medical community with the information they need to do their jobs. But these days that means not only picking carefully from among an ever-increasing number of print journals, plus a multitude of online periodicals and reference databases, but also paying more for the resources that make the cut.

Call it what you wish—a double whammy, a catch-22, or a pretty pickle. The financial challenges facing biomedical research libraries throughout the nation are enormous and complex. Doubledigit percentage increases in journal subscription prices have dramatically reduced libraries' purchasing power. A 2004 study in the Journal of the Medical Library Association determined that biomedical journal prices jumped 52% from 1996 to 1999, and another 32% from 1999 to 2002. Furthermore, the proliferation of journals serving ever more narrow specialties and of innovative nonprint resources has compounded the cost squeeze.

At Dartmouth Medical School and Dartmouth- Hitchcock Medical Center, the demand for more journals and for increasingly sophisticated but costly online reference tools, such as Up-to-Date and MD Consult, is on the rise. New scientific subdisciplines require new resources. Newly hired faculty and newly created departments often request new sources of information.

But as a result of soaring serials costs, the Dartmouth Biomedical Libraries have had to eliminate 11% of their journal subscriptions since fiscal year 2000—canceling 48 in 2004 alone. And Dartmouth is not alone in this struggle. Research libraries across the country are also canceling journal subscriptions. Tufts, for example, dropped 51 titles in 2003. Cornell, Duke, Harvard, and the University of California at Berkeley are among the many other institutions that have trimmed their journal offerings.

Dollars and sense

Since 1986, the average price of science, technology, and medical journals has risen by 215%. —Morgan Stanley (2002)

Between 1994-95 and 2001-02, the typical U.S. research library's expenditures on electronic resources increased nearly 400%, to almost $1.4 million. —Association of Research Libraries

Scientific, medical, and technical journals have been the fastest growing sub-sector of the media business over the past 15 years. —Morgan Stanley (2002)

Because of a weak dollar in some years, U.S. research libraries have had to bear price increases of 20% or more for some overseas journals. —Library Journal

The implications of such cuts reach well beyond libraries and threaten the core of scientific discovery and advancement. Peer review—the examination and critique of a study by the author's scientific peers—has long been the accepted system by which new research is evaluated, and it's new research that drives improvements in patient care and public health. As Harold Sox, Jr., M.D., editor of the Annals of Internal Medicine (AIM) and former chair of medicine at Dartmouth, puts it: "It isn't science until it's been peer-reviewed." So getting one's research published—validated by the peer-review system—is essential to academic promotion, to securing research grants, and to developing a reputation in one's field. It's thus no surprise that the future of biomedical publishing is being debated passionately among librarians, scientists, and clinicians alike.

One might therefore expect officials at Dartmouth's Biomedical Libraries, faced with such tremendous obstacles, to be begging for more money from the administration. However, their attitude suggests a broader understanding of the institution and its mission and of just how

out-of-control biomedical publishing has become. Although their journal budget has risen from about $875,000 in '99-00 to $1 million in '04-05, the increase hasn't been enough to keep pace with soaring subscription prices.

"I could easily spend, this year, $150,000 more than I am going to spend and have it be worthwhile, used material—not fringe stuff," says Margaret Sleeth, associate director for information resources. "The Medical School doesn't have that much money to give me, but let's say they did. Two years from now, I'd still be crying for more money because the cost of what I just committed to will have gone up."

The dollars add up quickly. For example, DMS pays $24,000 a year for restricted access (meaning only five people at a time can use it) to the online resource MD Consult, and the Journal of Comparative Neurology costs $19,500 a year.

There are several factors driving up the cost of journals. One is the dwindling pool of subscribers. It's estimated that the number of scientists in the United States has increased from 1.9 million in 1965 to nearly 6.8 million in 2000. Yet fewer and fewer individual scientists are subscribing to journals. Instead, they access those they need via their institutions' electronic site licenses—allowing them to read their favorite journals online from the comfort of their office or lab or home. This holds true in the private sector as well, where, for example, several physicians in a group practice may share a single print or online subscription.

"It used to be that every doctor in a practice group took the [top] journals," says William Morain, M.D., a former DMS faculty member who is now editor in chief of the Annals of Plastic Surgery. "But now, only one copy is taken" by the entire group.

The resulting cost-shift, says DMS's Bill Garrity, has been borne largely by libraries. For all the wonders of the advent of digital publishing—such as interactive features, searchability, and remote access—this shift has been one of its major drawbacks.

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Jennifer Durgin is Dartmouth Medicine's senior writer. She joined the magazine's staff this past June.

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