The Dartmouth Biomedical Libraries' two locations—one on the Medical School's Hanover campus and one on the Medical Center campus in Lebanon—currently subscribe to about 1,100 journals. About 47% of those titles are purchased only in digital form, meaning Dartmouth no longer gets the print version, and 80% have some digital component. Over the past two years—for various reasons, including to offer 24/7 service to their geographically scattered clients—DMS librarians have switched nearly 500 titles from print or print-withdigital to digital-only.

It's a common misconception that electronic subscriptions—which function more like leases—are cheaper than print subscriptions. Actually, the cost is often much greater. For example, Dartmouth can buy a print subscription to the New England Journal of Medicine (NEJM) for about $400, while a site license—which allows Dartmouth faculty and staff to access the NEJM online, from home or work—costs the library $5,800. Similarly, the American Association of Cancer Research has a package of five journals that costs Dartmouth $2,000 in print form. The price for the same package in digital form would be $11,000, but that's an expenditure DMS has chosen not to make.

It's a common misconception that electronic subscriptions —which function more like leases—are cheaper than print subscriptions. Actually, the cost is often much greater. For example, Dartmouth can buy a print subscription to the New England Journal of Medicine for about $400, while an online site license costs the library $5,800.

The archival implications of digital access are also worrisome. "For the length of your agreement, your contract, you have access [to the journal]. But if, at the end of the contract, both parties walk away, you may not have anything to show for it. Whereas if you stop a print subscription, nobody's going to come and take the paper copies away from you," Sleeth explains. "If the world were perfect, we'd buy both print and digital."

The administration has been "hugely cognizant and supportive" of the libraries' struggle, Sleeth and Garrity emphasize. "They've done, I think, whatever they can.

They've granted us a lot of discretion in how we fund for information," says Garrity.

"Like all of us, they don't have an answer either," adds Sleeth.

But some librarians and academics believe they do have an answer—in a concept called the openaccess initiative, which aims to provide readers with no-cost access to published research.

"In the age of print, open access was physically and economically impossible," reads a report by the Scholarly Publishing and Academic Resources Coalition (SPARC), a group formed by the Association of Research Libraries to "correct market dysfunctions" in scholarly publishing. "But thanks to the Internet, it's an emerging reality. Now, the tradition of producing journal articles without expectation of payment combined with electronic publishing offers an unprecedented public good: the free online availability of peer-reviewed scientific and scholarly journal articles."

But even if putting an article on the Internet is less expensive than printing it, preparing peer-reviewed articles is still time-intensive and costly. The top medical journals—such as NEJM, AIM, and the Journal of the American Medical Association—employ large editorial staffs. Sox, for example, works full-time as the AIM's editor. The journal, published twice a month, also employs more than a

dozen full- and part-time deputy and associate editors—all of them physicians who must be paid competitively—plus a statistician. Add printing, distribution, and administrative costs to the equation and, Sox estimates, it costs between $10,000 and $12,000 to evaluate and prepare each published article.

Most journals do not have quite so much overhead. Rarely are deputy and associate editors paid, and often even the editor in chief receives a small honorarium instead of a salary. Still, many fixed costs remain. "Publishers have had to purchase equipment and design the platforms necessary for the electronic distribution and searchability of STM [science, technology, and medical] journals," according to a study in the Journal of the Medical Library Association. "This includes the cost of archival storage, a new responsibility for publishers, because libraries have historically provided that function for print journals. These investments have created added value for libraries and their users, but they have been in addition to the fixed costs of continuing to publish the print versions."

While the concept of open access is appealing from the reader's perspective, one looming question remains: who will bear the costs that can't be eliminated? Proponents of open access say there are many ways to fund such a publishing plan. Yet the only models currently in use are ones in which study authors—the researchers—pay. For example, BioMed Central (BMC), a for-profit publishing company, charges authors between $525 and $1,500 per accepted article. The fee is waived, however, if the researcher's institution holds a BMC membership, which costs between $1,612 and $8,060, depending on the size of the institution. Dartmouth is not a BMC member but does subscribe to two of the company's subscription-based products—a journal called Genome Biology and a database of scientific illustrations called Images.MD.

Another open-access publisher is the Public Library of Science (PLoS). A nonprofit organization, it charges authors $1,500 to publish in its two journals—PLoS Biology, launched in October 2003, and PLoS Medicine, launched in October 2004. The group was funded by a $9-million start-up grant from the Gordon and Betty Moore Foundation.