Garrity and Sleeth question the long-term sustainability of ventures like BMC and PLoS, however. "Are junior faculty going to be so confident that this new model is good that they're going to publish in these less-than-prominent journals?" Garrity wonders. "Your career can be made or broken by having that article in Science. Are junior faculty going to be confident enough to 'experiment'? Are tenure committees going to consider a publication in Journal X as prestigious as a publication in Science?"
Many librarians support open access, adds Sleeth, in order to build momentum for the creation of institutional repositories where a university's own research papers would be archived and made freely available. "I think that's where people dream of being, but getting from here to there is the hard part."
In addition, as AIM editor Hal Sox notes, open access could have implications for professional societies that depend on the revenue generated by the journals they publish. "I'm not sure what kind of business model they're going to adopt once those grants run out," says Sox. He notes that a typical peer-reviewed article for the AIM costs several times more than the author fees that BMC and PLoS charge. "A publishing model that doesn't pay the full cost of peer review—I see that as a real threat to the public interest," he says. "Clinical journals that can't do the kind of peer review that the major journals do run the risk of publishing things that aren't right. And when you're talking about new treatments, getting it wrong is a big-scale mistake."
Another concern for Sox (who is based in Philadelphia but continues to hold an appointment on the Dartmouth faculty) is "that members of the American College of Physicians might find less reason to be members if they could get free access to the Annals. Annals is consistently, far and away, the top-rated benefit of being a member of the College in surveys that we do periodically. So organizations like ours have good reason to be concerned about the potential impact of free access."
Dartmouth vascular surgeon Jack Cronenwett, M.D., coeditor of the Journal of Vascular Surgery, is also critical of the authorpays concept. "I would question any model in which authors were required to pay for publication, because theoretically that implies discrimination on the front end," he says. "What we have
now potentially is discrimination on the back end, where access may be limited but is at least possible. Any individual can go to [a library]; it may be inconvenient, but one can get there."
Author-pays models also disadvantage major research institutions, Cronenwett points out. For example, if DMS's 877 faculty members published an average of two papers apiece per year in journals that charge $1,500 per paper, the tab would be $2.6 million. Meanwhile, undergraduate schools that do not conduct much research would have access to all those results at no charge.
The fact that scientific publishing has both nonprofit and for-profit players is also a complicating factor. Even many society-owned journals are actually published by for-profit companies. Such firms "have the people right there who are capable of doing all the copyediting and the publishing. And they ship it out and they bind it and they mail it," explains Ann Barry Flood, Ph.D. She is a professor of community and family medicine at DMS as well as the coeditor of Health Services Research, a journal published by the for-profit firm Blackwell. Open access has "the potential of taking away the rationale and reason behind Blackwell wanting to do this," she continues. "They have to at least make [some] money."
The public sector is also wrestling with all these issues surrounding access to scientific information. In July 2004, the House Committee on Appropriations
ordered the National Institutes of Health (NIH) to "make the complete text of [peer-reviewed] articles and supplemental materials generated by NIH-funded research available on PubMed Central," a digital library maintained by the National Library of Medicine.
Congress told the NIH that such a system must be implemented in 2005. It will ensure that any published peer-reviewed paper resulting—even in part—from NIH funding will be freely available online six months after its publication. Proponents of the concept, including patient-advocacy groups and 25 Nobel laureates, argue that the latest scientific findings should be accessible to the average citizen. "When a woman goes online to find what treatment options are available to battle breast cancer, the cutting-edge, peer-reviewed research remains behind a high-fee barrier," the Nobelists wrote in an August 2004 letter to Congress. "Families looking to read clinical trial updates for a loved one with Huntington's disease search in vain because they do not have a journal subscription."
"A publishing model that doesn't pay the full cost of peer review—I see that as a real threat to the public interest," says Harold Sox. "Clinical journals that can't do the kind of peer review that the major journals do run the risk of publishing things that aren't right. And when you're talking about new treatments, getting it wrong is a big-scale mistake."
But, wonders Ethan Dmitrovsky, M.D., chair of pharmacology and toxicology at DMS, "what would be the mechanism for support of the journals if they do not have revenue from subscription fees or page charges?" (Some journals charge authors a fee for each page of their article.) Dmitrovsky is associate editor of four prominent cancer journals, and he also chairs an NIH peer-review committee and routinely serves on NIH review panels. "There's greater pressure on the research dollar today than ever," he continues, "given the fact that we're expecting the consequences of the flattening of the NIH budget to be evident. And, again, that raises the question, how will we support the publication process?"
Opponents of the NIH initiative maintain that taxpayers will bear the burden because the NIH will have to spend an additional $2 million to $4 million to post