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Paper Cuts

Yet it's the depth of that pocket that has fueled the access debate. "In 2001, Reed Elsevier's STM division's operating profit was 34%," according to the Association of Research Libraries' 2004 report. The report also noted that "multiple-year licenses to large bundles of content" force libraries "to cancel titles from smaller publishers to cover price increases of the bundles."

Even Sleeth and Garrity, who are skeptical about open access, recognize the need for alternative publishing models. Dartmouth benefits from the package deals that group several journals together for one discounted price. But Sleeth expects that to change soon, as the inflexibility of the bundles—which often require multiyear subscription commitments—force her to make cuts elsewhere.

In essence, says Garrity, DMS faculty "do have open access. There are no barriers for the Dartmouth community to read and use information we provide to them. The barrier is that we can't afford everything."

And "everything" is a constantly growing universe. Adding to the problem is the proliferation of new journals. As Sleeth notes, "Ten years ago there was just Nature. Now we subscribe to the original Nature and several spin-offs, all of which are expensive: Nature Biotechnology, Nature Cell Biology, Nature Genetics, Nature Immunology, Nature Medicine, Nature Neuroscience, Nature Reviews Cancer, Nature Reviews Drug Discovery, Nature Reviews Genetics, Nature Reviews Immunology, Nature Reviews Microbiology, Nature Reviews Molecular Cell Biology, Nature Reviews Neuroscience, [and] Nature Structural Biology. And that doesn't count the five new titles they are publishing for 2005 that we can't afford to add."

And the burden is only exacerbated, Sleeth says, when "some editorial board" realizes that the cost of biomedical journals "is a big problem. They'll say, 'We don't want to be associated with

An August 2004 report compared the average expenditures of research libraries on for-profit and nonprofit publishers in 2002. For-profit publishers were far more taxing on libraries' budgets, with average expenditures per publisher ranging anywhere from two to 20 times more than per nonprofit publisher.

Elsevier anymore, so we're going to start a new journal.'"

"So the old Elsevier journal still exists," Garrity chimes in. "People still want it."

"But now we have a competitor," continues Sleeth, "which maybe only costs $500 versus $2,000, but that's $500 more that we're going to have to come up with. People want the new one, too, but the old one people still want."

The scientific and medical publishing market is often described as "inelastic" because the "products"—the journals, that is—can't be substituted for one another. For example, if a researcher needs a specific article from the October 2004 issue of Nature Genetics, there is no acceptable alternative.

Dartmouth currently has either a print subscription or licensed online access to 96 of the top 100 science journals. Even so, Sleeth maintains a wish list of journals, many of them quite narrowly focused, that members of the faculty have requested but to which DMS does not subscribe. As of October, the list contained more than 115 titles, which would cost an additional $95,000 a year. Yet narrowly focused journals play an increasingly essential role in advancing science and medicine.

"There's a lot to be learned that is important to practitioners of highly specialized and narrow fields," explains Sox, who was involved with the founding of two relatively small journals, the Journal of General Internal Medicine and Medical Decision Making. "Much of this research, the larger journals don't have

room for," he explains, "and in some cases don't see as necessarily part of their mission to publish. And yet there's a need for scientific communication. So, I guess I'm not particularly troubled by the proliferation."

Although Sox worries about the burden on medical libraries, he also worries about "barriers to communication of valid scientific research that may impact favorably on patient care."

As with any great conundrum, close examination of the issue raises more questions than conclusions. For now, Sleeth and Garrity are stretching their budgets as far as they can to maintain the high quality of Dartmouth's biomedical journal collection, while educating faculty and administrators about the issues. "We're hanging on by our fingernails," says Garrity. "We've been really good and doing what we can and buffering the faculty and the researchers and the clinicians and educators from these tensions, but it's going to implode at some point." No one's quite sure what that implosion will look like. But it's likely to be composed of many more journal cancellations. Further cuts will "seriously erode" quality, they say.

The scientific and medical publishing market is often described as "inelastic" because the "products"—the journals, that is—can't be substituted for one another. For example, if a researcher needs a specific article from the October 2004 issue of Nature Genetics, there is no acceptable alternative.

"We're just librarians," Garrity concedes. "At the end of the day, it's the faculty who are publishing the information. . . . We're the handmaidens to the research and clinical enterprise."

"I'm not sure that librarians are going to be the people that solve this," adds Sleeth. "I think it's going to be the institution and the academy."

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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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