Another Call for Open Access

The following is a snippet from my upcoming book that was ultimately cut.

The profitable world of paywalled research

The majority of academic research is published in journals controlled by a few commercial publishers, which make up a $19 billion global industry.

Journals profit immensely from tax-payer funded research, and usually charge exorbitant fees for access to articles that most tax-payers cannot afford. It's a system that, as a Deutsche Bank report put it, is a bizarre "triple-pay" system, where the government funds the research, pays for the peer review, and then buys the final product.

It’s a clever business model for these commercial publishers; in fact, they have higher profit margins than tech companies like Alphabet, Apple, and Meta. But we, the taxpayers, subsidize this profit. Our tax dollars pay for a portion of this research and then pay again to access the research results. It’s bonkers. 

Why open access matters

When research is locked behind paywalls, it hinders collaboration, slows down innovation, and perpetuates disparities in access to knowledge. The Open Access movement upends this broken model, making research accessible to anyone, regardless of their ability to pay. It breaks down these barriers, allowing all clinicians, researchers, policymakers, entrepreneurs, and even patients to access the latest findings, share insights, and build on each other's work. It accelerates the translation of research into practice, leading to faster development and proliferation of new solutions.

The impact factor trap and publication bias

Another challenge with academic publishing is that in order to make money, journals must prioritize their "impact factor"—a metric determined by the frequency with which their articles are cited—as a measure of prestige and a means to attract high-quality submissions and subscribers. The result is sometimes a misalignment between what gets published and what truly benefits the medical community.

For instance, negative studies and replications—important for validating and refining existing research—often have less "news value" and, therefore, less citation potential, making them less attractive to high-impact, closed-access journals. In fact, on average, studies with negative or null results take one to four more years to be published, if at all, compared to studies with positive results. This publication bias is amplified as any study that aggregates data from earlier research may inadvertently distort results by underrepresenting negative or null findings.

Similarly, our obsession with papers with statistically significant results potentially incentivizes researchers to not share their findings, or worse, manipulate their data or selectively report findings to achieve a more publishable paper. This bias towards positive results can hinder the progress of evidence-based healthcare by skewing the overall body of knowledge. 

Why I support open access

In addition to helping speed up innovation, open access can also help chip away at this publication bias. By removing financial barriers to publication, Open Access allows for a more comprehensive and balanced representation of research findings, ultimately leading to a more accurate and reliable body of knowledge that can better inform healthcare decisions and practices. The goal is not to eliminate the valuable curation and peer-review process that reputable journals provide but to ensure that access to knowledge is not limited by financial constraints, thus promoting a more diverse and representative body of research evidence.

The tides are turning on open access globally. In some countries, any research supported by public funds must be available in open-access academic journals as soon as it’s published. Major philanthropic organizations like the Gates Foundation also now mandate that the research they fund be published openly. In 2019, the U.S. National Cancer Institute’s “Cancer Moonshot” research program began requiring grantees to make papers developed with its funding free to read. And Plan S, a coalition of research funders, has thrown its weight behind open access, requiring that research they support be published in compliant open-access journals or platforms.

These changes in academic publishing toward making open access the norm rather than the exception are promising. While there are still challenges to overcome, such as sustainable business models, keeping quality high, and the cost of Article Processing Charges (APCs)— the fees that publishers charge authors to cover the costs of publishing and distributing their work in open-access journals, there is momentum behind this movement. As more research becomes freely available, we can begin realizing the potential for more collaboration, innovation, and, ultimately, improved healthcare outcomes.