In a small, rural, rust-belt town there sits a nondescript office building not far from the town square. The building is an unassuming amalgam of storefronts, offices and vacancies. Near one of the offices, there hangs a shingle: "Psychiatrist's Office." Patients arrive faithfully, dutifully awaiting the chance to receive comprehensive, compassionate care and the most appropriate medicine for their maladies.
My mother runs this clinic, striving to provide the best and most cost-effective medicine possible. She must avoid extraneous expenses so that her patients are able to access quality care despite the depressed economy. Without the resources to purchase all the necessary but expensive journal subscriptions, many of which cost hundreds to thousands of dollars per year, she is unable to access the most recent medical discoveries that would benefit her patients. At times, she has had to call upon me — a medical student at Johns Hopkins not yet in clinical practice — to seek out current studies and provide synopses of the most recent science. She should not have to resort to such convoluted means to obtain information that is so vital for her patients' well-being.
In our outdated system of disseminating research papers, the information vital to human medicine sits locked behind paywalls. If you've ever tried to open the full text of a journal article, you've likely faced a prompt demanding $15-$32 per article reader fee. Two of the largest scholarly publishers, Elsevier and the American Publishing Association, have invested untold sums to push for industry-friendly legislation that would keep this lifesaving information from the hands of the physicians charged with caring for our country's injured and ill.
Yet, in 2008, physicians and the American people won a great victory. Congress moved to allow the National Institutes of Health Public Access Policy to provide free access to the results of the approximately 90,000 governmentally funded studies published each year. This policy provides access to NIH-funded studies within one year of publication, providing at least reasonably new information upon which physicians can make their clinical decisions. However, not all scientific information is publicly accessible — and what is available has been the target of a recent industry-sponsored attack.
The so-called Research Works Act, introduced by Rep. Darrell Issa, a California Republican, and Carolyn Maloney, a New York Democrat, would have rolled back the NIH's Public Access Policy, including PubMed Central, a free database that more than 500,000 online users access on a daily basis. This bill, and its many iterations, was designed by the Netherlands-based behemoth, Elsevier, to serve the profit margins (greater than 35 percent) of the print industry and the coffers of politicians, no matter the expense to the public. Due to public outcry, a boycott of Elsevier and politicians' shift in focus to the upcoming elections, the RWA was shelved. Even though the Research Works Act is effectively dead, the threat of heightened access restrictions remains.
Recently, Rep. Mike Doyle, a Pennsylvania Democrat, reintroduced an alternative bill, the Federal Research Public Access Act (FRPAA). FRRPA is the antithesis of the RWA. The bill is now awaiting committee votes in both the House and Senate; if passed, it would require major recipients of federal money to submit an electronic copy of research that's been accepted for publication in a peer-reviewed journal. This bill would ensure that the information is preserved in a digital repository, permitting free public access and long-term safeguarding. It would require that each taxpayer-funded research paper be made available to the public free of charge no later than six months after its official publication date.
Thanks to the diligence of so many students, scientists, clinicians and public supporters of free and open access to research, FRPAA has been reintroduced, and the RWA has been thwarted, at least for now. These proponents of open access refused to accept that in this digital age, clinicians should be so removed from the data providing the foundation for evidence-based practice. FRPAA will grant clinicians like my mother the ability to use this information that is so crucial for the appropriate treatment of their patients. Our voice has been heard, but the fight rages on. FRPAA has to traverse the harrowing political environment of the House and Senate to succeed. We must use our voices and our votes to support free and open access to publicly funded research, and thereby improve the health care provided to the American people.
P. Logan Weygandt is a medical student at the Johns Hopkins School of Medicine. His email is email@example.com.Copyright © 2014, Los Angeles Times