A recent letter to the editor in the Canadian Medical Association Journal (CMAJ) highlighted a potential opportunity to increase access to subscription-based journals for individuals in low and middle-income countries. It turns out that a few journals give their peer reviewers’ free journal access or a free subscription as a thank you gift for their effort.

How widespread is this policy in the medical publishing world?

Unfortunately not very. Of the 21 journal editors contacted (including CMAJ, Lancet, BMJ, JAMA, etc.), only three actually provide reviewers with free journal access. The gift ranges from a 3-month (Lancet) to a 12-month subscription (BMJ and the Journal of Intellectual & Developmental Disability).

On the positive side, 20 out of the 21 journals were members of the Health InterNetwork Access to Research Initiative (HINARI), the World Health Organisation’s programme to provide free or low cost online access in the developing world to scientific research. This is encouraging, but HINARI is not perfect and many are still left without access.

For example, a BMJ Rapid Response highlighted that health care workers in middle-income countries such as Malaysia are often caught in the middle. Too rich for aid but not wealthy enough to afford the high cost of journal subscriptions.

However, despite the fact that most original research relevant to low and middle-income countries is open-access, the majority of the education articles, clinical reviews, news pieces and commentaries are still often behind firewalls that require payment.

The move for more open-access journals is encouraging. For example, the Howard Hughes Medical Institute, the Max Planck Society and the Wellcome Trust will be launching eLife, a new open access journal later this year.

Why don’t more journals provide peer reviewers with free subscriptions? Not only is it a symbol of appreciation for the hours of gratuitous time altruistically invested but it could be used to help others. Likely there is no pressure or demand for it. The majority of peer reviewers are already at academic institutions with subscriptions.

Has this happened to you before? What have you done with this free gift? Although few journals seem to be endorsing this policy, it may serve as a small way to increase access to those who otherwise do not have it.

In the future, if you review an article for the BMJ, the Lancet or the Journal of Intellectual & Developmental Disability (or other journals that provide free subscriptions after peer reviewing), rather than deleting the email consider who might benefit.

If you review for a journal that does not, ask the editor why not?

This week brought back fears from a decade ago. Michele Bachmann, a US Republican presidential candidate, claimed that the HPV vaccine was a "very dangerous drug" that could lead to "mental retardation".

HPV or human papillomavirus is a virus that is associated with the development of genital warts and cervical cancer. Just this week, the Lancet reported that the global cervical cancer rates have increased over the past 30 years to 454,000 cases in 2010.

Clearly cervical cancer is an issue that cannot be ignored. Vaccines against HPV are life-saving.

Bachmann’s claims drew a sharp response from the American Academy of Pediatrics who stated that her comments have “absolutely no scientific validity.” To date over 35 million doses have been administered in the US with an excellent safety record.

Why did she bother to meddle with science? The answer is deadly simple: politics. Republican rival Rick Perry issued an executive order requiring girls in Texas to get the HPV vaccine in 2007. In a heated debate, Bachmann suggested that the decision was made in return for political donations from Merck, the manufacturers of Gardasil (the HPV vaccine used in the US).

Conflicts of interest are a separate issue; the focus here is on science.

The concern amongst health care professionals is the damaging impact false claims have on vaccination rates. The perceptions of vaccines changed forever after a now retracted article was published in the Lancet in 1998. In this small study of 12 children the now-disgraced British doctor Wakefield linked the Measles Mumps and Rubella (MMR) vaccine to autism. The media coverage and speculation that followed led to UK vaccination rates dropping to 80% in 2003-4.

Vaccine fears have fueled the recent outbreaks of measles. Before the MMR vaccine, measles was thought to be “as inevitable as death and taxes”, mumps infection could lead to sterility in post-pubescent boys and pregnant women that contracted rubella had children with serious congenital defects. The MMR vaccine was a public health success before Wakefield.

Politicians can throw mud at each other all they like but when they enter the ring of public health, they jeopardise putting all our health at risk. Society cannot let another vaccine crisis strike.

A US bioethicist has stepped forward and offered $10,000 to Bachmann’s charity of choice if she can prove a claim that the HPV vaccine caused mental retardation. Will she take on the challenge? For the sake of public health, hopefully not.

It’s always a pleasure to listen to Sir Ian Chalmers but the topic of choice at SAPCprimary care conference is to irresistible to not blog about.

Most of you reading this blog will be involved in doing or reporting research: it seems you may be wasting a lot of resources. If you aren't involved in research then you may want to know, why does so much effort go to waste?

If you don’t know who Iain Chalmers is? He did this small thing, setting up the Cochrane ollabaration, and now directs the James Lind Library.

In 2009, Iain and Paul Glasziou published a piece you should consider reading in the Lancet which highlighted the problems: “85% of research investment is wasted worldwide.”

If you are an epidemiologist then the four questions you would want to ask are published some time ago by Austin Bradford Hill
1. Why did you start?
2. What did you do?
3. What answer did you get?
4. What does it mean?

If you can’t answer these questions about the research you are doing then it seems you should go back to the drawing board.

Part of the solution is to create better questions, relevant to patients, and developed by patients. You may be surprised that a resource to make uncertainties explicit and to help prioritise new research is actually available. It is called DUETs. It has been established to ‘ publish uncertainties about the effects of treatment which cannot currently be answered by referring to reliable up-to-date systematic reviews of existing research evidence’.

I am continually frustrated with the amount of guff published in the media about the latest ‘dramatic health cure’, Yet an imitative like DUETS never gets a jot of news space. However, this initiative is unlikely to away, and at some time in the future it is likely it will pervade all aspects of research.

The key take home messages are: there is substantial avoidable waste, research should address known uncertainties and engagement of patients and the public is essential.