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Increasing access to journals through peer reviewers

Peter Gill
Last edited 23rd April 2012

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?

Do words speak louder than actions? Reflections after the summit.

Ami Banerjee
Last edited 3rd October 2011

I deliberately resisted blogging about it for a whole month, partly because I wanted to see the build-up and the aftermath of it, and partly because I wanted to see what everybody else said about it. I am, of course, talking about the UN High Level Meeting for non-communicable diseases (NCDs) on 19th and 20th September. The only other occasion that the UN has met like this on a health issue is for HIV/AIDS. The stakes were and are undoubtedly high and momentum has gathered and continues to gather. Yet there is definitely a sense of anti-climax after the summit. The organisation and run-up to the meeting seems to have been dogged by logistical but more importantly, by blocks through governments and multinational companies concerned about hard outcomes from the meeting.

I followed ex-BMJ editor, Richard Smith’s blog keenly throughout the meeting. It does not seem like the key stakeholders were invited or asked for opinions in time. As he said, probably the best thing to come out of the meeting and the pre-meeting is the NCD Alliance, a robust organisation of all the important stakeholders joined for the common purpose of raising awareness.

There is no question that awareness has been raised, and the summit was covered by medical journals, including the Lancet and the BMJ. Interestingly, the major American journals were notable by their silence on the first NCD summit of its kind. Yet, these same journals are the first to publish trials of expensive therapies for cardiovascular diseases, often with major conflicts of interest. On the subject of conflicts of interest, there are particular concerns about NCDs and the way big company interests are still able to play a major role in the UN.

The newspapers and other press gave coverage, but not as much as one would hope. Some of the loudest calls for actions came from celebrities such as Jamie Oliver. Looking around the WHO website, I did not find much in the way of concrete outcomes.

During my clinical cardiology practice, I have asked doctors and patients in the last few months if they knew that the meeting was happening. Almost without exception the answer was “no”.

On the second day of the summit, Richard Smith depressingly concluded:
“The big failures for me have been the failure to raise understanding of NCDs among the wider population and—as discussed at this morning’s meeting—the failure to recognise the need for a system that has at its centre patients not professionals.” It does not come much more damning than that.

What is the point of global health and health policy if it is not engaging at all with end-users? At the BMA Global Health event last week, I could not help feeling that this is an issue across global health and health policy-makers. Words are important but so are actions, particularly if the global fight against NCDs is to succeed.

A recent study in BMJ Open used the newly developed WHO International Clinical Trials Registry Platform (ICTRP) to find out how many current studies recruiting children for drug studies collect pharmacokinetic data.

The findings of the study were shocking: only one-quarter of 1,081 trials studying medicines in children collect pharmacokinetic information. Further, only one-third of the medicines identified as a priority by the European Medicines Agency actually collected data (at the time of the study in 2008).

Well what is pharmacokinetic data and why is it important? Pharmacokinetics refers to the study of external substances after they are ingested in the human body. For example, when you swallow a pill, pharmacokinetics explains how long it takes your body to absorb the medication, how long it takes your body to break it down and how long the drug works for.

When children are given medication, doctors, nurses, pharmacists and patients assume that drugs would not be available for children unless they have been rigorously tested and understood. In fact, the truth is quite different. Off-label (outside the product license) and unlicensed (without a license for use in children) prescription rates in children range from 11-80%. There are significant gaps and inadequacies in research conducted in children.

Children are not just small adults and have different safety and efficacy profiles of medications than adults due to differences in physiology, disease pathophysiology, pharmacokinetics and pharmacodynamics. Even adverse drug reactions occur more frequently in children with off-label prescribed drugs.

This vital problem needs to be addressed at multiple levels and the WHO has taken a lead role. The ICTRP will help to improve awareness and make it easier to access accurate, up-to-date, understandable information about clinical trials in children.

The WHO has also launched the ‘Make medicines child size’ campaign in 2007. Hopefully this will address the lack of child studies worldwide as only 38% of trials in children are conducted outside of North America. Clearly studies conducted on children in the US or UK cannot be directly applied to children in Sub-Saharan Africa or India.

Outside of the WHO, the StaR Child Health initiative was founded to improve the design, conduct, and reporting of paediatric research.

A spoonful of sugar to help the medicine go down is not enough. More is needed to understand drugs in children.

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