Ransomized Clinical Trials
Today I purchased four songs on iTunes and no surgical literature. Next week I’ll do the same even though my digital life is filled with links to excellent research. Sort of.
Surgery Unnecessary in All Cancers: A Double-Blinded Prospective Randomized Controlled Multi-National Trial of 3.7 Million Patients, says a link. I’m intrigued.
Up pops a news article referencing the trial. I skim, finding a link to the study in a prestigious journal. I know the routine, but I click anyway.
You could be reading this full article… says a ransom note on the landing page. My options: $35 to view a single article, an invitation to subscribe to the journal, a reminder that I may have access through my institution,..
I immediately reach for my wallet. Just kidding. Instead, I mutter: Thanks, Journal of Three-card Monte, for reminding me there ain’t no such thing as a free lunch. Then I buy another song at iTunes just for the satisfaction of getting my 99¢ worth.
Maroon 5 gets my money without second thought; important surgical lit gets deferred like a DRE. Why the rub? Because I’ve been paying for music a la carte since the jukebox, while science literature used to land on my desk for free. $35 is sticker shock! Are my colleagues in the developing world seeing the same $35 price tag? Can my friend Mabior send Springer a fat chicken, monthly from South Sudan, as his subscription fee?
Apple makes buying easier than reaching for a dollar. And cheaper: I paid more in ’77 for We Will Rock You than for Moves Like Jagger today. When Elsevier hooks me up with one-click, 99-cent literature singles, I’ll buy those babies up like a tween with an iTunes gift card. I’ll fill my iPod with randomized trials. I’ll mix trauma/ICU mash-ups, and Siri will hum me Cochrane reviews at LA Fitness while I get my pilates on.
Strange place, the peer-reviewed journals find themselves now: long the collectors, editors, and distributors of studies that transformed medicine, the major science publishers now refine quality research and prevent its otherwise viral spread. Investigators must cringe as their findings are meted out to institutional subscribers while millions of would-be readers are thwarted at paywalls.
Information wants to be free, right? I understand the business model of the publishers, but patients shouldn’t have to wait for the trickle-down of evidence-based care. Where do my patients and I get this sense of entitlement? We’re accustomed to a free internet education. We hit print, not pay, for a hardcopy of whatever. We’re spoiled by the mischief of Napster and the goodwill of sites that create educational content then give it away, such as Wikipedia and Khan Academy. (Free is indeed hard to compete with, as discussed in this ’09 Slate article.)
We consumers need a lecture (free, please) teaching us the value publishers add to the work of investigators. Here’s my layman’s view:
Formerly, much of the publisher’s value was in distribution. Now, distribution is dirt cheap on the internet. Also, today’s budding researcher is pretty self-sufficient. A generation who grew up on Microsoft Office has poster-ready graphs before the last patient is even enrolled in the trial. Peer-review? At the least, peers should be pre-viewing important research – offering critique before an expensive trial is conducted – not waiting around to poke holes in monthly submissions.
Don’t researchers yet co-plan related studies, share data, and continuously collaborate on a dynamic body of science? I only just learned of research tools such as Mendeley and ResearchGate, but I’m surprised the internet hasn’t already obviated the need for our historic scientific publishing model in the same way print journalism and music production have been transformed.
The whole idea of periodic literature is so last millenium. It’s not how we roll now. We roll continually in our hyper-connected world. Continually communicating, educating, entertaining, working, shopping, and building networks relevant to our lives.
Evolution sucks for some species – just ask Neanderthal and the cassette tape. Is it live or is it Memorex? Actually, it’s memento. And while ink and paper served us extraordinarily well for a thousand years, I now carry a printed journal only for that portion of the flight when all electronic devices must be turned off and stowed.
Chris Porter MD
Note: this is opinion, not a paid piece.