Education and debate

Navigating across medicine's electronic landscape, stopping at places with Pub or Central in their names

Tony Delamothe, editor, bmj.com. 

BMJ, London WC1H 9JR

tdelamothe{at}bmj.com

Attempts to use the internet to free up access to the world's biomedical literature have resulted in several similarly named initiatives emerging over the past two years. PubMed Central, BioMed Central, and the Public Library of Science have joined the slightly older PubMed, which has a different function but a name similar enough to add to the confusion.

The debates around free access are some of the most important that have taken place in the three centuries of scientific publishing.¹ Yet confusion about who wants to do what to whom is hampering this debate. This attempt to dispel some of the confusion was up to date at the time of writing, but given the speed at which medicine's electronic landscape is changing, it is likely to date fast.

	PubMed

PubMed provides access via the world wide web to over 11 million Medline citations dating from the mid-1960s to the present. It covers 4300 journals devoted to medicine, nursing, dentistry, veterinary medicine, healthcare systems, and the preclinical sciences. PubMed also provides access to life science journals that are not indexed by Medline but have submitted their full text to PubMed Central (see below).

As well as providing access to these abstracts and citations, PubMed links to more than 2000 websites that provide full text articles (figure). Access to these full text articles usually entails registration, subscription fees, or some other form of payment, although bmj.com is free.

In the four years since PubMed was launched as Medline's web interface, it has become the starting point for literature searches for most medical researchers. Over one million searches are conducted through PubMed each working day. A service provided by the US National Library of Medicine, PubMed is paid for by the US taxpayers.

Decisions for authors
In terms of exposure, publishing original biomedical research in a journal not indexed in PubMed is akin to sealing a manuscript in a bottle and launching it on the tide. For authors, it's publish in a journal indexed by PubMed or perish.

Decisions for publishers
Research journals that want to be taken seriously need to appear in PubMed. The main route inacceptance by Medlineis difficult. Only 15-20% of applications to Medline are successful, and the process can begin only a year or two after publication of a new journal. The fact that publishers can leapfrog this hurdle by agreeing to submit the full text of articles to PubMed Central has fuelled publishers' grievances against PubMed Central. Should Medline level the playing field by being less exclusive? Arguments about constraints on space in the paper world do not apply online.

	PubMed Central

As its name suggests, PubMed Central is an extension of PubMed and is similarly funded by the US taxpayer through the National Institutes of Health. Whereas PubMed provides free access to bibliographic citations and abstracts, PubMed Central provides free access to the full text of peer reviewed articles.

Suggested in 1999 by Harold Varmus, when head of the US National Institutes of Health, PubMed Central became operational within a year. In its first iteration, the full text of original research articles had to be made available from PubMed Central some time after publication. Fearing lost subscriptions, most publishers sat on their hands and hoped it would go away.

Given this negative reception, PubMed Central proposed an additional "decentralised model" earlier this year. Although publishers must still send the full text to PubMed Centralto allow for sophisticated searchingPubMed Central could route users back to publishers' sites to access the full text. Publishers have to guarantee free access to this material within a year of publication.²

View larger version (71K): [in this window] [in a new window]   Screenshot of abstract of a BMJ article on PubMed, showing its Link Out facility. In this example, the blue button links directly to the full text of the article on bmj.com

Few journals are currently available on PubMed Central. These are BMJ, Bulletin of the Medical Library Association, Molecular Biology of the Cell, Plant Physiology, Proceedings of the National Academy of Sciences of the United States of America, and 55 journals published by BioMed Central (see below). Another dozen have pledged to participate. None is yet available in the new decentralised format, but 17 journals have either signed up or indicated that they will participate (Ed Sequeira, personal communication).

Decision for authors
Most researchers want to maximise exposure to their work and the credit that it brings them. However, in a world where ever more material is read by ever fewer people, the standing of the journal in which a study appears is widely used as a proxy for the quality of the study itself. (Research assessment exercises have led the way here.)

Decisions for publishers
Publishers' initial response to PubMed Central was a staunch defence of the status quo. Researchers may conduct and write up the research as well as peer review and edit articles, but publishers expected to sell the results of their labours back to them and their librarians at a substantial profit.

	BioMed Central

BioMed Central is an independent publishing house that aims to provide immediate free access to peer reviewed biomedical literature. It publishes all articles deemed scientifically sound simultaneously on its own websites and through PubMed Central.

BioMed Central provides a quick route on to PubMed Central for authors disenchanted with traditional journals' slow peer review process and their practice of charging users for the finished product. It does this in two waysthrough its own electronic journals and by giving groups of scientists the ability to set up electronic journals under their own editorial control. Most of BioMed Central's large stable of electronic journals began publishing within the past 18 months; all of them are indexed by PubMed, even those that are yet to publish an article. To pay for this service, BioMed Central is considering introducing authors' charges of $500 (£330) per accepted article from next year.⁵

Decisions for authors
Publishing in a BioMed Central journal gives interested readers free access to the full text article as soon as it is publisheda potential increase in exposure compared with publishing in more restrictive journals. But like all new entrants, BioMed Central's journals have yet to establish themselves as prestigious destinations for authors, for whom impact factors loom large. Understandably, BioMed Central is "working to develop additional methods for judging the relative importance of particular pieces of research."⁶

Decisions for publishers
Publishers need to decide what to do in response to the BioMed Central "experiment." Should they ignore it, emulate it, or buy the companyif they believe it is several years ahead of the curve?

	Public Library of Science

Sharing some of the same architects as PubMed Central, the Public Library of Science is a pressure group best known for its open letter (box), which has attracted more than 28 000 signatories from 172 countries. The last paragraph of its letter is crucial. It states that signatories will publish in, edit or review for, and personally subscribe to only those journals that have agreed to grant unrestricted free distributions rights to all original research within six months of publication. What many signatories and publishers may not have grasped is that "unrestricted free distribution rights" means exactly what it says: six months after publication anyone should be able to reuse any material, for any purposeincluding commercial ones.

By the library's September deadline, no scientific journal had committed itself to free distribution rights after six months. Even BioMed Central, whose journals head the Public Library of Science's list of those that have come closest to adopting its policy, retains exclusive rights to commercial reuse of material in its journals.⁶

Decisions for authors
As signatories would have had no journals to publish in, edit or review for, or personally subscribe to from September, the Public Library of Science recommended that signatories should "make every effort to publish our work in, and give our full support to, journals that have adopted the policy proposed in the open letter." (Policy, here, apparently does not extend to "unrestricted free distribution rights.") But resistance from most publishers "has made it clear that if we really want to change the publication of scientific research, we must do the publishing ourselves." So the library will launch its own journals. Author charges of about $300 per published article are expected to cover the costs of peer review, editorial oversight, and publication. Unrestricted rights to access, distribution, and use of all articles will be assigned to the public domain.

Decisions for publishers
Although many journals are now freeing up access to their articles soon after publication, they are still guarding their commercial rights beyond that. Compliance with the demands of the Public Library of Science could mean losing revenue from reprints of articles more than six months old, for which pharmaceutical companies pay medical journals substantial amounts of money. Should they forgo this income to comply with these demands? Or will the arrival of the Public Library of Science's own journals mean action is already too late?

	Conclusion

The current practice of scientific publishing results from the balance of power among authors, funders of research, publishers, academia, and the alliances between them. As the great disrupter, the web seems likely to confound the status quo, although exactly how is hard to predict. The wheel is still in spin.    

	References

1.	Future e-access to the primary literature. www.nature.com/nature/debates/e-access/index.html (accessed 16 October 2001).
2.	Sequeira E, McEntyre J, Lipman D. PubMed Central decides to decentralize. www.nature.com/nature/debates/e-access/Articles/pubmed.html (accessed 16 October 2001).
3.	Free online full-text articles.http://highwire.stanford.edu/lists/freeart.dtl (accessed 16 October 2001).
4.	Campion EW, Anderson KR, Drazen JM. A new web site and a new policy. N Engl J Med 2001; 344: 1710-1711[Free Full Text].
5.	BioMed Central. BioMed Central to consider charging authors for paper submissions. Press release, 29 June 2001. www.biomedcentral.com/info/pr-releases.asp?pr=20010629 (accessed 16 October 2001).
6.	What is BioMed Central? www.biomedcentral.com/info/whatis.asp (accessed 16 October 2001).