- Des Spence, general practitioner, Glasgow
The BMJ is owned by the BMA. The BMJ sometimes publishes articles that openly question or counter BMA policy. It’s also willing to confront vested interests and to offend the great and good. The BMJ is no trade association rag but a global independent medical institution and fearless defender of medical free speech. It is the intellectual soul of the British medical profession. The BMJ has never censored what I write, even when it clearly makes the editor’s toes curl in discomfort. I write not as a sycophantic employee but, being a member of the BMA, as a small shareholder of a publication I believe in. The BMJ champions open access to research,1 but should it go further?
Before 2004 the BMJ offered free access to all of its articles online. Since then an electronic pay wall has been erected because the BMJ Group is a profit making limited company. Original research is open access, but the rest of the content is not. Doctors, let alone the public, struggle with primary research; what everyone wants is interpretation of the evidence—that is, opinion. To get past the pay wall as a BMA member you need a password, often an irritation to doctors. Otherwise you pay £20 (or $30) for an article, however old it is. Fees are waived for poor countries, but this still shuts out many potential readers; traffic to bmj.com has reduced, debate is limited in the rapid responses, and sometimes the site seems clinical and sterile.
Medicine affects us all. It is contentious, political, and emotional, and everyone has a right to comment. Doctors aren’t interested in the profitability of the BMJ but want open debate: from BMA members and non-members, from the UK and international doctors, and, importantly, from patients. We should end the intellectual protectionism and make the BMJ fully open access.
Amid the general poverty of medical reporting, the need for an open and impartial medical source has never been greater—a void that the BMJ could fill. This would raise its profile, establish a precedent, increase traffic to bmj.com, and, importantly, help repair the public image of doctors. Removing the pay wall has revenue implications for the BMJ and the BMA: loss of subscription revenue would take a slice out of the £10m profit the association gained from the BMJ Group last year. Pharma advertising may be ethically questionable, but it would be essential under this scenario. Could advertisers pay a higher rate? Or would BMA members consider a small hike in their membership fees to allow full open access to the BMJ for everyone in the world?
The BMJ is a rare counterweight to the enormous corporate marketing machine of medicalisation. Open access to all medical knowledge is such an important principle, and protectionist pay walls are a long term folly that may ultimately see the influence of the BMJ decline. We, the share owning BMA membership, should be allowed to decide the purpose and future of the BMJ.
Cite this as: BMJ 2012;345:e4735