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Publishers’ charges for scoring systems may change clinical practice

BMJ 2015; 351 doi: (Published 12 August 2015) Cite this as: BMJ 2015;351:h4325
  1. Hugo Farne, specialist registrar and academic clinical fellow in respiratory medicine, Imperial College London, St Mary’s Hospital Campus, London W2 1NY
  1. hugo.farne{at}

Much medical knowledge is copyrighted, but charges to reproduce clinical scoring criteria such as the Mini Mental State Examination may see them disappear from guidelines, writes Hugo Farne

A small but important change is quietly taking place in academic publishing, to the detriment of authors and readers alike.

The National Institute for Health and Care Excellence (NICE) recommends using the Wells score to assess patients with a suspected pulmonary embolus, for example, and it recommends the CHA2DS2-VASc score to identify which patients with atrial fibrillation are at high risk of stroke and should start prophylactic anticoagulation. However, if you wish to publish an article, book, smartphone application, or website that reminds readers of these scoring systems, it will cost you dearly—as much as $750 (£486; €690) goes to the Annals …

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