- Email: [email protected]
Affordability of medical journal subscriptions in developing countries
towards article processing charges to publish in journals such as PLoS Biology. Such high fees will dissuade scientists from sending their articles to these journals or will make scientists reliant on pharmaceutical companies, even for research which they have otherwise done on their own limited budgets. Many journals do allow authors to apply for that amount to be waived, but scientists would hate having to beg for charity to get their work published. It is imperative that journals have different subscription tariffs and article processing charges for different countries, bearing in mind the average gross domestic product of each country. If a study does not have the support of a funding agency, article processing charges must be waived. If this is not done on an urgent basis, research from countries with limited resources will become marginalised. Binu V John Department of Medicine 2, Christian Medical College and Hospital, Vellore, Tamilnadu 632004, India (e-mail: [email protected]) 1
2
McLellan F. Publishers face backlash over rising subscription costs. Lancet 2004; 363: 44–55. Tamber PS, Godlee F, Newmark P. Open access to peer-reviewed research: making it happen. Lancet 2003; 362: 1575–77.
Response from Elsevier Sir—Binu John raises important issues. At Elsevier (publishers of The Lancet), we are very aware of the challenges of equitable and affordable access for researchers in the developing world and have several initiatives to enable access to our content. The largest example of these initiatives is our participation in the Hinari (Health InterNetwork Access to Research Initiative) led by WHO.1 By means of this project, Elsevier journals, including The Lancet, are made available for free to institutions in countries with a gross national product (GNP) per capita of less than US$1000 (1998 World Bank figures), and at deeply discounted prices for countries with a GNP per capita of $1000–3000. In 2003, this scheme led to nearly 13 500 full-text downloads of The Lancet alone. India in particular is an active participant in the Health InterNetwork (HIN), which aims to support and strengthen public health services and to provide access to high-quality, relevant, and timely health information. The HIN portal provides access to this information and to networks of policymakers, researchers, and health-service providers. India was selected as the first
1326
HIN pilot country because it has several priority public-health programmes as well as skills and resources that could contribute significantly to the development of HIN. In addition to participating in these important global projects, we have also undertaken several initiatives to increase equitable access to health information. For example, a special monthly edition of The Lancet is now available in Spanish and we have just launched a Chinese edition at a locally set price. Other editions are planned, including one for the Indian market. The network of Elsevier local offices enables us to develop new products specifically for each geographical region. As these ideas develop, more and more high-quality scientific, technical, and medical material will be available to lower GNP countries who need them. Dominic Vaughan Managing Director, Health Sciences UK/NL, Elsevier Science, 32 Jamestown Road, London NW1 7BY, UK (e-mail: [email protected]) 1
Health InterNetwork. http://www.health internetwork.net (accessed Mar 30, 2004)
How effective is published medical education? Sir—In a Commentary (Oct 11, p 1170),1 Chris van Weel shows that transfer of scientific knowledge to every-day practice is less straightforward than expected. The provision of an adequate estimate of the effectiveness of an intervention strategy is deemed to be a central difficulty.2 In Germany, measurement of lipase and amylase concentrations is routine practice, even in the absence of acute pancreatitis symptoms. We published an educational article highlighting the clinical uselessness and economic waste of this approach. We noted that: increases in lipase or amylase concentrations have no diagnostic effect for the detection of pancreatic diseases, apart from acute pancreatitis; measurement of amylase concentrations is much less reliable than that for lipase in the diagnosis of acute pancreatitis; and lipase or amylase concentrations do not predict the course of disease.3 The journal in which our article was published is delivered free of charge to every medical doctor in Germany. 70·3% of physicians can recollect each issue, more than any other medical journal.4 Since publication, our article has been
Number of requests for analyses
CORRESPONDENCE
Lipase
500 000
Amylase
400 000 –3·1%
–1·5%
300 000 –9·9%
–7·8%
200 000 100 000 0 2001
2002 Year
2003
Number of requests for lipase and amylase analyses, 2001–03
discussed with more than 100 colleagues and has been debated in a section of the Deutsches Ärzteblatt, other medical journals, and a leading German newspaper.5 We investigated whether our article led to a decrease in lipase and amylase analyses in Germany. We sent questionnaires to 70 randomly selected public and private laboratories. Within 4 weeks, 23 (33%) responded. 16 replies, reporting 40·2 million single laboratory samples (between 13·3 and 13·6 million per year), were fully completed and subsequently assessed (figure). The slight annual decrease in lipase and amylase orders was not affected by our educational article (arrow). Despite the publishing journal having the broadest dissemination and recognition in Germany, our educational article had no effect on daily routine. This information could suggest that a substantial proportion of the medical community might take little notice of published medical education. Whether the increasing number of educational and review articles in the national and international medical press is an adequate way to improve every-day practice is therefore questionable. *Niels Teich, Joachim Mössner, Volker Keim Universität Leipzig, Medizinische Klinik und Poliklinik II, Philipp-Rosenthal-Strasse, 27, 04103 Leipzig, Germany (e-mail: [email protected]) 1
2
3
4 5
van Weel C. Translating research into practice—a three-paper series. Lancet 2003; 362: 1170. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225–30. Teich N, Orth M, Keim V, Mössner J. Diagnostik von Pankreaserkrankungen: Bestimmung von Lipase und alpha-Amylase meistens verzichtbar. Dtsch Arztebl 2002; 99: A2717–19. Jachertz N. Hohe Reichweite, hohe Erwartung. Dtsch Arztebl 2003; 100: B1753. Sahm S. Die versteckten Bauchschmerzen. Frankfurter Allgemeine Zeitung, Apr 23, 2003: N2.
THE LANCET • Vol 363 • April 17, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
2
McLellan F. Publishers face backlash over rising subscription costs. Lancet 2004; 363: 44–55. Tamber PS, Godlee F, Newmark P. Open access to peer-reviewed research: making it happen. Lancet 2003; 362: 1575–77.
Response from Elsevier Sir—Binu John raises important issues. At Elsevier (publishers of The Lancet), we are very aware of the challenges of equitable and affordable access for researchers in the developing world and have several initiatives to enable access to our content. The largest example of these initiatives is our participation in the Hinari (Health InterNetwork Access to Research Initiative) led by WHO.1 By means of this project, Elsevier journals, including The Lancet, are made available for free to institutions in countries with a gross national product (GNP) per capita of less than US$1000 (1998 World Bank figures), and at deeply discounted prices for countries with a GNP per capita of $1000–3000. In 2003, this scheme led to nearly 13 500 full-text downloads of The Lancet alone. India in particular is an active participant in the Health InterNetwork (HIN), which aims to support and strengthen public health services and to provide access to high-quality, relevant, and timely health information. The HIN portal provides access to this information and to networks of policymakers, researchers, and health-service providers. India was selected as the first
1326
HIN pilot country because it has several priority public-health programmes as well as skills and resources that could contribute significantly to the development of HIN. In addition to participating in these important global projects, we have also undertaken several initiatives to increase equitable access to health information. For example, a special monthly edition of The Lancet is now available in Spanish and we have just launched a Chinese edition at a locally set price. Other editions are planned, including one for the Indian market. The network of Elsevier local offices enables us to develop new products specifically for each geographical region. As these ideas develop, more and more high-quality scientific, technical, and medical material will be available to lower GNP countries who need them. Dominic Vaughan Managing Director, Health Sciences UK/NL, Elsevier Science, 32 Jamestown Road, London NW1 7BY, UK (e-mail: [email protected]) 1
Health InterNetwork. http://www.health internetwork.net (accessed Mar 30, 2004)
How effective is published medical education? Sir—In a Commentary (Oct 11, p 1170),1 Chris van Weel shows that transfer of scientific knowledge to every-day practice is less straightforward than expected. The provision of an adequate estimate of the effectiveness of an intervention strategy is deemed to be a central difficulty.2 In Germany, measurement of lipase and amylase concentrations is routine practice, even in the absence of acute pancreatitis symptoms. We published an educational article highlighting the clinical uselessness and economic waste of this approach. We noted that: increases in lipase or amylase concentrations have no diagnostic effect for the detection of pancreatic diseases, apart from acute pancreatitis; measurement of amylase concentrations is much less reliable than that for lipase in the diagnosis of acute pancreatitis; and lipase or amylase concentrations do not predict the course of disease.3 The journal in which our article was published is delivered free of charge to every medical doctor in Germany. 70·3% of physicians can recollect each issue, more than any other medical journal.4 Since publication, our article has been
Number of requests for analyses
CORRESPONDENCE
Lipase
500 000
Amylase
400 000 –3·1%
–1·5%
300 000 –9·9%
–7·8%
200 000 100 000 0 2001
2002 Year
2003
Number of requests for lipase and amylase analyses, 2001–03
discussed with more than 100 colleagues and has been debated in a section of the Deutsches Ärzteblatt, other medical journals, and a leading German newspaper.5 We investigated whether our article led to a decrease in lipase and amylase analyses in Germany. We sent questionnaires to 70 randomly selected public and private laboratories. Within 4 weeks, 23 (33%) responded. 16 replies, reporting 40·2 million single laboratory samples (between 13·3 and 13·6 million per year), were fully completed and subsequently assessed (figure). The slight annual decrease in lipase and amylase orders was not affected by our educational article (arrow). Despite the publishing journal having the broadest dissemination and recognition in Germany, our educational article had no effect on daily routine. This information could suggest that a substantial proportion of the medical community might take little notice of published medical education. Whether the increasing number of educational and review articles in the national and international medical press is an adequate way to improve every-day practice is therefore questionable. *Niels Teich, Joachim Mössner, Volker Keim Universität Leipzig, Medizinische Klinik und Poliklinik II, Philipp-Rosenthal-Strasse, 27, 04103 Leipzig, Germany (e-mail: [email protected]) 1
2
3
4 5
van Weel C. Translating research into practice—a three-paper series. Lancet 2003; 362: 1170. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225–30. Teich N, Orth M, Keim V, Mössner J. Diagnostik von Pankreaserkrankungen: Bestimmung von Lipase und alpha-Amylase meistens verzichtbar. Dtsch Arztebl 2002; 99: A2717–19. Jachertz N. Hohe Reichweite, hohe Erwartung. Dtsch Arztebl 2003; 100: B1753. Sahm S. Die versteckten Bauchschmerzen. Frankfurter Allgemeine Zeitung, Apr 23, 2003: N2.
THE LANCET • Vol 363 • April 17, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.