Select Committee on Science and Technology Written Evidence


APPENDIX 8

Memorandum from Dr Virginia Barbour

  1.  I am writing in a purely personal capacity as a scientific and medical editor employed for the past four and a half years at The Lancet, a leading general medical journal. I trained as a medical haematologist in the UK, and as a scientist in both the UK and the USA. I then became an editor at The Lancet. My reasons for becoming an editor were similar to the reasons that I went into medicine and science; because I am interested in understanding the causes of diseases, and applying this understanding to the ultimate aim of improving health. For this aim, I believe that the free flow of scientific information is essential; not only to other researchers and physicians, but also to an increasing medically sophisticated public.

  2.  I am shortly to leave The Lancet for a job at the Public Library of Science, a not-for-profit organisation that is committed to open access (ie, free to the reader). By contrast, The Lancet is owned by Reed Elsevier, a large for-profit publisher. The Lancet is available as an individual subscription, but is more often sold to institutions as part of a bundle of journals; I understand the committee will be investigating this practice.

  3.  The main reason for my move is that I am not convinced that the current user-pays model of publishing, to which The Lancet's editors are bound by Elsevier's management, is in the best interests of either the medical or scientific communities, or the general public. Although scientific and medical editors and publishers have an important role in making scientific data available in a useful format, the access restrictions of some publishers do not serve the medical or scientific communities, or the general public well. Making information available only for a high fee at the point of access has the most severe repercussions for one particular group of end-users; patients. I can illustrate best the issues that can arise from the current policy of restricting access using a few recent examples of papers published in The Lancet.

  4.  On 29 November 2003, The Lancet published an article entitled "Caesarean section and risk of unexplained stillbirth in subsequent pregnancy".[1] This article reported that the absolute risk of unexplained stillbirth in a pregnancy following a caesarean section at or after 39 weeks' gestation was 1.1 per 1,000 women who had had a previous caesarean section and 0.5 per 1,000 in those who had not. Reading such a result should allow a doctor or a patient to understand that although the chances of having a stillbirth increased, they were still low. Unfortunately several newspapers chose to report simply that the "risk" doubled. In The Guardian on 28 November, this was the full text of their report on the article:

  5.  "Risk posed by C-section birth

  Women whose first child is born by caesarean section double their risk of having a subsequent stillbirth, according to a Cambridge University research in The Lancet. The caesarean rate has doubled in 10 years."

  6.  This report, although technically accurate, is misleading because of what it omits—the absolute risk as well as than the relative risk—and suggests that the writer either did not appreciate the importance of reporting the absolute risk, or chose to selectively report the more sensational relative risk. The misleading report would not be so important if it were not that case that the original article is only available to non-subscribers for $30, which is likely to deter most patients from obtaining it.

  So this work, which was funded entirely by public agencies—Cambridge University, Greater Glasgow NHS Board, and the Common Services Agency, Edinburgh, is not available to the public except for a substantial fee. Incidentally, journalists are allowed full free access to any article that they want in advance of publication. What does such an embargo achieve, apart from publicity for the journal? Advance notice should allow journalists to interpret the work accurately for the public. However, as shown by the reporting of this and many other articles, newspapers and news outlets are primarily interested in attracting readers; even more serious broadsheet newspapers tend to prefer sensational news rather than dull but worthy research. [2]

  7.  A second example of an article where access to the original report would have been in the public interest was the Million Women Study[3], published on the 9 August 2003, of the risks of breast cancer associated with hormone replacement therapy. This study, along with a commentary[4] has generated huge public interest, led to changes in prescribing guidelines and in the day to day practice of physicians, but again is only available for a fee. Again it is funded by public agencies; Cancer Research UK, the NHS Breast Screening Programme, and the Medical Research Council.

  8.  Editors have become increasingly aware of the desire of both authors and users for the free flow of information. I am a member of the advisory board of the Microarray Gene Expression Data Society, an organisation of scientists and editors that has worked to promote the free access to the scientific data that underlies microarray experiments. Although The Lancet, along with many other journals, has signed up to this principle, they often do not make the final papers available free—a clear contradiction of intent. Authors realise the absurdity of this situation, and are beginning to request that such papers are made available for free, ie, on an open-access basis.

  9.  The final issue that I want to raise is copyright. At the moment Elsevier insists on authors signing a rather restrictive copyright agreement that limits or requires substantial fees for reproduction of the data. This restriction can have severe repercussions for end-users. I was recently told by a publicly-funded scientist that to make 30 copies of an article (of publicly-funded research, although from another country) for teaching purposes Elsevier required several hundred pounds in fees.

  10.   The Lancet's editors work around some of these policies. For example, we make some content free to all. This policy was implemented for all papers relating to the SARS epidemic; it is widely acknowledged that the daily free exchange of information was pivotal in the rapid progress towards determining the cause of this disease. At The Lancet, editors and managers seem to have different aims; the former to promote the free flow of information; the latter to generate revenue.

  11.  In summary, I believe that unrestricted access to information contained within primary research is essential. Physicians and scientists rely on this flow of information for their work and practice. The public should not have to rely solely on journalists to interpret research, since journalists have different priorities to scientists and scientific editors. Instead, everyone should be able to read freely the primary research (often funded by public agencies) upon which decisions concerning their health care are made.

January 2004




1   Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet 2003; 362: 1779-84. Back

2   Harrabin R, Coote A, Allen J. Health in the News: Risk, reporting and media influence, King's Fund 2003.  Back

3   Beral V, Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 2003;362:419-27. Back

4   Lagro-Janssen T, Rosser WW, van Weel C. Breast cancer and hormone-replacement therapy: up to general practice to pick up the pieces. Lancet 2003;362: 414-15. Back


 
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