We had a lot of trouble finding a publisher because their rates are astronomical. In order to pay for such things, one must try to attract enough advertising, which has its own ethical considerations regarding objectivity of the journal. What comes out is that we are volunteering our good will for the sake of science, while someone else is making a big profit over our good will.

I for one was overjoyed when I heard of the PLoS journal and its innovative concept of free access and dedication to quality. The fact remains that most socialized medicine countries can not afford the high rates to access even a single article published by the big companies, and this increases the gap in health care delivery between the haves and the have nots. I once tried to buy into a service that gives access to many journals at once, but the $20,000 price tag (more than half the yearly salary of most physicians in the world) scared me off. The use of medical libraries is often impractical as they may be far from practitioners and limited in budgets as well.

We need a solution to this second problem as well.

Yosef Leibman
Founding Editor, Israeli Journal of EM
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When reading your e-mail above regarding access to medical journals by low income countries, I was wondering if WAME members were aware of WHO’s Health InterNetwork Access to Research Initiative (HINARI). I did not see Israel on the list of eligible countries, however. (Israel seems to be considered a high income country with per capita GNP of over $10,000.)

Unfortunately, this information might not help you specifically, but it may help other WAME members who are in countries with a low GNP per capita.

From HINARI’s Web site: Over 3680 journal titles are now available to health institutions in 113 countries, benefiting many thousands of health workers and researchers, and in turn, contributing to improved world health. Local, not-for-profit institutions in two groups of countries may register for access to the journals through HINARI. The country lists are based on GNP per capita (World Bank figures, 2001). Institutions in countries with GNP per capita below $1000 are eligible for free access. Institutions in countries with GNP per capita between $1000-$3000 pay a fee of $1000 per year / institution. Eligible categories of institutions are: national universities, research institutes. Professional schools (medicine, nursing, pharmacy, public health, dentistry), teaching hospitals, government offices and national medical libraries. All staff members and students are entitled to access to the journals.

Eligible countries: http://www.who.int/hinari/eligibility/en/index.html

Participating institutions in eligible countries: http://extranet.who.int/hinari/en/browse_institutions.php

If in an eligible country, to register for free or reduced access: http://extranet.who.int/hinari/en/registration.php

My society is in the process of joining this initiative and providing our three journals free to impoverished countries. Here’s an answer to a question I asked of a HINARI representative: As a partner/contributor to the HINARI initiative you will not receive any part of the $1,000 “low cost access” fee collected from those in countries listed in band two with a GPN per capita between $1,000-$3,000. This money, as I understand it, goes to HINARI to help cover the costs of running this program. As I understand it, the $1,000 paid by those who qualify in these countries gives them access to all 3,680 (and counting) publications. It isn’t a per publication charge. hinari@who.int is the e-mail to use when inquiring about partnering to offer your publications to low income countries. According to HINARI’s Web site, 2554 institutions in 107 countries are taking advantage of this initiative.

Hope this helps someone.

Kimberly Fradette-Taylor
Publications Manager, American Society of Nephrology
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For anyone interested, the WAME policy statement on free journal access for poor nations and HINARI specifically is available at
http://www.wame.org/resources/policies#poor .

The policy (from 2000 and still in effect) is copied below:

In response to the World Health Organization Health InterNetwork Access to Research Initiative (HINARI) (1), an increasing number of the world's leading medical publishers are allowing free Web-based access to scientific journals in those countries that cannot afford to pay for them. Since we as medical editors view disseminating medical knowledge as among our greatest honors and responsibilities, we heartily endorse this practice, and encourage all medical editors and publishers around the world to adopt it.

1. World Health Organization. "Life-saving" scientific information boost via Internet to health researchers in Africa, Central Asia and Eastern Europe. http://www.who.int/inf-pr-2000/en/pr2000-76.html

Margaret Winker
Vice-President, WAME
Deputy Editor, JAMA
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If anyone needs less-formal information about WHO's HINARI, I have worked with them for five years (including two Geneva trips) in initiating our Health Sciences Online project. I'd be glad to answer any questions I can (presumably in non-listserve emails since not everyone may be interested), if you'd prefer to do a little quiet inquiry before contacting WHO.

Erica Frank
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I thank everyone for their suggestions about getting articles.

However, in socialized medicine countries, going by mean income excludes countries where physicians are poorly paid while the economy is overall strong. This would mean that many countries like Israel, Scandanavia, Gulf Countries, UK, would be excluded even though in my example, physicians receive similar salaries as bus drivers.

I would like to suggest some solutions.

1) Major journals should follow the BMJ and the NEJM example of making certain key articles free—especially review articles.

2) Many editorials have very important information and can not be accessed because they have no abstract. Since they tend to be shorter, they should be offered at lower rates.

3) If you are an author, consider publishing an email address (many do not) to allow people to request reprints.

4) All journals should consider freeing up all articles that are older than six months old, as these are the ones that have little market financially, but still could be useful

Yosef Leibman
Founding Editor, IJEM
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For many, HINARI is AN OPPORTUNITY for the poor countries, but for us, citizens of the poor countries, we do not have any access for HINARI! There are countries that do not pay HINARI, countries (like Morocco) that pay little HINARI,  and, finally, countries that pay a lot. But on our premises, only the professors of the large universities have this privilege with HINARI, not students, neither the private doctors nor the doctors of the public hospitals of small averages and capacities. Thus do not tell Leibman things that do not exist!

Hnid Karim
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The situation in most countries is that smaller hospitals—even teaching ones—due to financial constraints, do not have libraries. Residents are taught updated information through the major journal of their specialty that the head of the department will perhaps subscribe to. University libraries are more and more going to online subscriptions, which bar use by non-members of the university (even to the extent of requiring id numbers from the university).

What disappoints me is that I believed that my suggestions were reasonable, yet the response was minimal. WAME does have subscribers, who are editors for the large journals, who can respond to this initiative in the name of advancing science. Forgive me, dear colleagues, but let’s hear from the BMJ and JAMA, and JGIM, etc. I still believe that the financial loss of freeing up an occasional article or older articles is minimal, and will help those of us fighting in less fortunate places to improve the lives of our people.

Yosef Leibman
Founding Editor, IJEM
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I agree with Dr Leibman that publishers should provide free access to their journals’ content when the commercial benefit wanes. Whether that is at 6- or 12-months is open for discussion. When our journal recently accepted bids for a new publisher, one of the demands was that (a) there be open access after 6 or 12 months (the new publisher chose 12), and (b) that 12 months after publication they provide all articles to PubMed Central, which also offers free access.

Finally, a publication about 2 years ago in BMJ showed that open access led to more citations. (When I’m writing an article, if I can't download an article so I can read it, I won't cite it.) So if one believes that the Citation Index is helpful (and some journals use it to market advertisements at higher rates), then there may be commercial benefit to journals to providing open access to their content.

Bill Tierney
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Thanks: this is an interesting and important debate.

For the record, the BMJ is an open access journal.

We make the full text of all original research articles available to all, for free, on bmj.com, and they are all published as soon as they have been accepted, edited, and proofed. And we transfer them immediately to PubMed Central, complying without delay with the policies of the NIH, the UK Medical Research Council, the Wellcome Trust and other funding bodies in making publicly funded research available to all.

We do not have any author charges either.

Other content on bmj.com is fully available to all after one year, but we do also free up, immediately, one or two articles a week such as editorials and debate articles.

Lastly, the BMJ and all the BMJ Journals make all content free immediately to those in less developed countries through the HINARI scheme.

If you'd like to know more about the BMJ's approach to publishing research please see:

EDITORIALS:             

Trish Groves.

Why submit your research to the BMJ?
BMJ
Jan 2007;334:4-5. doi:10.1136/bmj.39057.516250.80

Trish
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Regarding the following statement, “Finally, a publication about 2 years ago in BMJ showed that open access led to more citations. (When I’m writing an article, if I can't download an article so I can read it, I won't cite it.)

So if one believes that the Citation Index is helpful (and some journals use it to market advertisements at higher rates), then there may be commercial benefit to journals to providing open access to their content.”:

Just for the record, this paper wasn't published in the BMJ, but in PLoS Biol , and it was 1 year ago, not 2 years ago :

http://biology.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pbio.0040157

BMJ has published other papers on open access, but none showing a citation advantage.

Gunther
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In addition to many benefits to readers, authors, and general public "Open Access" initiative allows our copyright to be retained by the authors (we agree to to share with readers, but do not lose). If we have to use any portion of the article (figures, tables etc) in the future for any projects (eg writing a book), we can use it freely without problems associated with the situation when we have to transfer our copyright and lose it forever.

This is an extremely important issue, but is usually underestimated. All the hard work we have done or will be doing is not ours if it is not under "Open Access" initiative!

Vinod B. Shidham
Executive editor & Editor-in-chief, CytoJournal
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Copyright forms with which I have always worked, include a provision to allow authors to use their own material freely. I am not sure, but I think that is pretty standard.

"Publisher, in turn, grants to author the royalty free right of re-publication in any book of which he or she is the author or editor, subject to the express condition that lawful notice of claim of copyright be given."

If something like this isn't in your copyright transfer agreement form, then you might want to consider adding it or something similar. I agree, as authors we should retain the rights to use our own research without having to jump through hoops later.

Kimberly Fradette-Taylor
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It strikes me that what some countries really need are the spare copies of such magazines—other places need to get organised, and sponsoring companies, etc, too. A regular transfer of spare and read magazines would be ideal and cheap.

Vivienne Miller
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I was inspired by the letters I received in support of this idea. While I doubt we will see any changes soon, I would like to thank the people at BMJ and JGIM for their approach and support for this idea. I am disappointed that the JAMA journal people stayed clear of this discussion.

I would like—in conclusion—to provide a list of useful journals that, to the best of my knowledge, give free on line access. The list is incomplete, and I encourage all who know of other journals to add to the list

The Canadian Medical Association Journal

Canadian Journal of Emergency Medinice

Medical Journal of Australia

The PLoS journals

Emedicine (George Lundberg's project)

Israeli Medical Assocation Journal

Israeli Journal of Emergency Medicine

Saudi Medical Journal

The following often have free articles

BMJ

JGIM

Clinical Infectious Diseases

Yosef Leibman
Founding Editor, IJEM
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I just read the last two posts and couldn't help but add this Web site to the discussion:
www.freemedicaljournals.com

It lists over 400 journals arranged alphabetically or by specialty. It should make for a valuable resource for anyone interested.

Vivek Prasad
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Danish Medical Bulletin also has free access:

http://www.danmedbul.dk/index.html

Peter Gøtzsche
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“I encourage all who know of other journals to add to the list.”

The Directory of Open Access Journals (http://www.doaj.org/) lists 2585 journals (incl 222 in medicine).

Rather than cluttering this list with messages like "here is another free journal", it might be a better idea to consult the directory listed above and add non-listed journals there.

Gunther
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It is good to see so many medical journals making their content freely available. Can anyone remember which journal was the first to make its full text freely available on line? The BMJ was an early innovator, but was it the first?

John S Dowden
Editor, Australian Prescriber
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At the Obafemi Awolowo University, Ile-Ife, Nigeria, HINARI is available to all staff and, I believe, students also, at least through their lecturers. The username and password on campus is made available through the university library.

Clement O. Adewunmi
Editor-in-Chief, African Journal of Traditional, Complementary and Alternative Medicines
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In El Salvador, we also have access to HINARI. The service was sponsored by the Salvadoran American Medical Association. It cost them $1000 a year, and at our university we were given the password. I think the cost is reasonable bearing in mind the amount of people that can have access...everything has been working fine, but for some reason I could not access Lancet articles.

I have a question: Does anybody here work in a journal that is not in HINARI? If so, why is your journal not in HINARI??
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The response to my Feb 28, 2006 letter to HINARI was that I must belong to an institution!

Hnid Karim