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  Publishers cut off doctors` free access to medical journals in poor countries
  18 มกราคม 2554

Date: 18 January 2011



Wealthy publishers of the world`s most important medical journals are accused of destroying an agreement to allow medics in poor countries to get online access for free

What a world of possibilities must have opened up for a hospital doctor or a medical student in Bangladesh or Kenya when the World Health Organisation concluded an agreement with publishers in 2001 to put the world`s most important, respected and groundbreaking medical journals online for free. Suddenly the boundaries were down. A doctor in downtown Nairobi might have a clinic with crumbling walls and precious little equipment, but he had access to the same cutting-edge knowledge as any medic in New York or London.

Until now. Of late, it seems that commerce has trumped altruism. HINARI, the Health InterNetwork for Access to Research Initiative that the WHO set up, appears to be falling apart. Several major publishers, including Elsevier, owner of the Lancet and Lancet Infectious Diseases, which run so many important papers on health in the developing world, and others withdrew free access from Bangladesh at the beginning of this year. Kenya and Nigeria have also lost free access. The WHO, not keen to let on that its laudable initiative was failing, has now revealed that restrictions have been imposed in 28 of the 64 poorest countries in the world. As with the free trials offered by online DVD rental companies, the period of grace has run out and it`s time to pay. Except that these universities and medical schools don`t have the cash.

Doctors and researchers in the UK are appalled to learn that Bangladesh has been told it will no longer get free journal access from Elsevier. The charge is being led by Richard Smith, former editor of the British Medical Journal, who helped set up HINARI. The deal was signed in BMA House in London. He has the support of Richard Horton, editor of the Lancet, who has run a long commentary by Smith, together with an editorial of his own on the Lancet website here. It all has a slightly Alice in Wonderland feel. Elsevier has reversed its decision for the moment and Horton has extracted an undertaking that no such decisions will be made again without reference to Elsevier`s journal editors.

But the long-term future is problematic. Elsevier, in a letter also published on the Lancet site, says it will charge from 2012, arguing that countries like Bangladesh will need to move from free access to affordable but commercial deals. Other publishers are moving down the same road.

Smith and others are unimpressed by commercial arguments, pointing out that online access costs publishers practically nothing - and their profits are huge. They warn that publishers could pull down upon themselves the opprobrium attracted by Big Pharma, when it dragged its feet over access in the developing world to lifesaving Aids drugs:

In exchange for a few dollars, these publishers risk creating a torrent of ill-will against them from the excluded countries, authors around the world, and quite possibly, their own staff. Pharmaceutical companies have learned the hard way that buccaneering tactics in poor countries do not work and will not be tolerated, and the consequence is the severe damage of their image, brands, and products.

Keyword: World Health Organisation / Publishers / Doctors