At 200 Years, a Fortress of Medical Research Confronts The Information Age: Part Two

Apr 17, 2012

INTRO: As the New England Journal of Medicine celebrates its 200th anniversary this year, more and more researchers and science journalists are calling for fundamental changes in the way we get scientific information. They say medical journals keep the real process of science research in the dark for taxpayers who fund that same work. In the second of a two-part series, WNPR’s Neena Satija reports on the snags in the research process and how some people are working to get rid of them. (Read and listen to the first segment here.)

Here’s how scientific publishing works today. Let’s say a neurologist wants to conduct an important experiment about epilepsy. He needs money to do that, so he applies for a grant. Grants often come from federal research agencies like the National Institutes of Health or from the National Science Foundation, which receive tens of billions of dollars in taxpayer money each year. Once the neurologist is awarded his grant, he’ll start his research, and he might talk about it at scientific conferences.

That’s where we hit the first snag, according to Boston Globe’s health/science editor Gideon Gil. Reporters at the conference might ask that neurologist what he’s up to, and they’ll get this response.

GIL: “Well I can tell you about my research but I can’t get into specific findings because I have a paper that I’ve submitted to the New England Journal, and if I talk to you about it they won’t publish it.’”

That’s because of the Ingelfinger rule, named after the editor of the New England Journal who came up with it in 1969. The rule says that the journal won’t publish research that’s already been published or released elsewhere. Gil says journals apply that rule too strictly.

GIL: “Our role is to tell the public what is happening of importance in medical research, and part of that is to hold people accountable for how they’re using government money, and I think it becomes more difficult for us to do that.”

New England Journal editor Jeffrey Drazen disagrees. He says scientists are free to talk about their work at conferences, but if his staff accepts their work, they’d better be prepared to let the journal be the first to put it out there. 

DRAZEN: “We have our own internal rules, and if you don’t like it, you can still publish yourself elsewhere. But if you want to publish with us, we want primacy. We don’t want you selling your snake oil or whatever it is, before we have a chance to look at it.”

Before it even gets published, though, the research might hit another snag. Let’s say the neurologist first submits his research to the New England Journal of Medicine, hoping for the prestige of getting published in one of the top-tier journals in the world. It might get rejected not because it’s sloppy work, but because the journal editors decide it isn’t “high-impact” enough. So what happens to the research then? It gets submitted to another prestigious journal that may again decide it’s too specialized. So the authors go to yet another journal.

MICHAEL EISEN: “Papers languish in peer-review for months and even sometimes years.”

That’s Michael Eisen, who founded the non-profit publisher Public Library of Science in 2001. One of PLOS’ journals only vets research based on its scientific validity, not its so-called impact. So that research on epilepsy can get out to other neurologists as quickly as possible instead of wading through a hierarchy of highly-selective journals.

EISEN: “This is not literature that people don’t want to share….and the fact that we accept that restriction on access and that we accept massive delays in getting that information out there, it’s just, it’s insane.”

OK, so that paper on epilepsy has finally been published. Now we can access it, right? Well…that depends. If the New England Journal’s published it, you have to be a subscriber. Eisen thinks that’s another major snag in the research process.

EISEN: “We’re paying publishers billions of dollars of year. That money is largely coming from public sources. And at the end of day despite paying them all this money, the content is accessible to only a very very thin slice of the population.”

PLOS puts all its material online for free in a model known as Open Access. It covers its expenses by charging authors a few thousand dollars per paper in submission fees, and offers fee waivers or discounts to those who can’t afford it. The New England Journal’s Jeffrey Drazen says that’s all well and good for PLOS, but it wouldn’t work for his publication.  

DRAZEN: “When you buy a journal, it’s not the physical thing. Rather, you’re paying the editors to sift through thousands of submissions and bring you the few hundred they think are important. We pay for a lot of stuff that you never see.”

Still, the journal makes a lot of money. Its owner, the Massachusetts Medical Society, won’t say how much. But its profits are estimated to be in the tens of millions. Public Library of Science turned a modest profit for the first time in 2010, making about $3 million. Eisen thinks his model will win out, since it’s already starting to be copied by others. But he does think journals like the New England Journal of Medicine are making that transition a lot slower.

EISEN: “I don’t begrudge them the right to make a profit on a product. It’s the fact that they have a subscription-based business that is so lucrative that makes them, in my mind, unwilling to do the right thing for science and for medicine.”

These snags in the research process mean delays in getting scientific information to the public. We can’t find out about science as it happens. Instead, journals send reporters alerts about upcoming articles each week, and reporters write about them. Health/science editor Gideon Gil says this isn’t the best method for science journalism.

GIL: “You can become too reliant on that. It’s sort of like getting a handout, and you know you get your weekly fix from the NEJM.”

Some scientists are starting to bypass journals altogether using the power of the internet. They’ll post their work on a web site and invite colleagues to give them feedback. It’s a concept known as “open science,” and it could eventually lead to the death of the scientific paper. Of course, that makes the New England Journal very nervous. Jeffrey Drazen thinks open science is great for theoretical physicists. Not for doctors.

DRAZEN: “If I’m studying plasma physics and I have some new idea called fusion, I can put it out there and people can criticize it. And the only people who will be hurt will be the people who waste their time if it turns out that my idea is totally wrong. On the other hand, a medical journal, a lot of physicians read our medical journal, and when you’re deciding something that could make the difference between life and death for a patient, you want to have a different standard.”

But no single research paper is that important. After all, there are papers that say coffee’s good for you, and others that say it’s bad. We have to look at one result is part of a whole body of research. And the way that science research is published today makes it very difficult to do that. Ivan Oransky is editor of Reuters Health and also runs a blog called EmbargoWatch, which examines how journals control the flow of scientific information.

ORANSKY: “Science doesn’t work every week. It doesn’t happen in these punctuated episodes once a week or once a month when the journal comes out. It happens in a continuum. And by allowing journals complete control, essentially, over when something can be written about, you are perpetuating this really false idea that science happens when something gets published. It’s just not true.”

So what’s in store for the next 200 years of the New England Journal? Well, the competition’s only getting fiercer. Thousands of scientists have signed petitions calling for better access to scientific research. eLife, a new journal funded by the Max Planck Institute, the Wellcome Trust, and the Howard Hughes Medical Institute, will publish all the articles it accepts online for free without charging anybody. And more researchers are just plopping their work online for all to see, and criticize. For WNPR, I’m Neena Satija.

Read more at the Connecticut Mirror at http://ctmirror.org/story/16035/nejm-part-ii.