If not now, at some point in your life you have probably subscribed to at least one magazine. For example, in the past I’ve subscribed to Harper’s Bazaar, Cycling, The New Yorker, and the New York Times Magazine. Here is how the business model works: I pay money to subscribe, the company which publishes the magazine then gives part of that money to its writers who write the articles and editors who review and edit them. The rest of the money (including advertising income) goes to printing and administrative costs and what’s left over is called profit.

Unlike printed newspapers which have lost much of their readership (not to mention income) to the internet, weekly and monthly magazines are still doing pretty well and bringing their investors a decent return.

Now, get this, here’s the business model of the academic magazine, or ‘journal’, industry. Let’s focus on health journals. Libraries, hospitals, research centers, and even private doctors will pay anywhere from $500 to 1,000 a year to subscribe to a highly regarded journal in their specialty. Where does that money go? It doesn’t go to the authors of the papers – they’re not paid a dime. Nor does it go to reviewers – they’re not paid either. Which means that all of the income from all of those subscription fees goes to printing and administrative costs. And, yes, also to the nearly $1 billion growth seen over the last decade at major academic publishing houses like Elsevier.

So why then does Barbara Aronson, a self-described socialist from Israel and coordinator of the library of the World Health Organization, describe Elsevier as “complete angels” when it comes to making health information accessible in the developing world? We’ll get to that in a second, but first an alternative model of academic publishing, which just might turn the industry into an open commons of peer-reviewed academic bloggers. (Since ‘blogger’ these days seems to refer to anyone who publishes any text online. And why not?)

As John Willinsky emphasizes in his book (available both as a free electronic download or to be purchased in print) The Access Principle, the debate over greater access to information and scholarship is nothing new. The public library was a revolutionary idea in that any individual could walk into a public building and read anything without paying a dime to copyright holders. Of course, if you make photocopies of those texts to read them outside of the library, that is illegal, but so long as you read them within the library, you are breaking no laws. In fact, you can even watch entire DVDs and listen to CDs at a public library. That is legal. Copying those DVDs and CDs to your computer to listen to them outside of the library: illegal.

The revolutionary idea of the public library was that the government should shoulder the burden of copyright costs so that the general public – both rich and poor – has greater access to knowledge and information. Britain took this idea even one step further, creating six “copyright libraries”, which are legally entitled to receive one free copy of each book, pamphlet, map, music sheet or score, and periodical published in the UK. It is a social contract between the government and the publishing industry aimed at enabling greater access to information regardless of economic status.

There is still another restriction: how close you live to those six copyright libraries. If, for example, you live in Zimbabwe where there are very few public libraries – especially research libraries – then your access to all of this information is null.

But you argue, it’s 2008, we have the internet, why not just make these libraries of free scholarship available online? Two groups are trying to do exactly that. One is the open access publishing movement, which really took hold in April 2003 when “a group of individuals interested in promoting open access to the scientific literature met at the headquarters of the Howard Hughes Medical Institute in Chevy Chase, Maryland, and drafted a statement of principles that is now referred to as the Bethesda Statement on Open Access Publishing.” Similar statements were made in the UK and Germany. Many researchers and academics (especially younger ones) immediately supported the statement and vowed to only publish in open access journals.

Even before the Bethesda Statement, in early 2001, Patrick Brown of Stanford and Michael Eisen of UC Berkeley started an online petition calling for scientists to pledge to discontinue submission of papers to journals which did not make the full texts of their papers freely available to all. In October 2003, half a year after the Bethesda Statement, the two researchers helped launch the Public Library of Science (PLoS), a collection of peer-reviewed journals, which meet their definition of Open Access Publication. PLoS and BioMed Central are now the two biggest publishers of open access scholarship. Open Access content is, almost always, distributed via the internet. Readers are free to print out, copy, and redistribute the scholarship as printed publications.

Critics of the open access model of publishing claim that commercial publishers play an instrumental role of filtering (gatekeepers) and deciding which papers deserve to be published. They also arrange the peer review process and keep an archive and index of past articles. Critics also eagerly point out that, like public libraries, open access journals, so far, depend on government grants and have yet to prove themselves to be financially sustainable.

There are other criticisms, eleven of which are given counter-arguments by open access advocates from BioMed Central. Most applicable for this conference on Global eHealth is “Myth 7”, which states “poor countries already have free access to the biomedical literature.” It refers to two initiatives of the World Health Organization – HINARI and AGORA – for which 28 commercial publishers make a total of over 2000 scholarly journals freely available to relevant institutions in poorest countries (defined as having a per capita annual income of less than $1000); and at a deep discount for some slightly less disadvantaged countries (per capita annual income between $1000 and $3000).

HINARI is the brainchild of the above-mentioned Barbara Aronson, the coordinator of the WHO’s library, who agreed to sit down with me at the Access to Information track of Rockefeller’s eHealth conference. As always, the complete audio of our conversation is available below. What follows is an edited and abridged transcription.

DS: How did the idea for HINARI come about?

BA: There have always been people from WHO’s committees from very poor countries and they would spend their lunch times and their coffee breaks running into the WHO library [in Geneva] with a long list of articles they wanted to photocopy. Of course they didn’t have time to do all of this so I would say, give me the list, explain to me what this is about, and I will help you. And they would say, OK, this list is for my research, this list is for my graduate studies, this list is for my son who is in his second year of medicine, and this list is because my mother is sick and I’m trying to figure out what to do for her. It seemed to me to be a remarkably inefficient system.

One day a colleague from Kenya came into the library and said to me, have you seen PubMed? And I said what is PubMed? And he said, MEDLINE is now on the the internet and free. I heard about it from a colleague in Kenya. So, in other words, it reached Kenya news before it reached Geneva news. This put on a lightbulb for me. We were beginning to see the first journals come online.

So I started thinking how we could harness what PubMed has got and then have the journals online because if PubMed is useful in Kenya, just imagine how useful online journals would be.

The opportunity came in 2000. In a meeting on information at the WHO, everyone in the room agreed that the highest priority was access to the price of literature. And they meant journals and they meant databases – because some of the most useful databases are also proprietary.

So, that was April 2000 and by March 2001 we had agreement on the framework of HINARI.

DS: Wow, that is really fast. So, what were the greatest obstacles during that time? How did that happen?

BA: There weren’t really any obstacles. It was perfect timing. Kofi Annan that same month announced his millenium agenda and one of the things was that we were supposed to do something about was the digital divide and we were supposed to do it in public-private partnerships with industry. This was the first time that the UN ever said we could work with the private sector, which is real groundbreaking stuff for the UN. I know it sounds ridiculous, but our attitude had always been, ‘if we need you, we’ll write a check.’ You know, ‘you’re not worthy of being our partners in anything,’ which is really wrong and in technology you have got to work with industry because industry is where it is happening and where the norms are actually being created.

What we did is we got the six biggest publishers together because they publish between 75% an 85% of the body of journals that we wanted the poorest countries to have access to. We knew that if they would say yes, everybody else would follow suit. We sat down in a room with them and we said, look, here’s what the economies of the world look like. It was a bar graph with four bars: 1.) here are the richest countries of the world – your markets are saturated there, 2.) then you have the fast growing countries – they are quickly approaching the situation of the wealthy countries, 3.) then you have a group of countries with a GNP between $1,000 and $3,000 per capita – we said, OK, you have some subscriptions here, mostly paid for by aid agencies, 4.) then we showed them the last column – there are more than 70 countries in this bar, you don’t have any sales there, you don’t even know the names of these countries, they have the worst health problems in the world, nobody is doing research about their health problems, they need everything, they need to train doctors, nurses, they need to do their own research and solve their own problems. And they are doing the whole thing without access to the latest scientific information or much information at all. And, what do you think about that?

That’s about how long the presentation took – what I just said now. Elsevier, which is the biggest and wealthiest of the publishing groups said, OK, that group gets free access, and the group next to it gets a discounted rate …

And then all the other publishers looked at Elsevier and said, are you really doing this? And Elsevier said yes and then they all said, OK, we are too.


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That is the first ten minutes of our 16-minute conversation. We go on to discuss the future of the academic media ecology (that is, the business model) and the respective pros and cons of commercial and non-commercial publishing.

Other interviews with Aronson are available on ITConversations and Medscape.