Friday, February 01, 2013

Yes: Keeping small town docs out of the loop

LATimes has an article on a hacker who killed himself for being threatened with 30plus years in jail for downloading....scientific papers and posting them free on line (and not making a profit out of it).

Yes, as I have commented on several websites: The fact that medical journals are behind pay walls mean that a lot of us in private practice in rural areas would not be able to access these things.

The battle over open access has been raging for years — and Swartz's death only promises to make that battle even more heated, activists say.
Most people can't afford the high prices charged for scholarly and scientific research published in hard-copy journals or on the Web behind pay walls, creating what Malamud says is "a members-only country club of knowledge."
With the rise of the Internet, activists had hoped to change that. About a decade ago, scholars and scientists, libraries and universities started to publish peer-reviewed research online free of charge after the release of the Budapest Open Access Initiative in 2002.
The movement steadily gained steam, said Heather Joseph, executive director of the Scholarly Publishing and Academic Resources Coalition, which works to broaden public access to scholarly research. In 2005, the National Institutes of Health adopted an open access policy. Nearly 2.5 million articles are on the NIH database, and more than 700,000 people access PubMedCentral every day. But NIH is still the only federal agency with an official public access policy on the books.
Ah, but what they don't say is that often Pub Med only lets you see the abstract on line.

You have to arrange to join them as a rural doc and then ask them to have your local medical school library (usually located in medical schools in major cities) to send you a hard copy of an article.

That's what I had to do when I did research papers on antibiotic/seizure medicine interaction.
The point is: if I were a doc in the ER, I couldn't google these papers.

Maybe they have changed things since I last accessed it (I've been retired for awhile) but it was easier to google a problem than to try to find routine stuff on Pub Med.

Why is this a problem? Because a lot of the studies have holes in them.

I mentioned below about a newspaper article mentioned that diet diaries might not be accurate.

And a lot of us docs know that things like " cuts the heart attack rate by 80 percent" might in reality only mean that your rate goes from 24/100 000 to 20/100 000, and it doesn't include the other things that might affect the study (Aspirin cuts your rate of heart attack, but may put you in the hospital needed a blood transfusion for GIBleed. The early cholesterol studies showed a cut in heart attack death rates, but the crude death rate was the same: In one study, there was an increase of violence related deaths, in another study, a similar increase in deaths from bowel cancer. Most docs quipped that, given the choice, we'd chose to die of  a heart attack or being shot in bed by the spouse of our girlfriend than dying of bowel cancer).

And a lot of the most heralded studies have flaws, from poor reporting to low numbers or different populations.

To find this stuff, you have to read the whole article. That is why many hospitals still hold journal clubs.

Years ago, I complained that articles allow "Letters to the editor" to be published weeks later, but what they really need is a forum to discuss these things.

But that would take free access to the articles to begin with.

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