Why Be a Medical Editor?

Jerome P. Kassirer, MD Tufts University School of Medicine, Boston, Mass, and Yale University School of Medicine, New Haven, Conn
JAMA. 2001;285:2253.

Thousands of medical journals exist, and new ones are published each year. Curiously, despite a vast "market" for medical editors, the field has no career track, no training programs, no faculty, no schools, and no classes. Few medical students set out to become medical editors. Instead, editors spring from physicians of all stripes: those who like to write and have shown a propensity to do so; specialists and subspecialists skilled in their own domain; and physicians who have served as associate editors or as members of a journal's editorial board. With the exception of a few dozen journal editors who do their jobs full time, most medical editors work part time, sharing their editorial work with other research, education, and patient care duties.
I write about editing from some experience. During my recent tenure as editor-in-chief of the New England Journal of Medicine I presided over 425 weekly issues of the Journal. I made countless decisions about which manuscripts to accept, which to reject, and which to revise. I edited manuscripts, sometimes extensively. With a staff of outstanding dedication and excellence, I introduced multiple new clinical features and initiated series of articles on many topics, including quality of care, delivery of health care, and the techniques of molecular medicine. I added enriching graphics, redesigned the Journal's format, introduced one of the first medical journal Web sites, and wrote more than 60 editorials. I shortened the time for handling manuscripts by a third and set a friendly tone between our editors and authors who sent us their work.
Even though a career path to medical editing is rather nebulous, I would encourage medical students who aspire to spend part of their career as a medical editor. A medical journal is a special part of the world of medicine. The reports of original research are a fundamental underpinning of most journals. Research projects are simply not complete unless the work has been subjected to evaluation by a researcher's peers, published in a journal, and exposed to criticism by the medical community.
This process of peer review selects out papers that are authoritative, usually novel, and often important to the advancement of medicine. In turn, these papers become the foundation for further research and the basis of day-to-day medical practices. Often the process of successful editorial peer review and publishing is a critical determinant of an author's academic advancement. Another special purpose of a medical journal is to publish material that informs a variety of medical, social, economic, and political subjects such as abortion, assisted suicide, fatalities from handguns, and the medical use of marijuana.
Because medical editors bear some of the responsibility for the reliability of published research and, in turn, for the care of patients, the health of the public, allocation of resources, and standards of medical ethics and professional behavior, editors must be trustworthy. Readers must believe that editors will make sound and even-handed decisions, that they will be open to many points of view, and that they will select or reject material only on the basis of merit, and certainly not for business or political reasons. To preserve this trust, an editor must avoid giving favors, must not be beholden to any special-interest group, and must be willing to publish articles on controversial subjects, even if they involve the organization that owns and publishes the journal.
In order for editors to preserve freedom of action and expression, they must have no conflicts of interest that might bias them in choosing reviewers, making editorial decisions, or issuing public statements. Editors cannot be influenced by whether individual decisions will affect their journal's profitability, for example. Complete separation of editorial decisions from financial issues, therefore, is essential to ensuring the editor's independence. If it becomes known that an editor's judgment can be influenced by extraneous factors such as income from specific advertisements, the journal will lose the respect of its readers.
Editors are often visualized sitting at a desk struggling over one manuscript after another. They do that, but they do far more. They think about how electronic publishing and emerging sources of information will affect their journal. They develop and adhere to certain principles of publishing that authors and journalists sometimes find irritating. They deal with endless calls from journalists about papers they are publishing. They must be creative in envisioning the future of their discipline; they must try to discern not only what their readers might want, but, more importantly, what their readers need. They watch the medical, social, and economic events that are shaping medicine. Like editors of newspapers, magazines, and other media, they have a bully pulpit that they can exploit to benefit medicine. By commenting on contentious issues and conflicts, a skilled editor can contribute to the important debates of the times.
Few people will make their entire careers in medical editing, but many will spend years at it. If you have a creative spark and a love of language, if you derive pleasure from helping others improve their work, if you think that you can help inform the discussions about the future of medicine, and if you have thick skin, an editor's job is worth contemplating.
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Peer review process

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Nature vs Science vs Open Access

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Open access: a giant leap towards bridging health inequities

Bulletin of the World Health Organization 2009;87:631-635. doi: 10.2471/BLT.09.064659

Health knowledge generated in the world’s laboratories is passed down the information chain through publications, through its impact and application, its subsequent “translation” into appropriate contexts for different user communities, arriving finally with health workers and the general public, as the diagram of the knowledge cycle from the Canadian Institutes of Health Research has shown.1 Studies have shown that access to published health research by the research communities in developing countries is no longer “fit for purpose”.2 As has been well documented, rising costs of subscriptions and permission barriers imposed by publishers have barred access to the extent that local health research and health care have been damaged through lack of information.3,4 For example, Yamey5 tells of a physician in southern Africa who could not afford full access to journals but based a decision to alter a perinatal HIV prevention programme on one single abstract. The full text article would have shown that the findings were not relevant to the country’s situation.
With the advent of the internet there is little justification for continuing to create barriers to access. Richard Smith, as the former editor of the British Medical Journal, said, “Most research is publicly funded, and when the internet appeared it made no sense for research funders to allow publishers to profit from restricting access to their research”.6 This is true not only for publicly funded research but for private health charities around the world. As the Open Access Policy of the Wellcome Trust states, “We . . . support unrestricted access to the published output of research as a fundamental part of its charitable mission and a public benefit to be encouraged wherever possible”.7
Science is a collaborative process and openness is fundamental to knowledge advancement. Nowhere has this been shown more clearly than by the 2003 outbreak of SARS (severe acute respiratory syndrome) during which, at the height of the epidemic, there was unprecedented openness and willingness to share critical research information, leading to the identification and the genetic mapping of the responsible coronavirus by 13 collaborating laboratories from 10 countries.8 The recent release of essential H1N1 data published in several toll-access journals relevant to the H1N1 influenza pandemic points to the recognition that access to health research information is critical in the containment of infectious outbreaks.9
It is difficult to see how the United Nations’ Millennium Development Goals can be achieved without free international access to the world’s publicly funded research findings or without collaborative initiatives. Goals 4 to 7 depend on the sharing of research findings for success, while Goal 8, which emphasizes the need for global partnerships for development, recognizes that sharing knowledge and capacity building establish the infrastructure for building future aid programmes.
Any solution to the inequality of access to health-care information must be based on the development of an independent and sustainable national research base. Lessons in development aid from the past few decades clearly show that mechanisms that reinforce the dependency culture are no longer appropriate.10,11
The United Nation’s HINARI, AGORA and OARE programmes, whereby registered libraries or qualified institutions in countries with a Gross Domestic Product (GDP) of < href="http://www.who.int/bulletin/volumes/87/8/09-064659/en/index.html#R12">12 However, such donor programmes have several limitations.13 They are not driven by science (journals are donated by publishers at their own discretion rather than selected by researchers); they are only available to the poorest countries (as countries’ economies improve, they no longer qualify); some low-income countries are excluded (e.g. India, even though its GDP level qualifies it for access) because publishers fear damage to their existing sales; access is only available from registered libraries and on provision of a password controlled by libraries; publications may be withdrawn and there are no contractual arrangements regarding content continuity.
In a letter to PLoS Medicine, Villafuerte-Gálvez et al. said that, since 2003, Peruvian medical students and health professionals have substantially benefited from access to high-quality scientific information through HINARI but that recently students and faculty had not been able to gain access to several top journals that were available at the launch of the programme.14 Moreover, the number of users had dropped by 52% in 3 years. Such was the value of the donor material that copies were made available to colleagues unable to access them.
A key to resolving the deep knowledge gap lies in creating a global knowledge base that includes essential research emanating from both research communities in developing countries as well as from “international” research. Without regional knowledge, the picture is incomplete and may result in inappropriate programmes. As an example, bacille Calmette–Guérin vaccine developed in Europe for combating tuberculosis is of limited efficacy in China and India, the countries hardest hit.15 Molecular typing studies by van Embden of the Netherlands have shown that the Indian tuberculosis strains are different from those in western countries.16 Similarly, as Andrew Hattersley has pointed out, effective treatments for diabetes in the United Kingdom may not work in India and vice versa, as environmental and genetic factors can affect the success of treatments.17
It is equally crucial to ensure distribution of publications between neighbouring countries since they may share similar health problems that are seldom covered by established international journals. A study by Lown & Banerjee to assess the New England Journal of Medicine’s coverage of health issues of the developing world, found that in 416 weekly issues over an eight-year period < href="http://www.who.int/bulletin/volumes/87/8/09-064659/en/index.html#R18">18 Other studies have shown similar evidence of systematic bias by medical journals from developed countries against highlighting diseases of poverty, and recent reports have documented the problem of neglected tropical diseases.19,20
Overcoming the limitations
The statement and recommendations of the Budapest Open Access Initiative on which all subsequent open access developments are based, is concerned with free public access to peer reviewed publicly-funded research publications.21 It recommended two routes to achieving open access: (i) deposit author’s copy of already published articles in the author’s institutional repository (or a subject-based central repository where an appropriate one exists); or (ii) publish in an open access journal.
Both these routes have the major advantage of being driven by science and building research capacity as researchers can compile personal collections of material specific to their work, regardless of whether it has been published in local or international journals.22 Open access is sustainable as the establishment of institutional repositories is low cost in the developing world and publishing in open access journals is mostly free to authors (only a minority of commercial journals charge a document management fee, usually waived for authors from developing countries). Services that have focused on providing maximum visibility to regional journals, such as Bioline International23 (70 open access journals from 17 developing countries), SciELO24 (approximately 500 journals from Latin American and other Spanish and Portugese-speaking countries) or MedKnow Publications25 (79 journals mainly from India), show high usage both from neighbouring developing countries and from wider international communities alike. The example of Bioline International usage in 2008, showing 4.2 million full-text downloads from a global audience, is typical. Usage from the interoperable institutional repositories is equally high, and rising. The usage of full-text material from institutional repositories that have installed statistical data packages shows low-income countries are among the top users – again demonstrating a real need for previously unattainable information.26,27
As open access has become established, major international institutes and funders have begun to require that copies of articles that result from their support are deposited in institutional repositories or published initially in open access journals. In the United Kingdom, more than 90% of publicly funded medical research is covered by open access mandates. In the United States of America, the research access policy of the National Institutes of Health promises to make available publicly about 80 000 articles per year. Globally, as at 5 June 2009, there were 84 open access mandates28 from such prestigious organizations as Harvard University, Massachusetts Institute of Technology, Southampton University, all the United Kingdom Research Councils, the Wellcome Trust and many other institutes, universities and departments, 17% of which are from developing countries. There are now 4184 open access journals published,29 15% in developing countries and 1351 institutional repositories30 – approximately 17% of these are located in developing countries. At the same time, there is much supporting infrastructure activity – developing institutional repository networks, developing software that allows harvesting between repositories and similar regional developments.31,32 These figures demonstrate the increasing global acceptance of open access policies as a way to enhance research around the world.
There have been many misconceptions about open access that have retarded its acceptance. It has been said that open access is equivalent to “vanity press” and that it lowers scholarly standards, but this is not the case since copies of author’s final accepted articles deposited in institutional repositories have already been accepted for publication following review and open access journals incorporate rigorous peer review. Again, whereas it had been feared that the imposition of author-fees by some commercial open access journals would disenfranchise authors from developing countries, it is now clear that revenues can be maintained in alternative ways, such as print subscriptions, other publishing services or reprint sales. As has been shown by the MedKnow Publications service, Mumbai, there has been an increase in subscriptions to the hard copy version since providing open access to the online version.25
It is also incorrect to say that self-archiving automatically infringes copyright in all cases. The majority (63%) of non-open access journals allow deposit of copies of published articles in institutional repositories (sometimes with an embargo period) and most open access journals allow authors to retain copyright (see statement on copyright from Science Commons and the Scholarly Publishing and Academic Resources Coalition, SPARC).33 It has been said that the connectivity problems in developing countries render open access inappropriate, yet these problems, while real, apply equally to non-open access online publications. Moreover, the International Development Research Centre (IDRC) recently reported that the research needs for access to new information drive connectivity and vice versa.34 While much remains to be done, both connectivity and access to broadband are improving globally, and new mobile technology is beginning to play a major role in health care communication. It has been said that research information is not appropriate for health workers, yet access to new research drives development of new health applications and builds a strong national science base which in turn strengthens medical services and national economies.35
The way ahead
It is our view that the United Nations and other international organizations should give strong support to the open access movement, which holds such promise for both research and public health. In this respect, it is gratifying to see that one of the stated objectives in the report of the Intergovernmental Working Group on Public Health, Innovation and Intellectual Property is to “promote public access to the results of government funded research, by strongly encouraging that all investigators ... submit to an open access database an electronic version of their final, peer-reviewed manuscripts”.36 It is hoped that this will translate into action in the form of vigorous support for low-cost institutional repositories and local open access journals, as well as by raising awareness of the many benefits of open access. Initiatives such as TropIKA,37 incorporating open access medical publications for tropical diseases that are most prevalent in developing countries, are encouraging, as is the recent announcement by the Council of Scientific and Industrial Research in India, urging the establishment of institutional repositories in each of its more than 35 laboratories as well as conversion of all their journals to open access.38 The recent adoption of an open access mandate by the University of Pretoria in South Africa again demonstrates recognition of the importance of open access for developing regions.39
While it may be helpful to continue the donor programmes as long as they are needed, it is only through removing the barriers to access to global research that health improvements can be accelerated. Open access delivers free access to millions of research articles for all with Internet access regardless of institutional affiliation or national GDP. It builds research and health-care independence and replaces the dependency culture that is now widely criticized.40 The report of the Global Forum for Health Research states, “Strengthening research capacity in developing countries is one of the most effective and sustainable ways of advancing health and development . . . and of helping correct the 10/90 gap in health research”.41 Open access is a necessary first step. ■
Competing interests: None declared.
Sudsawad P. Knowledge translation: introduction to models, strategies and measures. Ottawa, ON: Canadian Institutes of Health Research;2007. Available from: http://www.ncddr.org/kt/products/ktintro/allinone.html [accessed 29 June 2009].
Aronson B. Improving online access to medical information for low-income countries. N Engl J Med 2004; 350: 966-8 doi: 10.1056/NEJMp048009 pmid: 14999107.
Zerhoni EA. Access to biomedical research information. Bethesda, MD: National Institutes of Health; 2004. Available from: http://www.taxpayeraccess.org/docs/NIH_access_report.pdf [accessed 29 June 2009].
INFOcus. Rising journal costs limit scholarly access. Atlanta, GA: Emory University Libraries; 2007 Available from: http://www.lyponline.com/infocus/0907/Special_Report.htm [accessed 29 June 2009].
Yamey G. Excluding the poor from accessing biomedical literature: a rights violation that impedes global health. Health and Human Rights 2008:10. Available from: http://www.hhrjournal.org/index.php/hhr/article/view/20/88 [accessed 29 June 2009].
Smith R. A great day for science. The Guardian, 11 October 2008. Available from: [accessed 29 June 2009].
Position statement in support of open and unrestricted access to published research. London: The Wellcome Trust; 2008. Available from: http://www.wellcome.ac.uk/About-us/Policy/Policy-and-position-statements/WTD002766.htm [accessed 29 June 2009].
SARS. how a global epidemic was stopped. Manila: World Health Organization Regional Office for the Western Pacific Region; 2006.
American Society of Microbiology makes 14 research publications of Influenza AH1N1 freely available [media release], 4 May 2009. Available from: http://www.asm.org/Media/index.asp?bid=64503 [accessed 29 June 2009].
Thorbecke E. The evolution of the development doctrine and the role of foreign aid, 1950-2000. In: Tarp F, Hjertholm P, eds. Foreign aid and development. Routledge; 2000. Available from: http://are.berkeley.edu/courses/ARE251/2004/papers/Thorbecke.pdf [accessed 29 June 2009].
Riddell RC. Does foreign aid really work? New York, NY: Oxford University Press; 2007.
Developing countries’ access to the world’s leading journals. [HINARI/OARE/AGORA programmes information leaflet]. Available from: http://www.oaresciences.org/publicity/Hinari-Oare-Agora_Leaflet.pdf [accessed 29 June 2009].
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Villafuerte-Gálvez J, Curioso WH, Gayoso O. Biomedical journals and global poverty: is HINARI a step backwards? PLoS Med 2007; 4: 220- doi: 10.1371/journal.pmed.0040220.
Arunachalam S, Gunasekaran S. Diabetes research in India and China today: from literature-based mapping to health-care policy. Curr Sci 2002; 82: 933-47.
Van Embden JD, Cave MD, Crawford JT, Dale JW, Eisenach KD, Gicquel B, et al., et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993; 31: 406-9 pmid: 8381814.
Hattersley AT. Multiple facets of diabetes in young people. Curr Sci 2002; 82: 273-8.
Lown B, Banerjee A. The developing world in The New England Journal of Medicine. Global Health 2006; 2: 3- doi: 10.1186/1744-8603-2-3 pmid: 16542448.
Horton R. Medical journals: evidence of bias against the diseases of poverty. Lancet 2003; 361: 712-3 doi: 10.1016/S0140-6736(03)12665-7 pmid: 12620731.
Sumathipala A, Siribaddana S, Patel V. Under-representation of developing countries in the research literature: ethical issues arising from a survey of five leading medical journals. BMC Med Ethics 2004; 5: 5- doi: 10.1186/1472-6939-5-5.
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Chan L, Arunachalam S, Kirsop B. Open access archiving: the fast track to building research capacity in developing countries. Sci.Dev Net, 11 February 2005. Available from: http://www.scidev.net/en/features/open-access-archiving-the-fast-track-to-building-r.html [accessed 29 June 2009].
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Suber P. India’s CSIR asks its labs to adopt OA mandates. Open Access News, 9 February 2009. Available from:http://www.earlham.edu/~peters/fos/2009/02/india-csir-asks-its-labs-to-adopt-oa.html [accessed 29 June 2009].
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10/90 report on health research. Geneva: Global Forum for Health Research; 1999. Read More!

Perceptions of open access publishing: interviews with journal authors

Published at BMJ 2005;330:756 (2 April), doi:10.1136/bmj.38359.695220.82 (published 26 January 2005)

The traditional business model in scientific journal publishing is based on subscription charges to readers. This model might restrict access to knowledge and generate undeserved profit for publishers.1-3 An emerging alternative is open access publishing, which gives lawful free access to journal content on the internet and is funded by means other than readers' subscriptions. Several models for financing this have been proposed, including an author pays model, where authors' contributions to the cost of publishing replace readers' subscriptions. The author's contribution is usually referred to as an "author charge," which might be paid by research funders or the author's institution. Some journals currently charging authors, such as BioMed Central journals, have made provision for institutional membership, which offers exemption from charges to individual authors. Currently, several biomedical publishers, including the BMJ Publishing Group,4 are considering moving towards open access funded through author charges, but we know little about authors' attitudes or likely responses to such charges. The evidence so far is limited to experiments with heavily subsidised author charges and several surveys of authors with limited sampling,5 low response rates,6-7 and polls of authors from specialty journals about their preference for author charges or subscription models.8 9
Most journals experimenting with authors' fees charge less than Wellcome's estimated cost of $2500 (£1329, 1914) for producing an article.10 Consequently, these experiments cannot anticipate the long term sustainability of such a business model. To determine what motivates authors to publish in specific journals, whether they support open access publishing, and their perceptions of journals that charge authors fees, we carried out a series of interviews with authors to explore their understanding and attitudes.

We divided the list of corresponding authors who submitted to the BMJ in 2003 into regions reflecting areas from which the BMJ receives most submissions: United Kingdom; North America; Australasia; and Europe (excluding United Kingdom). We used computer generated random numbers to select a sample of 10 authors from each region and a further 10 in the European sample for use in case of language difficulties.
Data collectionWe conducted semistructured interviews by telephone (see bmj.com for interview schedule). Authors were asked if they were familiar with the terms "open access publishing" and "author pays models" and what they understood these terms to mean; whether they were in support of open access publishing; how they felt about the idea of author charges replacing subscription costs; whether they would consider submitting papers to author pays journals; and whether they would submit to the BMJ if it introduced publication charges.
We provided definitions to participants not familiar with the terms and to those who gave inadequate descriptions. We defined open access as "the provision of lawful free access to journal content online with its production funded by means other than subscription charges." An author pays model was defined as "an alternative method of funding journals whereby subscription charges are replaced with author charges for publication." When all interviews were completed, we independently collated responses and grouped the data according to emerging themes.11 Both interviewers (SS and LT) verified subsequent themes.

We attempted to contact 50 authors. Eleven were excluded (seven incorrect contact details, two absent, two language problems). Of the 29 eligible authors, 28 (72%) took part.
The 28 authors, aged 31-60, lived in the United Kingdom (seven), United States (five), Canada (two), Australia (four), New Zealand (three), the Netherlands (two), Denmark (three), Germany (one), and Finland (one). Twenty one were men. Respondents had been active researchers for between two and 30 years; 18 had been active researchers for at least 10 years. Authors had published between zero and 305 articles, and 18 had published at least 25 papers. Over half (15) had published in at least 15 different journals. Most had received research grants. Participants had a wide range of research interests.
Familiarity, support, and reservationsAll except four authors reported that they were familiar with the term "open access publishing" and defined it accurately when prompted. Some assumed open access meant publishing without peer review or printed journals. Half (14) reported that they had not previously submitted to an open access journal or were uncertain if they had. Only two had submitted a paper to an open access journal other than the BMJ. Several said that it can be difficult to discern editorial policies for specific journals because libraries subscribe to e-journals which appear to be open access, while some journals have temporary open access to selected content.
Almost all authors supported the concept of open access publishing. Authors reported benefits for themselves and other researchers, including easier and faster literature searching; reduced costs in terms of time savings, photocopying, interlibrary loans, and subscriptions; faster dissemination of results to a wider audience; more equitable access; and the potential for medicine to improve globally.
Respondents were concerned that open access publishing might lead to vanity publishing (poor quality research being published for a fee) and a flood of non-peer reviewed papers on the internet. Peer review, they said, is extremely important and resources might be directed away from this to fund open access.
Willingness to submit to open access journalsMost authors were willing to submit to open access journals. Many said open access was not a relevant factor when they were selecting a journal. Some questioned the quality and reputation of existing open access journals.
Familiarity with author pays modelTwelve authors were not at all familiar with the term "author pays model." However, another 12 were either familiar with the term or had heard of the concept of journals charging authors fees to fund publication. Several had not made the connection between author charges and open access publishing. A further four authors reported being familiar with the term but failed to describe it accurately; one believed it to be vanity publishing and three described page charges. Only nine authors could name some existing author pays journals.
Attitudes towards author chargesAuthors were mostly against author charges. Many thought there were negative implications of shifting costs to authors and that authors themselves should not be required to pay. Some thought charges might be acceptable if grant agencies and universities agreed to support authors. Some were concerned by the idea of paying to publish in non-peer reviewed journals and that the standard of publishing might decline. A few commented on the difficulty of implementing the model and the need for author charges to become standard so that the quality of journals could still be evaluated.
Several authors were concerned for those who could not afford to pay and said waivers would be necessary. Unfunded research, including methodological work, research done by junior doctors and PhD students, and researchers in developing countries, might not be published.
An author pays system might represent an additional barrier to researchers, resulting in restricted publications, which could have serious implications (box 1).
Willingness to submit to author pays journalsOverall, authors were not keen on the author pays model and would hesitate to submit to journals operating under such models. A few said charges might deter them and they would first look for journals that did not charge. Some said they would only submit to an author pays journal if all journals charged authors or if the better regarded journals they usually submit to switched to this model.
Factors of importance when selecting a journal included impact factor, reputation, readership, speed of publication, and the quality of peer review systems (box 2). Therefore, they would continue to submit appropriate papers to journals they regarded as "high quality" even if they charged. Mediating factors, however, were how much journals would charge and whether research funders would pay on the author's behalf. If fees were too high granting agencies (public funders and charities) might not be willing to pay.
Reasons cited for not previously submitting to author pays journals included lack of familiarity and perceptions that they are not widely read, that they don't have impact factors, have inferior peer review, and are not of high calibre (box 3).

Authors were aware of the concepts of open access publishing and author pays journals. While nearly all authors supported the idea of open access publishing, few had knowingly submitted to an open access journal. Concern was expressed about implications of author charges for those who may not be able to pay. Many said they would probably continue to submit to journals they considered as high quality if they charged authors, but this would depend on price and whether they received financial support.
Box 1: Additional barriers to researchers (sample quotes)
Might restrict publications
I wouldn't want geniuses to be inhibited to publish as then I wouldn't have access to their work (U5)
But you don't want the barrier to be too high. If costs are too large it would skew the type of submissions received (AM8) I have some concerns...It is hard enough finding published literature for Cochrane as it is. It is even harder to find unpublished stuff. If the model was costly enough to drive publications underground that would make Cochrane's work even more difficult (A8)
Research process is hard enough
I would hate that. It's awkward as a scientist to go through writing your manuscript, it's time consuming. Having to find the money would make it worse (E14)
Box 2: Other factors are important when selecting a journal (sample quotes)
Charging policy would not influence choice of journal
Yes...it would not be prohibitive... But I would think more about it before submitting. The quality of the target journal you are trying to get published in is more important than having to pay a fee or not. I have not factored in open access as a reason to or not to submit. If one journal came up...of good quality...or if a journal changed to this status...it wouldn't at all influence my choice...even if there was a payment to be made (AM7)
Quality and reputation of journal
I would be willing to consider it. But what I am more concerned about is the quality of the publication. I have access to funds through which I could pay to publish...as long as the fee isn't too outrageous (AM10)
I would be quite unhappy about it. I guess if it was a really top journal [I would submit]...but I would be really unhappy about it. Basically for quite a long time I would not be able to afford to do this (A7)
This comes back to the journals we target...if they became open access journals our hands would be tied...We would continue to target BMJ, Lancet, JAMA in the first instance...this is standard with our unit and the work we do [trials]. If they became open access we would submit and pay grudgingly because they have a phenomenal reputation. There is huge motivation for researchers to pursue publications in journals with the highest impact factors. If open access had an effect on impact factors then we would move on in the long term but in the short term we would continue to target the same journals (A8)
Depends on impact factor
Yes...but again it depends on impact factor because the university I work for has guidelines. We are discouraged from submitting to low impact journals...there is a list of journals we can use. I think this is widespread, at least in top universities, particularly in the UK with the focus on the RAE [research assessment exercise] (A9)
I might. It has to do with the impact factor whether I am willing to pay. That [the impact factor] determines a lot (E14)
Findings relative to other studiesPrevious surveys in this area have been methodologically weak.5-7 We achieved a good response rate and were able to assess understanding of both the terminology and the concepts behind open access and author pays publishing. Some authors were unfamiliar with the terminology but were familiar with the ideas. In contrast, previous surveys found limited understanding of open access models, which could be due to an assumed familiarity with the terminology.5-7 The BMJ is an open access (but not author pays) journal, and this might also explain some differences. One survey found respondents associated open access with good quality, well indexed electronic material, and half the authors would not pay author charges under any circumstances.7 In contrast, some of our authors questioned the quality of existing open access journals and were more concerned about perceived quality of journals than open access or author charges.
Study limitationsOur sample was limited to authors submitting to the BMJ, where views may differ from those of other authors. However, we took a random sample of international authors, many of whom had published in many other journals so their opinions are probably representative.
Box 3: Reasons for not having submitted to author pays journals (sample quotes)
Perceived as not widely read
I would try the more traditional journals first with bigger readership. There is no point writing and getting published if no one reads it. I would submit to journals I know people read (U1)
Lack of impact factors
They are new journals and so we don't know their impact ratings, etc, yet. I would think about that side of things too (U10)
Inferior peer review systems
Not yet because I don't see them as having the same peer review impact as other journals. I would have to see their peer review comments and system to decide (U2)
Not high calibre
There are enough other journals of high calibre, I wouldn't go there [BioMed Central] (A4)
ImplicationsSeveral publishers are considering moving to open access and could therefore benefit from understanding authors' perceptions and concerns. Authors in this study reported journal quality was more important than open access when deciding where to submit. They said that initiatives such as the research assessment exercise have obliged authors to publish in journals with high impact factors. New open access journals with lower impact factors will need to do more to reassure authors of the quality of their peer review processes and impact.
Some open access journals, such as Documenta Mathematica and Journal of Insect Science, do not charge processing fees. Those considering author charges, however, need to recognise that there are problems with this model and that they may need to make special arrangements for dealing with unfunded research and submissions from developing countries.
Future researchThis small descriptive study has identified a range of attitudes towards open access publishing. Participating authors said their responses depended on how much journals would charge and whether funders and institutions would pay. The next step is to determine the acceptability of various charging models to stake-holders and to conduct a comprehensive economic analysis of these models before concluding which model is most suitable.
What is already known on this topic
Several publishers are considering the viability of adopting open access publishing models funded through "author charges," but little is known about how authors will respond to publication fees
What this study adds
Authors support the concept of open access, though few questioned had submitted to an open access journal
Authors did not know which journals publish with open access, and perceived journal quality was more important than open access when selecting journals to submit to
Authors disliked the idea of author charges without institutional support and concerns were expressed about implications for authors from developing countries and those working on non-funded research
Fives more boxes of sample quotes and the interview schedule can be found on bmj.com
Contributors: RS initiated the study; SS and LT designed the study, interviewed the authors, and interpreted the data. All authors assisted in writing the paper. SS is guarantor.
Funding: BMJ Publishing Group's research budget.
Competing interests: All authors are or were employed by the BMJ Publishing Group. RS has now left the group and is employed by the British subsidiary of the UnitedHealth Group, a large US health and wellbeing company. He is also on the board of the Public Library of Science, an open access publisher. The BMJ is currently an open access journal and is considering whether to adopt author charges to fund the publication process. The researchers who conducted the interviews and analysed the data (SS and LT) do not have a financial interest in what the BMJ decides to do. Because members of the BMJ staff were involved in the conduct of this research and writing the paper, assessment and peer review have been carried out entirely by external advisors. No member of the BMJ staff has been involved in making the decision on the paper.
Ethical approval: This study was approved by the BMJ ethics committee.

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