The Excitable Scientist

Mostly cheerful, sometimes snarky commentary on life science research and its broader impacts

On Paywalls and Privilege July 6, 2013

Filed under: academia,access,grad school,publishing — excitablescientist @ 8:55 pm

Over the past year, I’ve had the privilege of working with a superb colleague who recently had an article published in a high-impact journal, on which I was a co-author.  I feel so lucky to have been part of this process; it has been an awesome learning experience and has laid the foundation for what I think will become my PhD project. I’ve also learned so much about the politics and logistics of getting a paper published (mainly by observing the negotiations with editors and reviewers), something I think a lot of grad students don’t experience until much later in the game.


It does, of course, feel pretty cool to be published in a GlamourMag family journal.  One of my best friends, from the same country as me but currently working abroad, got very excited about this and posted a link to the article on a social media site.  Very soon afterwards, I read a comment by a mutual acquaintance that gave me pause: “Well done, but we can’t even open the paper to read it. Thanks, home country!”.  It was a sudden and stark reminder of the unequal distribution of scientific resources globally, and of my own position of privilege as a grad student in a well-funded lab in the West.  I can’t imagine how demoralizing it would be to be constantly treated as a second-class scientist by paywalls still in place at most major journals.  There are ways to get an article even if your institution doesn’t have a subscription to the journal – e.g. by e-mailing the corresponding author – but this is akin to having to go to the food bank instead of living in a society which has systems in place for all of its citizens to meet basic needs in a dignified manner.  It’s pretty clear to me that scientists in what’s now known as the Global South (not restricted to the southern hemisphere) work harder and smarter with fewer resources for less recognition.


Most e-mail interactions I’ve had with professors at other universities have been in the context of collaborations, sharing results, planning meetings- all joyful occasions, in which I have felt our groups have been on equal footing.  I imagine my self-esteem would be greatly reduced if the majority of my interactions with other profs were e-mail requests for their articles, highlighting my position as a grad student in an underresourced setting, implying the inadequacy of the setting, and probably of me.  I have probably 300 papers from closed access journals in my library, and have skimmed through probably double or triple that number in the past year.  If I didn’t have access to journals through my institution, that would necessitate sending thousands of e-mails requesting paper reprints: a colossal waste of everyone’s time.  In reality, I probably wouldn’t bother, and would base decisions of what to read based on what I can access, instead of on the quality of the science.


Much has been written about the ability of open access to facilitate knowledge exchange and therefore new discoveries, and of the cost of paywalls in terms of diminished productivity if people can’t access and therefore cannot build on what’s already been published.  I’ve long accepted that paywalls slow the pace of research at institutions that cannot afford to subscribe to major journals.  What I hadn’t thought about until now, and am finding more personally compelling, is the effect on individual researcher productivity and probably morale.  As any PhD student knows, working in biomedical research can be demoralizing enough owing to the high failure rate of experiments in the best of environments, without having to jump through hoops to even be able to read articles- something too many of us take for granted.


An increasing number of scientists and journals are making open access publishing a priority.  I’m ashamed to admit I’m not one of them, at least not in this particular instance.  I’m determined to push for the OA option on “my” future papers, but I didn’t have the guts to do it for a study I didn’t lead.  It would have been expensive, and probably would have been yet another uphill battle against the status quo.  That’s still no excuse for not trying.  And it’s a little bittersweet to think that many of my friends and family might be proud of me for publishing in a high-impact journal – if only they could read it.


Documentary review: Freedom from Pain August 2, 2011

Filed under: access,medicines,palliative care — excitablescientist @ 12:02 am

Many of you who know me in “real” life know I am passionate about extending access to essential medicines to patients around the world, especially in developing countries.   I am still haunted by memories of hearing people at the steps of my home country’s Cancer Institute beg for money for chemotherapy drugs, which they had to pay for out-of-pocket.  Living with cancer is enough of a heartbreaking ordeal, but not being able to afford the necessary treatments adds insult to injury.  My mother and sister (who both worked at the Institute) tried to shield me from these sights, but I am glad they weren’t successful, because this was a formative experience, and inspired a big part of my volunteer work during my undergrad career.


The reasons underlying a lack of access to essential medicines are many and complex – some are financial, often a result of high prices set by pharmaceutical companies; but even off-patent, generically produced drugs can be out of the reach of many patients in need, for reasons relating to transport infrastructure, difficulty accessing health care facilities, and a lack of health care workers trained to prescribe and dispense these drugs.


Sometimes, however, all the aforementioned factors are in place, and the reasons for denying access to life-enhancing medications to patients who desperately need them are purely bureocratic.  Such is the case with medical morphine, which costs pennies to produce, and is the painkiller of choice for people suffering from terminal illnesses such as cancer and AIDS.  Morphine for medicinal use has been an innocent bystander caught in the crossfire of the global war on drugs, because its misuse can lead to opiate addiction, and because it can be used to manufacture heroin.


The fear of abuse and diversion to the illicit drug market has prompted many developing countries to adopt excessively strict laws governing the medical use of morphine.  This makes them near-impossible to access even by patients suffering from severe, long-term, chronic pain.  As eloquently stated by Kimberly Green, a palliative-care expert in a health development organization in Vietnam, “Something is wrong when it’s easier to buy heroin than it is to buy morphine”.  In 2003, developing countries, representing 80% of the world’s population, accounted for just 6% of the total morphine consumption.  Access in the developed world is considerably better.


I recently watched Freedom from Pain, a 25-minute documentary on the under-reported lack of access to pain medicine crisis.  It’s an eye-opener.  I urge you to at least read the synopsis, which provides excellent examples of how the medical/legal systems of developing countries handle the medical use of opiates like morphine, the key barriers imposed on access, as well as stories of places where those barriers have been surmounted.


Success stories like that of Uganda (the first country in Africa to state, in words and practice, that palliative care is an essential service for all citizens), give me hope that one day I will live in a world where access to pain treatment is considered a basic human right in all countries, where the rational use of pain medications is practiced everywhere, and where the nebulous threat of fuelling the illicit drug market does not leave millions of patients suffering in agony.  Until then, there is a long road to go.


For further reading:

Morphine Remains Scarce for Pain Sufferers Worldwide (Time, 2010)

Medicines: Access to Controlled Substances (World Health Organization, 2010)

Global State of Pain Treatment (Human Rights Watch, 2011)