➢ Open access publishing is a rising trend in the orthopaedic literature and allows for free, public, and international availability of research findings.
➢ In contrast to traditional subscription journals, open access journals shift the financial burden of publishing from university libraries to authors and their individual research funds and grants.
➢ The benefits of open access include rapid knowledge dissemination without cost to consumers of the scientific literature, which may decrease research duplication and increase the rate of scientific progress, especially in the developing world.
➢ The potential risks of open access include the creation of journals with low oversight and minimal impact that may compromise the quality of the scientific literature.
➢ Researchers and surgeons alike are responsible for maintaining the quality of the orthopaedic literature by participating in the peer-review process and avoiding the temptation to publish quickly.
An orthopaedic surgeon has just completed a clinical outcomes research project in his area of expertise and wishes to publish a report in a widely read journal so that he can share his findings with the orthopaedic community. After the manuscript was rejected by two widely read subscription-based orthopaedic journals, the author submits the work to a so-called “peer-reviewed open access” orthopaedic journal that he finds online. Within two months, he receives a congratulatory acceptance letter stating that the manuscript has been accepted without revision and will be published both online and in print with open access. He is required to pay a $1400 processing fee to publish the work. He is hesitant to proceed because of his unfamiliarity with the title of the journal that he has selected, open access publishing, and the request for a processing fee.
Introduction to Open Access
Although the first open access journals did not appear in the biomedical literature until the 1990s, such journals have assumed an increasingly prominent role in the academic publishing arena over the past two decades. Today, calls for open access continue to grow on the basis of the central concept that “peer-reviewed research articles, donated for publication by authors with no expectation of compensation, should be available online, free, and with the smallest possible number of usage restrictions.”1 The aim of the present review is to provide a brief history of open access journals, to review the orthopaedic journals that currently participate in open access, to address the concept of predatory publishers, and to discuss the future implications of adopting this new publication paradigm.
Open access may be defined as the “unrestricted online access to articles published in scholarly journals.”2 Within the framework of open access, there are two models: gold open access, in which publishers make articles freely available to all, and green open access, in which authors upload their manuscripts to the web for distribution, often via manuscript-archiving services3. While the former is more common in medicine (including orthopaedics) and biology, the latter is more prevalent among disciplines such as mathematics, earth sciences, social sciences, engineering, and physics4. Other important terms include direct open access (which refers to journals that are fully available without limitations), delayed open access (which denotes free access after a defined period of time), and hybrid open access (whereby authors may choose to pay for open access or proceed with traditional subscription-based publication)4. Most open access journals utilize a Creative Commons license, which permits the public to freely share, copy, and distribute the work as long as the work is appropriately attributed to the authors, is not altered, and is not used for commercial purposes5. Given that open access journals do not generate revenue via subscription fees, they often require authors to pay article-processing charges to cover the costs of publication. A newer designation, platinum open access, recently has been coined to identify journals that do not charge article-processing fees for publication6.
The transition toward open access has been directed by several forces, including technology, finances, ethics, and professional incentives. One of the most important factors in this regard has been the transition to electronic publishing—driven by the growth of the Internet over the past twenty years—which has promoted open access by allowing the low-cost digital distribution of scientific articles7. At the same time, traditional subscription prices have continued to rise, often faster than the rate of inflation8. While specific prices often are hidden by nondisclosure agreements, estimates have suggested that university libraries sometimes can be required to pay up to $20,000 for a single journal title9,10. These high costs have forced many libraries to cancel journal subscriptions, thereby confining comprehensive journal collections to large, affluent institutions11,12. This “crisis of accessibility” has further engendered support for open access as it promises to keep scientific information available to researchers. In fact, proponents of open access argue that making scientific data instantaneously available to all will benefit not only researchers (by reducing the duplication of work) but also the general public (who will reap the benefits of more rapid scientific progress)13,14.
Open access journalism also has been supported by academicians, whose promotions and professional advancement are often determined, at least in part, by publications. The availability of a wide variety of journals in which to publish can support the ever-increasing pressures to publish novel research.
Proponents of open access also have criticized the traditional model of subscription journals, arguing that it allows scientific journals to profit from the time, effort, and funds provided by others. They note that the most demanding aspect of the publication process—peer review—is largely performed by academics who lend their time and energy on a volunteer basis. Research projects may be funded by government agencies, but it is the (privately owned) scientific journals that reap the profits8. The revenue generated by a single article has been estimated to be approximately $5000, which allowed the scientific publishing industry to generate revenues totaling $9.4 billion in 20118. As a result, the annual profit margins of academic publishers have been estimated to be around 20% to 50%8,15. Advocates of open access have suggested that there is an “obligation of reciprocity,” whereby research that has been funded with tax dollars should be freely available to the lay public who has already paid for it and to the researchers who have created it12,13. Similarly, government agencies, charitable foundations, and private funders all share the desire to ensure that their research is widely available to the public1. It is accepted that peer review has a cost, and it is expected that open access journals will charge article-processing fees to cover publishing expenses in order to allow for free and immediate access to the literature. However, the profit margins of open access journals are often considerably smaller, and overall production costs are typically lower. For example, the most widely known open access journal, PLoS One, charges $1350 per article, a figure that is one-third of the cost of publishing an article in the Proceedings of the National Academy of Sciences and 1/25th of the estimated cost of publishing an article in Nature8,10.
Pros and Cons of Open Access: What Do the Data Show?
As open access has become more widespread, it has garnered both support and opposition. In the field of orthopaedics, the availability of open access journals has been touted as providing several potential advantages to the worldwide orthopaedic community. For example, advocates contend that open access will result in an increased rate of article citation and, presumably, greater dissemination of knowledge13,14,16,17. Although we are not aware of any studies that have specifically examined the effect of open access on the rates of article citation in orthopaedics, a few studies in other fields have been performed to define this relationship17-20. In controlled experiments performed in the fields of physiology, general sciences, and social sciences, for example, investigators found that free access increased the frequency of article downloads and citations within the first year after publication but that these rates normalized after three years16,21,22. However, critics argue that these increased rates of citation do not necessarily imply that the articles are actually being read, as citations presumably could occur after review of only the abstract, which is usually publicly available for all journals16.
At this time, it does appear that the rise of open access has promoted the dissemination of medical research in resource-poor countries. The cost of traditional journal subscriptions is a substantial burden on institutions in the developing world, which are often unable to afford the high cost of Western scientific journals11. One study compared the reference lists of papers by researchers in India with those of papers by researchers in Switzerland and demonstrated that the Indian researchers were more likely to cite open access articles and less likely to cite articles published in expensive journals11. Similarly, a study that specifically examined the effect of open access in the developing world demonstrated that open access has had a substantially greater influence in the developing world than in more affluent countries and that it has resulted in a modest but clearly positive effect on global participation in science23.
While some argue that immediate access to the scientific literature has the potential to improve clinical outcomes, these ideas are empirical and are not backed by scientific evidence at the present time. We are aware of only one study that has specifically addressed this question24. In that investigation, mental health professionals in the field of clinical psychotherapy were asked to read an article that was distributed under four different conditions: no citation, normal citation, linked citation (at a cost), or free access citation. While those who were given free access were more likely to read the article, no changes in clinical practice were observed.
In rebuttal to the advocates who have emphasized the potential advantages of open access, critics have cited numerous potential pitfalls. For example, many have argued that open access will decrease the quality of the scientific literature without realizing any of the benefits described above. In particular, some have argued that open access journals have the potential to threaten the standard peer-review process and to lower quality-control standards. For example, when open access first originated in the 1990s, there were doubts about the legitimacy of these new journals19. There were concerns that increased article availability would cause subscribers to cancel their journal subscriptions, which threatened to undermine traditional academic publishing and to lower the quality of academic peer review19. However, this has not proven to be the case. Surveys of researchers typically have shown that perceived journal quality is the most important factor for journal selection, regardless of open access or author fees25. A direct comparison of open access and subscription-based journals founded within the past ten years demonstrated no differences in terms of quality or impact19.
Other concerns regarding open access are related to the article-processing fees that are charged by most open access journals. From the journal’s perspective, processing fees are necessary to cover the costs incurred in association with the publishing process. However, some have suggested that this arrangement represents a potential conflict of interest given that payment for publication could, in theory, influence a journal’s motivation to accept or reject a manuscript25. From our review, the average article-processing fee for open access orthopaedic journals is $1070 (range, $150 to $3000). Others have objected to article-processing fees on the grounds that they could cause research funds to be diverted toward the payment of publishing fees instead of the performance of scientific research3. For example, Frank estimated that if open access became the standard, Cornell University would require an additional $1.5 million and Harvard Medical School would require an additional $13.5 million to cover the publication fees associated with their annual article-publication rates26. While current open access models do transfer the cost of publication from university libraries to authors (and their research grants), the overall cost is likely to be substantially lower with open access.
Finally, the open access model has been criticized for its potential to spawn “predatory publishers,” which are for-profit companies that produce “low impact, low oversight” journals with little impact or visibility10. Some have described these publications as counterfeit journals given that they collect publishing fees while exploiting inexperienced authors who are motivated to publish the results of their research. Many of these journals are characterized by marketing techniques that can include “spamming” researchers to solicit manuscripts while promising rapid review and publication27. It has since been shown that some of these journals have falsified editorial boards and have even plagiarized manuscripts15,27. More recently, an investigator submitted an intentionally flawed sham manuscript to 304 open access journals and found that more than half offered publication without detecting the flaws and that approximately 60% of the decisions were made without any sign of peer review28. In response to the presence of these publishers, Jeffrey Beall, an academic librarian at the University of Colorado Denver, has posted a list of potential, possible, or probably predatory publishers (http://scholarlyoa.com/publishers/) and journals (http://scholarlyoa.com/individual-journals/). The scientific community must be aware of these journals, and orthopaedic surgeons should exercise caution when reading, referencing, or submitting manuscripts to unfamiliar journals.
Open Access in Orthopaedic Surgery
The number of open access journals is expanding for all specialties, including orthopaedic surgery. The Directory of Open Access Journals (http://www.doaj.org/) currently lists nearly 10,000 open access journals with >1.5 million freely available articles, and recent estimates have suggested that, in 2011, as many as 17% of published scientific articles were in immediate (12%) or delayed (5%) open access journals3. We are not aware of any peer-reviewed study that has specifically examined orthopaedic open access journals, but, using a variety of sources, we compiled a list of forty-two English-language open access publications focused on orthopaedic topics (Table I). In addition, by collecting information about the first year of publication, the number of issues published per year, and the number of articles per issue, we estimated the cumulative number of articles available in open access orthopaedic journals from 2001 to 2013 (Fig. 1).
Given that orthopaedic treatment can vary widely between countries and regions, our profession stands to benefit from the globalization of research and outcomes. However, established subscription-based journals may have a preference for research performed in North American countries such as the United States and Canada29. As surgeons, we should welcome high-quality research from developing nations to the extent that it is applicable to our practice. Open access provides the platform through which our surgical colleagues in the developing world can report their own experiences regarding the development of novel techniques and the treatment of conditions not otherwise seen in Western countries. These advantages are in addition to the known benefit of increased access to the literature among clinicians practicing in the developing world.
The trend toward open access publishing has been firmly established over the past decade and shows no sign of reversing. As such, we must be prepared to embrace and integrate open access publishing in a way that supports our science, encourages our researchers, and benefits our patients. Like any new technology, open access is not without its faults, and critics have appropriately raised concerns about academic integrity and profiteering by certain publishers. By understanding these risks and committing to improvement, open access has the potential to advance our field at a rapid pace and to bring orthopaedic research to a wider audience.
As described in the illustrative scenario that opens this review, many orthopaedic surgeons may wonder about the legitimacy of newer open access journals. Before submitting a manuscript to an open access journal for publication, one should evaluate the publication on the basis of the following criteria. First, one should check the publisher and editorial board for reputable names and colleagues who may be recognized from other publications. Next, one should search for the journal’s title at http://www.doaj.org/ and determine its impact factor as a secondary representation of overall distribution, recognizing that these benchmarks are not absolute reflections of journal or research quality. One should also visit PubMed as well as the journal’s archives to ensure that articles are published in a timely fashion and are actually freely available for download, consistent with open access guidelines. Once an article has been accepted for publication, one should confirm that the peer-review process has been completed and request to see the reviewer comments, even if the article was accepted without edits. If a journal meets these requirements and has a reasonable article-processing fee (average fee for orthopaedic journals, $1070; range, $150 to $3000), one can feel comfortable proceeding with publication. By adhering to these suggestions, we can improve the quality of the literature while benefitting our colleagues and patients. Instead of simply seeking to publish quickly, we encourage orthopaedic researchers to focus on publishing their research in journals that fulfill our moral commitments to wide dissemination and academic integrity.
Source of Funding: No external funds were received in support of this study.
Investigation performed at the University of California San Diego Medical Center, San Diego, California, and the Kaiser Moanalua Medical Center, Honolulu, Hawaii
Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.
- Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated