Open Access, 20 Years Later

Twenty years ago, the second issue of The Hematologist featured an interview in which Dr. Sanford Shattil, editor-in-chief of Blood at the time, discussed his views on the future of open access in medical publishing. His thoughtful comments resonate today, although the evolution of the open-access movement appears to have surpassed his expectations and more than fulfilled his warnings about its impact.

As noted at the outset of the interview, the movement toward open-access publication had escalated rapidly following the launch of the journal of the Public Library of Science (PLoS) that same year (2003). Dr. Shattil commented that at $1,500 to publish per article, authors would find publishing a paper much more expensive than paying page charges and charges for color figures (although the latter charge has since been dropped at Blood). Further, he pointed out that $1,500 fell well below the full cost of publication for a single paper and that PLoS had received a five-year, $9 million subsidy in the form of a foundation grant. While publication charges for PLoS One have increased only slightly since 2003, reaching just over $1,900, the cost of publishing a research paper in PLoS Biology in 2023 is $5,500, while the cost for publishing in PLoS Medicine is $6,300.

The idea that scientific reports should be immediately open and available is a laudable sentiment, allowing rapid communication of new knowledge “hot off the press.” However, it must be recognized that there are two major downsides. First, the financial burden of publication is placed on the authors. Although some funders allow the use of grant funds to cover the costs of publication, they do not necessarily increase the funding levels in the grants to prevent these charges from decreasing the funds available for performing experiments. The recent NIH directive calling for immediate access to the published results of NIH-funded research, for example, is silent on the issue of potentially increasing grant funds to cover publication costs. To put this burden in perspective, imagine that an active, successful investigator aims to publish five to 10 papers per year. Assuming an average publishing fee of $5,000, such a volume would require the commitment of $25,000 to $50,000 to publication costs alone. Not all investigators have access to such funds, meaning they are faced with the decision to pay out of pocket to publish their work, ask the institution to cover the costs, refrain from publishing altogether, or select a target journal based on cost rather than scientific stature. As Dr. Shattil pointed out, this gives a somewhat different meaning to the term “open access,” raising the question of “open to whom?”

The second, then-unanticipated consequence is the incentive created by a new financial model in which a journal derives its income entirely, or nearly entirely, from author-paid publication fees. This model has spawned a plethora of for-profit journals focused simply on publishing as many papers as possible. This represents the most pressing existential threat to the integrity of the scientific literature, as it undermines robust peer review, which is critical to guarding against the publication of false, misleading, or misinterpreted data. Some of these journals publish more than 5,000 papers per year, defying any ability to provide adequate peer review. A recent article in El País reported that, over one year, a single investigator (a meat expert) in Spain published a paper every two days, including articles on hospital management of monkeypox and treatment of gum disease with bee venom.¹  The article reveals an active industry in which people are paid to provide authorship, helping to promote the stature of institutions, and in which pools of “collaborators” are paid to increase the stature of the co-authors. The report further notes that, in 2015, only a dozen journals published more than 2,000 papers a year, a number that has since increased to more than 50.

In his 2003 interview, Dr. Shattil was asked to respond to a comment by the Wellcome Trust, which argued that “the publishing of scientific research does not operate in the interest of scientists and the public but is instead dominated by a commercial market intent on improving its market position.” If the open-access movement was intended to combat this view of publication, it has fallen short of the mark, endangering high-quality, peer-reviewed journals at the expense of promoting open-access “paper mills.”

At Blood, we see a way to provide rapid and readily available access to new scientific knowledge in hematology through our hybrid journal. Central to this model is the commitment of our associate editors and editorial board to rigorous peer review, which serves both to identify valid research offering new insights and to enable reviewer feedback that can help to improve the quality of the final published work. Coupled with an average time to “first decision” of two weeks and “first edition” publication within one week of acceptance, our model ensures that members of ASH have rapid access to critical updates in their field. Authors can also elect to make their articles immediately and freely available to all upon publication for a fee that is competitive with those charged by other entities in the publishing industry. Furthermore, ASH provides open access for institutions in lower-income countries. Blood also respects the requirements of major funding bodies around the timeliness of access and copyright, ensuring that authors face no barriers to submitting their best hematologic research. Blood offers open access to authors who require it.

Blood does not operate for profit. It exists to advance hematology. The bulk of author fees are used to cover the costs of production and operations, including sustaining a fast, effective, and fair peer-review process. Blood will not increase its acceptance rate to generate surplus income. As its current custodians, we remain determined to provide ready access to high-quality, peer-reviewed research that defines hematology and drives improvements in our understanding of diseases and patient care with minimal delay.