Do medical journals need a more modern business model?

Do medical journals need a more modern business model?

Societal subscription journals once accounted for the majority of medical publications. Frustrations with and criticisms of high individual article access charges however are fueling an open access revolution. Elsewhere in industry, the subscription model for digital entertainment content is booming, as is the market for ‘subscription box’ clubs. The demands of society are changing, and so too must medical publishing.

The publication model debate is nothing new, yet it has been transformed by the recent appearance of academic piracy. Formed in 2011 by Alexandra Elbakyan, due to her belief that “article access charges are a barrier in the way of science”, Sci-Hub 1 circumvents publisher paywalls through user-friendly yet illegal technology, and everyone is using it, apparently2. Unsurprisingly, publishers have pursued legal action, but just like the music and film industry, this has so far proved unsuccessful2. Ironically, Sci-Hub’s popularity has grown following the associated media attention, such as the naming of Miss Elbakyan as one of Nature’s ‘ten who matter’ in 20163.

Whilst few support its illegality, lessons can be learnt from the rise of academic piracy. Many in the developed world see it as a symptom and no more, but those in the developing world see it as their only means of access to scientific literature. Given that research is delivered to publishers free of charge, conducted at the expense of taxpayers, peer-reviewed by volunteers, and that publishers make profits of between 15-20% from the associated revenue4, some argue that access charges are unethical5. This inevitably leads to the question of whether or not all articles should be freely available. Readership would certainly be increased, impact would be greater, and piracy would be finished. The trade-off is the financing of the article publication charge (APC) by all authors, but just as the ethics of charging readers is often examined, so too should be the charging of authors. Continuous gradual improvements in patient care do not exclusively arise from large-scale fully funded RCTs, and unfunded research has much to offer. If all journals were to shift to open access, unfunded researchers would be forced to personally finance the APC, though some offer discounts and waivers, thus generating another potential barrier in the way of science. For funded research, taxpayer or charity funded bodies would see their costs increase, as authors include this charge in funding applications.

There is no easy answer to the question of who should pay for research dissemination, but someone must do so. Printed subscription journals are relatively expensive to produce, with an article costing around £3900 to publish in comparison to around £1800 for an online open access article4. In order to survive in a changing marketplace, tested through disruptive technology, printed subscription journals could look to new, innovative ‘subscription box’ companies, where recurring physical deliveries of niche products are packaged as an experience with added value. As anaesthetists for example, subscribing to the AAGBI adds value through the provision of insurance for medical transfers, a means to acquire CPD, a discussion forum, and a glossy printed high quality journal, amongst other benefits.

With regards article access charges however, publishers could look towards companies such as Netflix and Spotify, where a relatively low subscription fee returns unlimited access to the majority of content, with the profits divided between publishers. The use of advertising could also be enhanced, and different levels of subscriptions could be offered. Today’s society demands value, flexibility, openness, and choice. Choice is currently available to the author with regards how the publication of their work is financed, but this comes at the expense of value, flexibility and openness for the reader. Tomorrow’s publishers must therefore acknowledge the difficult balancing act between the interests of researchers, readers, funders and journals, and the way in which these problems have been successfully navigated (eventually) by the music and film industries. To do otherwise may prove in the end to be a false economy.


Mike Charlesworth is an ST5 ACF in Anaesthesia at the University of Lancaster.





Lee Feddy is a Consultant Cardiothoracic Anaesthetist at University Hospital South Manchester.


Competing interests: None declared.


Before you go please don’t forget to…


Sci Hub. The pirate future of medical publishing. St.Emlyn’s. Published 2015. Accessed May 24, 2017.
Bohannon J. Who’s downloading pirated papers? Everyone. Science. April 2016. doi: 10.1126/science.aaf5664
Nature’s 10. Nature. 2016;540(7634):507-515. doi: 10.1038/540507a
Van Noorden R. Open access: The true cost of science publishing. Nature. 2013;495(7442):426-429. doi: 10.1038/495426a
Smith R. The highly profitable but unethical business of publishing medical research. Journal of the Royal Society of Medicine. 2006;99(9):452-456. doi: 10.1258/jrsm.99.9.452

Cite this article as: Simon Carley, "Do medical journals need a more modern business model?," in St.Emlyn's, May 24, 2017,

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