On Fri, 10 Aug 2001, Arthur Smith wrote [in part, in response to a message from Stevan Harnad]:
[sh]> [...] [sh]> Self-archived eprints can be designed to carry "health [sh]> warnings" that are as shrill as we like a priori (or, more sensibly, [sh]> a posteriori, once we get an idea of the size of the bogus paper [sh]> problem -- if there is any). > [as]> With medicine we are talking about lives that can be lost; I don't [as]> think a posteriori is good enough if we're seriously hoping that [as]> self-archives will be an appropriate means of distributing [as]> information to the final practitioners. And if it ISN'T an [as]> appropriate means of distributing the information, and the final [as]> end-users of the information ignore it in favor of traditional [as]> distribution of articles through journals, then where is the [as]> motivation for the authors to self-archive (i.e. if they are not [as]> reaching any more readers than they otherwise would)? I suspect that an informed discussion of the rather complex issues of 'E-Health' (including open online access to good-quality health-related information), is well beyond the intended scope of this particular forum. A "consumer-oriented" perspective: censorship on the grounds of protecting gullible patients and their families from untrustworthy health-related information is increasingly less easy to justify. We're well into an era where patients often bring long lists of questions and comments to consultations with health care professionals, based on information obtained online. Some of this information should be regarded as "jewels", and some as "junk". But, how to be sure which is which? In this new era, some well-informed patients and their families may know more about their own particular health problems, and about the currently-available interventions for managing them, than do many primary-care physicians (and especially, physicians who haven't been diligent about their continuing medical education). We're also well into an era of shared decision-making, where patients and families (if they wish to) may decide which option to choose, from among several options offered to them by suitably-qualified health care professionals. In addition to physicians, there are many other "end-users" of health-related information. Examples are patients and their families, people at higher-risk of particular health problems, opinion-leaders in the media and those involved in health-related advocacy roles, etc., etc. How best to meet the diverse needs of these various end-users? Medical journals will, I predict, continue to play an important role in adding value to the primary research literature, e.g. by helping to convert data and information into knowledge, in various forms appropriate for the various end-users. But, we've definitely entered a new era. Which parts of the old (pre-E-Health) models for health care will be retained, and which will be abandoned? My crystal ball is no clearer than that of anyone else. But, it does seem certain that the models will continue to change - including the models for the translation of new data and information into practically-useful knowledge. The issue of freedom of access to the primary research literature is, I believe, just one important aspect of this much bigger (and rapidly-evolving) picture. Jim Till University of Toronto
