Open-Access Publishing Model May Introduce New Biases in Oncology

OncologyLive, Vol. 20/No. 14, Volume 20, Issue 14

For clinical science, particularly oncology, there has never been a more exciting era than today.

Maurie Markman, MD

For clinical science, particularly oncology, there has never been a more exciting era than today. We are witness to truly spectacular advances in our understanding of the molecular basis of human disease and how environmental influences affect the health of individuals and communities.

In cancer management, the longstanding goal of stimulating the immune system to fight cancer is becoming a reality in an increasing number of clinical settings, and investigators are actively exploring how an individual’s microbiome can influence treatment outcomes and disease management. On the environmental side, the need to take meaningful action to counter the global epidemic of obesity and its upward pressure on cancer rates is now distressingly clear.

Clinical science and scientists have so much to offer individuals and society, and they have ever-more powerful technology (eg, gene sequencing, CRISPR) to achieve their lofty goals.

Yet all is not well within the hallowed halls of investigative medicine. It must be acknowledged that self-regulation within the scientific community is not as robust as it should be. This is demonstrated by recent events, such as a rogue scientist’s effort to garner fame and fortune by flagrantly employing a promising but still poorly understood technology, CRISPR, to manipulate the genes of a human embryo.1 Another example: the settlement of a disturbing lawsuit against a major US research institution at which an investigator was revealed to have fabricated information in multiple publications.2

One must add to this distressing list concerns about egregious, undisclosed individual and organizational conflicts of interest.3 These extend to government-funded research projects4; the failure of much published science to be reproducible by outside, competent investigators5; and the startling suggestion that more than 400 research articles from China are potentially ethically corrupt because they are based on transplants that involved organs taken from executed prisoners.6

Although the constellation of serious issues confronting the scientific establishment is at times bewildering, a unifying explanation for at least some of these concerning events is the accelerating pressure on investigators within academia to publish. The more peer-reviewed papers appearing in high-quality journals with a trainee, junior faculty member, or senior department member listed as the “first or second author,” the greater the likelihood of a job offer; a first grant; or tenure and, potentially, membership in a prestigious scientific society, respectively.

But the question to be asked is: What does this internal and external pressure to publish and obtain grants and tenure do to all-important scientific quality and society’s faith in the foundational integrity of science, scientists, and academic institutions?

A relatively new concern related to the publication and quality of scientific papers has emerged. The issue results from 2 unfortunately related ongoing events: the push by a number of groups for open-access scientific publication and the evolution of a Wild West atmosphere for online publication of information.

Major, well-recognized not-for-profit organizations have increasingly demanded that, upon acceptance for publication, research conducted with their funding support be made immediately available to the entire scientific community and the public.7 The profits generated by for-profit companies that publish the scientific papers funded by these groups have been cited as a reason for insisting on open access. The funders rationally argue that the current situation is problematic and demand change with a focus on completely open access for all.

Unfortunately, this view does not fully consider the time, effort, and costs associated with creating quality medical publications. These include essential peer review, mandatory statistical evaluations, critical analysis for plagiarism, frequently required editing for English language, and routine checking for typographical and other relatively minor data errors within the manuscript’s text, tables, and figures. In the traditional publication model, these inputs are covered by subscription fees, often from sponsoring medical organizations, and potentially substantial advertising revenue. In this model, advertisers should have no influence on the peer-review process, modifications to submitted manuscripts, or decisions about what a journal elects to publish.

However, it has been suggested that in an open-access strategy, the authors, organizations responsible for conducting the research, and their funders bear primary responsibility for the costs of publication.

This proposal brings us to the distressing state of online scientific publication, where predatory journals for which the specific model is author payment have proliferated. As evidence of the seriousness of this situation, a $50 million fine was recently levied against 1 of the major companies in this arena.8

Therefore, it is logical to inquire which authors and organizations are most likely to possess the financial resources needed to pay for open access and how this may affect the quality and objectivity of scientific publication.

In fact, it is reasonable to speculate that the medical industry or even groups with defined agendas (eg, not-for-profit advocacy organizations) may be in a superior position to support this novel approach to medical communication, including within the sphere of investigative oncology, as opposed to academics with limited or no funds to support such publication.

The fundamental issue is whether the proposed change in the publication model to open access will increase the value of the ultimate peer-reviewed product or cause harm if the standard for publication shifts even modestly from quality of material to an ability to pay. Unfortunately, there is no simple answer, just critical questions that need to be carefully and thoughtfully considered.


  1. Cyranoski D. CRISPR-baby scientist fails to satisfy critics. Nature. 2018;564(7734):13-14. doi: 10.1038/d41586-018-07573-w.
  2. Science News Staff. Duke University settles research misconduct lawsuit for $112.5 million. Science. March 25, 2019. Accessed June 24, 2019.
  3. Ornstein C, Thomas K. Memorial Sloan Kettering leaders violated conflict-of-interest rules, report finds. The New York Times. April 4, 1019. licts-.html. Accessed June 24, 2019.
  4. Rabin RC. N.I.H. to scrutinize private donations to scientific research projects. The New York Times. December 13, 2018. Accessed June 24, 2019.
  5. Kornfeld DS, Titus SL. Stop ignoring misconduct. Nature. 2016;537(7618):29-30. doi: 10.1038/537029a.
  6. Singh Chawla D. Study retraction reignites concern over China’s possible use of prisoner organs. Science. February 6, 2017. doi:10.1126/science.aal0711. Accessed June 24, 2019.
  7. Haug CJ. No free lunch - what price plan S for scientific publishing? N Engl J Med. 2019;380(12):11811185. doi: 10.1056/NEJMms1900864.
  8. Kolata G. The price for ‘predatory’ publishing? $50 million. The New York Times. April 3, 2019. nytimes. com/2019/04/03/science/predatory-journals-ftc-omics.html. June 24, 2019.