Saturday, May 20, 2006

Necessity is the mother of invention: open access, the developing world, and the cost-efficient solution

As authors and publishings in the developing world rapidly adopt open access publishing models and self-archiving practices, there are early signs that we are beginning to bridge the south-north knowledge gap.

Here is an hypothesis about a particular benefit of OA in less fortunate countries, which will be very useful in the developed world as well.

When it comes to the applied sciences, it stands to reason that scientists in the developing world have much more incentive to seek cost-effective solutions, than scientists in the developed world.

For example, many medical researchers in the developed world, particularly those who are funded or partially funded by for-profit companies, have reason to seek profitable interventions. Profit at a rate of percentage X of a high-cost intervention, is more profit than the same percentage of a low-cost intervention.

As an example, let's assume a 10% profit rate. Imagine you are a for-profit company selling medical products and tests. Your researchers come to you with two proposals. One is a medical test that will cost $1,000 per test (profit: $100). The other is an intervention with negligible costs (see below, listening to musics reduces the need for sedative medication). The total cost might be the shared cost of installing equipment to play music in a sterile environment, plus the cost of a one-page informational handout per patient - perhaps the total cost might be $1.00 per patient, the potential profit $.10.

If the purpose of your business is to make a profit - which research project are you likely to prioritize?

Scientists in less fortunate countries may not have access to the high-cost equipment needed to test costly interventions, and the people who fund them may be much less interested in finding such solutions.

If this hypothesis is correct, this does not mean that people in the developed world do not wish cost-effective solutions. In this area, the desires of those in businesses that will make use of the research are not the same as the desires of patients, public and private health administrators, all of whom would like to have the best possible interventions at the least cost.

One example of a study in India that illustrates this potential: Harikumar et al. found that Listening to music decreases the need for sedative medication during colonoscopy, as reported in the Indian Journal of Gastroenterology. (Note: it is important that the patient choose the music). What a wonderful approach! A low-cost, low-risk intervention that will reduce complications (including fatalities), and speed recovery. Better outcome at less cost! As a follow-up to this study, I am wondering whether this approach could also improve the morale of the health-care professionals and other staff, contributing to their good mental and physical health, too!

This is only one of the many potential benefits from bridging the south-north knowledge gap. Here is a second hypothesis, assuming the first is proved: would very modest investments in research in the developing world and/or open access in the developing world, be a prudent financial investment for health administrators in the developed world?

For that matter, is this a good reason for providing ample public funding for the operating costs of universities, so that researchers can do most of their research without special funding? To put this another way - if we are judging our medical researchers on the basis of the size of the grants they receive, should we be surprised at a tendency to seek high-cost solutions? Researchers who wish to focus on cost-efficient solutions - might not need the million-dollar grants, after all.

This post reflects my personal opinion only and does not represent the opinions or policy of the BC Electronic Library Network or the Simon Fraser University Library.

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