Fair access to trauma research

Ma­ri­us Rehn, Hans Mor­ten Los­sius About the authors

«Any man’s death diminishes me, be­cause I am involved in Mankind»

John Donne (1572 – 1631)

The words of the poet John Donne appear as rele­vant to­day as when they were written 400 years ago (1). More than five mil­lion peop­le perish annually as a consequence of trau­ma, while innumerable others remain afflicted by per­man­ent or temporary dis­abil­ities. Trau­ma constitutes a ser­ious and in­creas­ing health pro­blem that causes untold suf­fer­ing for in­di­vid­uals, fa­mi­li­es and societies. The global trau­ma bur­den is heaviest in low-income countries, where primary pre­ven­ti­ve mea­su­res are often absent and the scale of the healthcare sys­tem is insufficient to cope with the ­challen­ges (2). Well organized emer­gency me­di­cal sy­stems and high-qual­ity trau­ma care in­crease the rate of sur­vi­val (3), and many of the deaths occurring in low-income countries could have been avoided. The­re are many hard-work­ing colleagues of ours who defy demanding conditions and provide excellent trau­ma care. Even though their dedi­cated efforts in local projects improve the trau­ma care pro­vided (4), stu­dies have shown that post-ac­ci­dent mor­tal­ity in low-income countries is higher than in high-income countries (5). The nega­tive socio-eco­nomic impact is reinforced by the low degree of de­vel­op­ment of re­habili­ta­tion ser­vi­ces and welfare schemes.

Ac­cess to trau­ma re­search is threatened

Cost-effective and field-friendly mea­su­res must be identified to counteract the consequences of this lack of ac­cess to emer­gency healthcare re­sources. One example of such mea­su­res was recently identified in a ran­dom­ized controlled study pub­lished in The Lan­cet. The study concluded that the rela­tively cheap preparation tranexamic acid re­duces mor­tal­ity among haemorrhaging trau­ma pa­tients (6). Health institutions in low-income countries have limited oppor­tun­ity to subscribe to costly jour­nals, even though user-friendly ac­cess to re­search is a precondition for being able to provide up-to-date trau­ma care. Until now, low-income countries have had open ac­cess to many sci­en­tific pub­li­ca­tions through the «Health InterNetwork for Ac­cess to Re­search Initiative», which is an agree­ment that was es­tab­lished with the aid of the World Health Or­gan­iza­tion. It is regrettable that many pub­lish­ers are now withdrawing from the agree­ment (7), and worrisome that our colleagues may no longer enjoy this free ac­cess.

Open ac­cess to trau­ma re­search

Open ac­cess to elec­tronic jour­nals pro­vides the user with free ac­cess to peer-reviewed pub­li­ca­tions. As a rule the cost of pub­lish­ing is covered by the author paying a pub­lish­ing fee. The author keeps his co­py­right to the art­icle, but allows the reader to download and distribute the full text at no cost. The ac­cess requires no password or assistance from a librarian, and is an Internet-based, user-friendly source of updated re­search results. An in­creas­ing number of pub­lish­ers follow this prac­tice, and a number of openly avail­able jour­nals have succeeded in achieving recognition in their respective fields (8, 9).

The Nor­we­gi­an au­thor­ities have given their sup­port to open-ac­cess publication channels (9), and their goal is to make all go­vern­ment-funded re­search openly avail­able (10). In Scan­di­na­via, Swe­den is at the forefront in requiring that all re­search funded by the Swe­dish Re­search Council must be pub­lished with open ac­cess (11).

Internationally, there are sev­eral openly avail­able jour­nals in the field of emer­gency me­di­cine. Critical Care, Emer­gency Me­di­cine Jour­nal, Scan­di­navian Jour­nal of Trau­ma, Resuscitation and Emer­gency Me­di­cine and Archives of Ortho­paedic and Trau­ma Surgery are all examples of jour­nals in the field of emer­gency me­di­cine that have a Eu­ro­pean orien­ta­tion and open ac­cess. Furthermore, The Jour­nal of the Nor­we­gi­an Me­di­cal As­so­cia­ti­on practises open ac­cess (12) and regularly publishes articles in Eng­lish. In parallel, sev­eral of the subscription-based jour­nals of­fer open ac­cess to se­lec­ted articles. Re­search­ers and clinicians with an interest in traumatology thus have sufficient op­por­tun­ities to publish openly avail­able articles, and the advantages are obvious. Pro­fes­sio­nal ad­vances in trau­ma care in high-income countries ought to be made freely avail­able on a global scale as a mat­ter of collegial solidarity. Open ac­cess to updated science can contribute to improvements in the qual­ity of trau­ma care, and thereby even out the difference in mor­tal­ity ra­tes be­tween the rich and poor.

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