The reason you can read Obama’s article for free – SEO, Jeong-wook
Professor of Pathology at the Seoul National University College of Medicine
Chairman of C.O.D.E.
Recently the news that US President Obama published a scholarly article, titled “United States Health Care Reform: Progress to Date and Next Steps” (http://jama.jamanetwork.com/article.aspx?articleid=2533698), has become a sensation on social media. It seems the fact that a sitting president authored and published a scholarly article has everyone talking. The article was published on the Journal of the American Medical Association that is recognized as an academic journal with high prestige and has impact factor of 37. Impact factor is a measure of the frequency with which an article has been cited by other researchers globally in a particular year and reflects the value of an academic research. JAMA’s editor emphasized that his paper was handled much like all other papers, going through the same review and approval processes. The article is being circulated widely on social media rather than viewed in libraries, recording more than 1 million page views and 47,000 downloads.
Some say that it is unprecedented to see an article authored and published by a sitting US president, which might or might not be true. While you can’t be an author of an article only because you have power, it is also not that unusual. But what’s unusual is that he discussed a topic that could be politically sensitive in a scholarly article. When you search the term “Thaad” in Naver Academic, an academic thesis search service, you will find 53 scholarly papers published in Korea but none of them has a president as an author. Although the topic is in a different field, no one can dispute that Obama’s article did a clear analysis of a socio-political issue.
Health care system is a critical issue both politically and socially in the US. While it boasts highly advanced medical sciences thanks to advances in science, there is a huge gap between the rich and the poor in health care system. In the 1960s, about 25 percent of the nation’s population had no insurance coverage. Since the health care system was adopted in the 1970s, the number has dropped to 15 percent, which is still a very high level. For a country that spent 13 to 16 percent of the national budget into health care, such a big gap is a disgrace and headache.
Although there are still people enjoying benefits of advanced medical technology, they are only a very small minority. Health care costs are rising due to the adoption of new diagnostic techniques, while the gap between the rich and the poor in medical services is growing when budget demands for this sector is dramatically increasing. It is a serious issue that tax payers’ money is not spent well enough to solve the undesirable health care issue of the poor; more worrisome, however, is the fact that increases in health care cost caused by advances in medical technology are like a time bomb that can potentially destroy today’s civilized society. In his article, President Obama pointed out that the percentage of people without health insurance fell from 16.0% in 2010 to 9.1% in 2015 and presented statistical data as well as his government’s efforts and achievements. He argued that the quality of healthcare services was improved through investments in health information technology and prevention while an estimated 30% of traditional Medicare payments now flew through alternative payment models, contributing to a sustained period of slow growth in health care spending.
At the end of his article, he suggested three lessons for future policy makers. The first lesson is that any change is difficult and, according to him, it is especially difficult in the face of hyper-partisanship where republicans and democrats are in disagreement in policy decisions. As the second lesson, he points out special interests of different industries. While hospital associations agreed to accept a reform of medical insurance payment system and to cooperate in reducing medical costs, pharmaceutical companies opposed any change to drug pricing. He urged pharmaceuticals to lower drug prices substantially, as in the cases of an affordable polio vaccine and widely available penicillin. The third lesson is the importance of pragmatism. What he notes is that practical approach is more important than theory or principle in both legislation and implementation. He emphasizes that even in a situation of a stark confrontation, there is always a solution if we try to find a common ground and negotiate based on realities. And lastly, he argues that faith in responsibility, belief in opportunity, and ability to unite around common values are what makes his nation great.
President Obama is a rare case and the US is a large country. Their situation is far different from ours. Some might argue that his article is meaningless to people outside of the field since understanding an article published in a scholarly journal and absorbing the knowledge is something possible for only a small number of educated people. However, when you read his article, you will realize that it is not about developing a technical treatment nor talks about legal terms and principles. Rather, he introduces in detail the government’s efforts to help poor and medically underserved populations and to provide sustainable health care benefits to many populations at low costs and asks for understanding and cooperation from people with different opinions.
A paper authored by President Obama was published and was shared through social media, so that we can read it for free and enjoy the knowledge and values it contains – all of them present us happiness and blessing. And happiness and blessing always send us a new message.
First, it sends us the message that medicine is not the preserve of doctors. It is for all citizens and something that everyone should know and enjoy the benefits. Some people might not be able to understand an article, but they can ask others. Contents and research outputs of an article are made public so that they can be verified. Many articles are shared to help anyone who has similar experience make use of them.
“Knowledge” can be also likened to “medicine,” since “knowledge is not the preserve of scholars.” There are no such a thing like distinction between “Knowledge for scholars” and “knowledge for laymen.” A scholarly article is valuable only if it is read and contributes to the advancement of knowledge. Any paper that has passed a review process to be accepted as a scholarly article must be made available to read and searchable.
Increasing healthcare cost caused by advances in medical technologies is inevitable, but more aggressive efforts are needed to tackle the issue. The increasing cost of accessing articles as more and more scholarly articles are published amidst academic development is also understandable, but unacceptable. While the development of the Internet has brought rapid spread of knowledge and lowered the barrier to access to knowledge, some for-profit publishers of scholarly journals are creating new barriers. Open Access is a movement in academia designed to protect users’ rights against profiteering publishers and to provide more opportunities to access published academic articles. Open access activists argue that scholarly articles should be made publicly available to promote sharing and openness and this can be possible if publication fees are paid for by researchers.
For example, if an individual in Korea subscribes to a journal called JAMA, he/she needs to pay a subscription fee of 100,000 Korean won per year. If an institution such as medical school or a university hospital wants to give people in the institution access to articles published in major journals, it needs to pay 0.5 billion to 10 billion Korean won as subscription fees, depending on the size of the institution. In the current subscription model, the public cannot read articles even if such a large amount has already been paid to publishers. Actually Obama’s article is an exception as his article is published in JAMA but we can still read it for free; and that’s because the article was published as an open access article.
What is Open Access?
Open access is an alternative designed to overcome challenges in the traditional scholarly communication. It seeks to allow authors of copyrighted work and users share information in order to ensure that anyone can access information freely, for free, without financial, legal, or technical barriers around the world. Open access is an information sharing mechanism emphasizing the following four principles: costs are paid for by the author; users have an access to the work for free; users enjoy permanent access beyond space and time; and authors owns the copyright to their work.