Josefina Coloma and Eva Harris write in "Open-Access Science: A Necessity for Global Public Health", that all aspects of science, including research, publishing and licensing need to be made more accessible to scientists in developing countries. They argue that many of medicine's most pressing challenges persist in developing countries, yet scientists and doctors in those countries are often excluded by the less-than-international research and development processes that they depend on to address their unique medical challenges. The authors note that in every area of science, doctors and researchers in developing countries compete unfavorably with those who have access to the collegial science environment that favors success within an ethnocentric 'western' paradigm. To address this inequity they urge that:
"...the whole spectrum of scientific endeavor should be as open access as possible, from training in laboratory and epidemiological techniques, proposal writing, and manuscript-writing skills to open-access publishing and socially responsible intellectual property policies."
They point to several initiatives aimed to correct the imbalances and provide links to organizations that offer support in these areas, including, The World Health Organization (WHO), the Pan American Health Organization (PAHP), Fogarty International at the NIH (FIC), and the Sustainable Sciences Institute (SSI).
The goals that the authors lay out perhaps define a new path for research but will open-access even begin to address the medical and research challenges of less wealthy countries? While these countries often have fine medical establishments, just as often they don't. Even if they can train doctors then they're faced with challenges like funding, hospital infrastructure and what people call "brain drain". As NPR reported last week:
"Physicians in Africa cycle out in what has been called a medical carousel that never turns full circle. They may start in South Africa, then move to the United Kingdom and on to Canada with their sights set on the United States. The last place on earth hardly any doctor wants to be is a small out of the way place in Africa."
Developing countries remain dependent on international assistance, and large scale public health initiatives for conquering infectious disease usually utilize NGOs or foreign assistance. Assistance often involves procuring resources (medicine, patents, expertise, equipment...) from the for-profit medical establishment. These doctors can arm-twist or coerce pharmaceutical companies to comply with non-profitable goals but this tactic is usually fraught with resistance and legal problems. The initiatives also depend on the prolonged largess of donors. Sometimes aid is tied to economic or ethical goals defined by donors. Other times donors don't understand the sporadic progress that prolongs public health goals, and usually they don't empower emerging economies to self-propel their own success. Such development projects are also dependent on the cooperation of political leaders in developing countries and on public health infrastructure that is usually different then ours, if not inadequate. Improving health for citizens of developing countries staggers under these odds.
The authors define steps to reasonably address the challenges presented by previous models. Many people argue that unless countries take responsibility for their own public health, "progress" as defined by the U.S., for example, will be thwarted. This is a good point, not to be confused with economic liberalism that policy makers often argue for (darker) motives for not providing aid. The most obvious objection to embracing their proposal surrounds the licensing of intellectual property. Less discussed is the extent to which these goals still mirror general development goals defined by Western backed organizations like the World Bank and US Agency for International Development (USAID), and whether the proposed open-access model will work any better then any previous model.
This more pessimistic view suggests that the authors started with a process that has historically been successful for many developing countries -- like the U.S., Europe, Japan, and Canada, then altered that familiar entrenched process slightly, molded it as they saw fit for emerging "developing" countries in order to "help" them get up to speed. By no means is this an ignoble goal, however it still assumes a paternalistic responsibility for deciding the best fit model for developing countries.
Alternatively, one could argue that while the authors urge that science research needs to be more open, the current more proprietary model that they are proposing to change is contained within the larger fairly impenetrable medical/pharma establishment. The impetus for any change will occur on a large scale basis only when the large medical/pharma model fails or ceases to work for the majority in the west (or the U.S). The authors offer changes to accommodate developing countries, but arguably their own platform -- the U.S. medical system -- threatens to implode. Long term, our current system is probably fiscally untenable. As well, globalization increasingly promises that the plagues of developing countries will be our plagues too. At some point, relevant participants may be motivated to employ a different model not only to accommodate developing countries, but for developed countries too. For now, our health care system is significantly bolstered by the pharmaceutical industry, publishing industry and research institutions, billions of dollars and millions of employees and there's no motivation for sea change.
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Acronym Required previously wrote about open research in "Accessible Research For All, By All- The Government, State, Universities and NGO's", Dutch Research- Free!". We have also written about public health initiatives in developing countries in the Public Health, and Science and Development sections.
