Canadian Medical Association Journal lifts online paywall to health-care material

OTTAWA — The Canadian Medical Association Journal is lifting a paywall that restricts access to much of its content in a bid to reach a broader audience and combat so-called fake news.

Editor-in-chief Dr. Andreas Laupacis said all content on the weekly online edition is now free to the public, with previously published material set to become available March 1.

Laupacis said Tuesday he hopes the move will open discussion to those beyond the medical community and attract new voices to the journal, including those of patients.

“They use the system and they pay for it so we think it’s important that they have access to as much information as possible, especially evidence-based information about how our health-care system works, so they can participate in trying to make it better,” Laupacis said from Ottawa.

While research articles, editorials and news stories have been available for some time, Laupacis said much more has been locked behind a paywall introduced in January 2010. That includes short topical opinion pieces and longer scholarly analysis that could inform policy makers or help patients understand controversial positions.

Previously, that other content was only made fully available after one year.

In an era when misleading health information abounds online, Laupacis said providing credible, evidence-based material can be one step towards keeping the public abreast of current medical issues.

“We’re not going to decrease the non-evidence-based information out there but at least we’re adding some more evidence-based information to the material that people have an opportunity to look at,” he said.

“Members of the general public, you know, probably don’t know as much about how the health-care system works as is ideal. On the other hand, I probably don’t know as much about climate change as I should.”

Laupacis said the journal’s roughly 700,000 monthly visits largely involve researchers, members of the Canadian Medical Association, and those in the health-care field here and abroad — but anyone could have paid to access the journal, which debuted online in 1995.

Subscription fees ranged from about $80 for medical students to thousands of dollars for institutions with multiple users, among them universities and hospitals.

Laupacis said the journal often tackles topics that resonate far beyond the medical community.

He pointed to a commentary published last month that examined an Ontario court decision that found there were circumstances in which a doctor could refuse CPR on a patient if they believed it was futile, even if the family demanded it.

“That’s a really important issue and I thought (it was) a very thoughtful analysis of that court decision and what that meant for physicians,” said Laupacis.

“I could see that a lot of patients and members of the public would find that commentary useful.”

The commentary in this week’s edition argues that conditional health guidelines may be warranted even when evidence is sparse or doubtful, noting that clinicians and patients may not have the time to wait for more concrete data.

Laupacis said he’s also in the process of restructuring the journal’s eight-person, all-physician editorial advisory board to include a more diverse membership, which could include patients and managers.

That, too, could shape how the journal approaches some topics in the future, he said.

The CMAJ launched in 1911, and will continue to offer a monthly print edition to CMA members. New content publishes online Monday mornings, 50 times a year.


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