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Electronic Letters to:

Peter A. Singer
The Global Alliance for Health Information
clinmed/2000110006v1 [Abstract] [Full text]

Electronic letters published:

[Read eLetter] GAHI, the real world and intellectual property
Chris Zielinski   (31 January 2001)
[Read eLetter] A proposal to provide access to the full-text of medical journals
Dr Aniruddha Malpani, MD   (31 January 2001)
[Read eLetter] Perpetuating the myth
Barry Markovitz   (31 January 2001)

GAHI, the real world and intellectual property 31 January 2001
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Chris Zielinski,
Project director
Health Information for Development

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Re: GAHI, the real world and intellectual property

dvt{at} Chris Zielinski

I read Peter Singer’s paper about an imagined "Global Alliance on Health Information" (GAHI) by with growing fascination and walked right into the sucker punch at the end ("Unfortunately GAHI does not exist. It should."): Congratulations!

Apart from the world of fancy described, it is worth noting that a real-world framework for electronic information transfer has been developed through the non-governmental and international communities over the last two years in the Information Waystations and Staging Posts project ( – the terms are helpfully defined in Tessa Tan Torres Edejer’s recent article in the British Medical Journal, Vol. 321, 30 September 2000 – available at This is now moving out of the needs assessment stage and into pilot and seed project activities.

Moreover, a model for the dissemination of locally appropriate content for health development exists in the International Health Network (IHN), which has similarly benefited from considerable discussion among non-governmental organizations through the Health Information Forum. Work is currently underway to identify and develop in appropriate formats suitable information materials.

So we are moving towards a GAHI in the "real world".

Another observation on the article concerns the role of intellectual property (IP). IP comprises copyright, trademarks and patents. Peter Singer seems to be against copyright and in favour of patents. However, the moral rights provisions of copyright under the Berne Convention are the strongest guarantees of the integrity of the health information being disseminated. This is especially critical – health information must be valid, timely and accurate. It seems that what Mr Singer is really concerned about is the price of health information (ideally zero), not copyright. Thus, I certainly agree with him regarding the price of essential information, but not about copyright.

Regarding the use of patents to finance a GAHI, apart from expressing some doubts about the infrastructure required to carry out licensing and collect royalties, I would note that there are controversies operating in this field as well – for example, some might argue that it would be better to resist the patenting of medicines and processes needed in developing countries, rather than encouraging it in the way suggested in the article.

Given these observations, one would have to wonder what the posited GAHI intellectual property rights division would be teaching while "educating health care workers and scientists around the world about intellectual property rights". What would teach about copyright? What about patents? What about the TRIPS agreement (widely distrusted and opposed by developing countries, yet mentioned with apparent approval by Singer)?

Chris Zielinski

Director, Health Information for Development project

Chair, Information Ethics, International Federation for Information and Documentation

Member, Internet Societal Taskforce Steering Group

P.O. Box 40, Petersfield, Hants GU32 2YH, United Kingdom

Tel: 0044-1730-301297 Fax: 0044-1730-265398

e-mail: dvt{at} web site:

A proposal to provide access to the full-text of medical journals 31 January 2001
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Dr Aniruddha Malpani, MD,
HELP - Health Education Library for People

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Re: A proposal to provide access to the full-text of medical journals

malpani{at} Dr Aniruddha Malpani, MD

As has been so eloquently pointed out, a major problem doctors in developing countries face is that they find it very difficult to access the full-text of articles from medical journals. Sometimes, instant access to the full-text of a medical article may spell the difference between life and death - and if the journal is not available, then a patient may die because of a lack of access to the information in the article.

I'd like to propose that all medical journal publishers be required or requested to produce an online version of their journals . While subscribers could be allowed free online access, ( and this would be a useful value-added service they could offer their subscribers ) , non- subscribers could be offered the option of paying online for access to a selected article. These articles could be published online as e-matter, very similar to the model which <> has used, on a pay-as-you-use basis. E- commerce will thus allow publishers to earn more money ; copyright would be protected - and medical doctors ( and patients !) from all over the world would then have instant access to any medical journal article ( for a reasonable fee, of course !)

All the abstracts published in Medline could then be linked to these full-text articles, so that any doctor anywhere in the world could access them immediately !

Dr Malpani HELP - Health Education Library for People Om Chambers Kemps Corner Bombay 400 036. India

Perpetuating the myth 31 January 2001
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Barry Markovitz,
Assoc Prof Anesth & Pediatrics
Washington University School of Medicine

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Re: Perpetuating the myth

markovitz{at} Barry Markovitz

How can one argue with such an eloquently presented concept as a Global Alliance for Health Information? Is there not an analogy with efforts to bring expensive pharmaceuticals to developing countries who cannot afford them? I would suggest there is a fundamental difference, and obscuring this difference has led Dr. Singer to make this proposal, but it should not be necessary!

Health information, insofar as we are discussing the results of biomedical research, is not paid for by publishers the way pharmaceuticals are by drug companies. The intellectual product of scientific research (usually funded by public agencies) is given to publishers for free. By an inappropriate obfuscation of the differences between commercial publishing (where the author is paid), biomedical publishers (usually) require assignment of copyright, limiting themselves as the sole legal distributor, enabling them to charge for copies or access. In the days of expensive paper publishing, this was necessary evil. This is not in the best interest of the scientist - who only desires the widest audience possible and has given away his/her work to achieve this - or the reader, who, even in weathy countries, cannot possible subscribe to all the journals necessary to maintain currency in any given field. With the advent of the Internet, there is no longer justification for scientists to be held hostage by publishers for distribution of their work. Save the peer review arguments - peer review is usually provided gratis by the scientists colleagues and is not part of the economic picture.

There are several models and proposals striving to correct this injustice - see for example the grassroots effort at or, as well as calls for abolishing copyright transfer in the first place (1, 2). I fear that Dr. Singer's proposal, while undoubtedly improving access to health information in developing countries, will only serve to perpetuate the myth that publishers "own" the information to begin with.

1. Bachrach SR. et al. Science 1998; 281:1459-1460 2. Markovitz BP. J Am Med Inform Assoc 2000; 7:222-229.

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