Five Years of Access and Activism

In April 2009, we marked the five year anniversary of PLoS Medicine’s first call for papers with an editorial titled ‘‘A Medical Journal for the World’s Health Priorities’’ [1]. The editorial was a renewed and revitalized call for papers, announcing a ‘‘refocusing of the journal’s priorities.’’ Going forward, we said, we would prioritize papers addressing those diseases with the greatest global burden. We would also aim to be as broad a journal as possible, publishing papers that explored not just biological causes of illness, but also social, environmental, and political determinants of health. Six months later, as we now mark the journal’s official five-year anniversary (our launch issue was October 19, 2004), has our refocused scope had any impact on what we publish? Gro Harlem Brundtland, former director general of the World Health Organization, has argued that health problems are ‘‘no longer just local, national or regional, they are global’’ [2]. Events over the past six months support this view, and have reaffirmed to us that our new direction — unreservedly global and inclusive of politics, society, and the environment — makes sense. Pandemic H1N1 influenza (‘‘swine flu’’) was identified in April 2009 and has spread rapidly across the globe. In May 2009, the global health impact of climate change moved higher up the international agenda through the launch of an innovative multidisciplinary report by University College London and The Lancet, called ‘‘Managing the Health Effects of Climate Change’’ [3]. Throughout the summer, violent political conflicts flared up in many of the world’s hotspots for war, such as Sri Lanka, Afghanistan, and the Democratic Republic of the Congo, causing major morbidity and mortality. These events illustrate how ‘‘human health remains inextricably intertwined with the environment — in its widest sense — in which we live,’’ as we wrote in our April 2009 editorial [1]. Authors have clearly taken notice of our refocused scope. We are now seeing an increasing number of cover letters that state that the accompanying submission is a response to our recent call for papers. Our new direction is also reflected in the papers that we have published in the last six months. Our focus on the global burden of disease can be seen in an international study, based on mental health surveys worldwide, examining the link between mental disorders and suicide [4]; in two systematic reviews that helped to answer important questions about drug treatment for tuberculosis [5,6]; and in a randomized controlled trial of solar drinking water disinfection that showed it not to reduce childhood diarrhea despite widespread promotion of the intervention [7]. Our focus on the interconnectedness between health and the broader contexts (ecological, social, and political) is seen in a study of the impact of demographic transition on dengue [8]; in essays on the link between home foreclosures (repossessions) and public health [9] and on the health impact of Somalia’s civil war [10]; and in our recently launched series on treating mental health problems in lowand middle-income countries [11]. We will, of course, continue to publish important laboratory and clinical studies that have clear implications for clinical medicine or public health. Examples of such studies from the last six months include the discovery and characterization of a new tumor suppressor gene, ductal epithelium–associated RING Chromosome 1 (DEAR1) [12]; a cohort study showing that preconceptional folate supplementation is associated with a 50%–70% reduction in the incidence of early spontaneous preterm birth [13]; and a study on the preclinical natural history of serous ovarian cancer [14]. In addition to PLoS Medicine taking a new direction, PLoS spent the spring and summer engaged in four new projects and initiatives that highlight some of our underlying values, ideals, and commitments. First, PLoS Medicine is deeply committed to promoting transparency in medical research, which is why the journal, represented by the public interest law firm Public Justice (http://www.tlpj. org), intervened in an ongoing court case in which women were suing Wyeth, the manufacturers of Prempro, a hormone replacement therapy [15]. We intervened in the case in order to unseal a massive amount of documentary evidence showing a coordinated campaign of ghostwriting from Wyeth on articles about this drug and other hormone replacement therapies. Our intervention was successful, and on August 21, 2009 we created the ‘‘Wyeth Ghostwriting Archive,’’ which makes about 1,500 relevant documents publicly available [16]. Second, PLoS is continually working to refine and improve the communication of health and science research. The 2009 H1N1 influenza pandemic highlights the need for a new way for scientists to rapidly exchange data, and on August 20, 2009 PLoS responded by launching an experimental online platform called PLoS Currents: Influenza [17]. Submissions are assessed by an expert group of influenza researchers, but in the interest of timeliness they do not undergo in-depth peer review. Published articles are also deposited into a new independent research database run by the National Institutes of