The website Sci-Hub (http://sci-hub.tw/) (1) offers access to medical and scientific research papers from all over the world to anyone ─ for free. So, what’s the catch? There isn’t one, except for the fact that this is an initiative by an enterprising hacker, Alexandra Asanovna Elbakyan, a Kazakhstani computer programmer, who has cracked the firewalls of the websites of medical publishers.

In general, most of us feel very uncomfortable about disrespecting copyright, because the concept of intellectual property rights has been so deeply ingrained in us. We have been brainwashed into accepting that medical journals need to be paid for, and that we need to respect the author’s labour. This makes sense at one level, but unfortunately medical publishing has been completely commercialised today, to the point where respected scholars like Dr. Marcia Angell, former editor of the prestigious New England Journal of Medicine, says, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor..”(2)

Furthermore, the purpose of medical journals is to make sure that reliable clinical research is accessible to doctors so they can help their patients. However, thanks to the monopoly created by Western medical publishing houses, most doctors in the developing world do not have access to this source of knowledge., So, while most people look down on hackers, and believe that it is unethical to upload content which does not belong to you, I feel it is the current state of medical publishing which is completely unethical. The actual effort of carrying out clinical studies is made by researchers, and generally paid for by governments; but the profits derived from publishing these articles is taken away by the publishers, multi-billion dollar corporates, who use their prestige to attract papers from the best researchers, where the rule is still – Publish or perish!

Given that most of the submission, peer review and editing is now done online for a few cents, they really have no justification for charging hundreds of dollars for a subscription. Even worse, some prestigious journals are happy to publish articles which promote the commercial interests of medical device manufacturers and pharmaceutical companies. How are they in a position to preach ethics to others?

Medical publishing is one of those industries which is ripe for disruption, and several people have tried doing this. For example, open access publishing (3) has been tried as a method of getting knowledge to where it belongs−the patient’s bedside. Unfortunately, this has failed because there are too many vested commercial interests which have prevented it from becoming successful. By making medical research publicly available to everyone, Elbakyan is doing a great service to billions of patients. We respect Google for making information easily available. So why don’t we respect Alexandra Asanovna Elbakyan for singe-handedly challenging the hegemony of greedy medical publishers? Let’s not forget that she is being completely altruistic, and has to depend on donations to fight the million-dollar lawsuits which publishers have filed against her to defend their monopolies.

What actually disappoints me is that every doctor isn’t even aware of the fact that this invaluable resource exists. I think it is unethical for doctors not to use this resource.

Access to this site has made a world of a difference to my patients, and to me. For example, we recently used the site to find out which researchers had published articles on the subject of preimplantation genetic diagnosis (PGD) and we were able to help our patients with this information

Patients are quite motivated to find out as much as possible about their medical problems and we need to let them know this treasure house of medicine exists. The information should be directly made available to them, so they can discuss it with their doctors.

If we talk of ethics, we should agree that the ends justify the means. Why should medical knowledge in these expensive medical journals only be available to doctors and patients from rich countries? Ha-Joon Chang (4) has shown that stringent intellectual property rights can actually stunt growth in developing economies.

Many leading luminaries have criticised our archaic copyright laws. As Noam Chomsky (5) pointed out, ” if that patent regime had existed in the 18th and 19th centuries and even through the early 20th century, the United States and England would not be rich, developed countries. They developed substantially by what we now call piracy.”

Lessig, in his open-source book (6), Free Culture: How Big Media uses technology and the law to lock down culture and control creativity, says,

These separate stories sing a common theme. If “piracy” means using value from someone else’s creative property without permission from that creator … then every industry affected by copyright today is the product and beneficiary of a certain kind of piracy. Film, records, radio, cable TV. … The list is long and could well be expanded. Every generation welcomes the pirates from the last. Every generation ─ until now.

Free access to medical journal articles is better for medical researchers as well, because they get a wider audience, and can create a bigger impact. Medical publishers, whose subscription models are now obsolete, would be the only ones to lose. Is it fair to allow them to continue to rake in the moolah by creating artificial limits to knowledge distribution?