Healthcare workers,
patients, students, and others frequently turn to the internet for medical information. For
most people, internet searching means using Google. Google
certainly is a good general choice and it will dredge up loads of interesting articles on all sorts of medical topics.
But it also brings up quite a number of irrelevant or questionable articles. The same goes for Yahoo, MSN
and other standard search engines. So how do you get more specific information? I'll
give you some good suggestions further below.
Patients frequently want access to the "professional information" i.e. they want what the doctors gets.
But also, a lot of doctors want what "the doctor gets." Once you graduate from residency, unless you are affiliated
with a medical school, it can be hard (and/or very expensive) to get access to all those online journals that you used to
get for free. Using the standard search engines it is hard to find full text medical articles. Not
everyone needs or wants these but some do desire or need the full text, including all the graphs, tables, and pictures.
Often the searcher reaches a page which offers to sell the desired full text article for a
hefty fee…perhaps around $30 dollars. That's a lot to pay for a single article. How do you get LEGALLY get those
for free or for much less? The answer usually depends on three things: 1) which medical journal you are
looking at (some have all or many of their articles freely available) 2) the internet pathway you chose to get to the article.
Sometimes you will need to pay a fee one way and not the other and 3) Unfortunately, it sometimes boils down to WHO YOU ARE
or WHERE YOU WORK. There are some information portals that give free access to specific groups such as
doctors and other health care professionals. That's great for them (and I am one of "them"). Also,
if you work for or go to school at a certain academic institutions, you will generally find that you have "free"
(not really free but the institution pays) access through your work or school related credentials. Some
professional organizations may provide the same thing.
So how do you a) find more specific, relevant and reliable medical articles and
b) get more access to full text write-ups in journals and textbooks?
- Using web sites such as this
one, neurospotlight.com, will give you a lot of access to many focused collections of pre-screened links
on given topics. They are not perfect. Even the best large link collections have many obsolete links. And
even if they are not, you may dislike some of my links. But, for example, if you go to my page on headache links, you
will certainly be able to find a lot of information on headaches. In the future I hope to subcategorize them better to facilitate
easier information retrieval.
- There are several search engines more specific than Google.
a. Google Scholar: http://scholar.google.com/schhp?hl=en&lr=
Google Scholar tends to retrieve journal articles and books.
It definitely directs one toward the higher quality articles. But I have found no general way to use it
to find free full text articles, though by chance it sometimes finds them. Though I acknowledge that
it has a lot of strengths, I have been somewhat disappointed by Google Scholar.
b. Pub Med: http://www.ncbi.nlm.nih.gov/pubmed/ (Or you can put www.pubmed.com into your browser and it will redirect to the fuller name above)
I think this
is a great search service for journals. It is mainly for journals and not for books, but there is a book
section that will search about 100 full text medical science books that it has online. Also, the site has
a lot of other options. You can print out lists of your references in various formats. Related sites provide genome searches
and links to genetic diseases. If you are fortunate enough to have access to a medical library you
can often link to your library account through pubmed and use its search abilities to find articles in your own institution's
library. In that way you can link to full text articles. But unless you have privileges at such a library, pubmed by itself
cannot give you full text unless the journal itself offers full text to everybody. It
does let you know if the journal has free full text availability. Overall Pub Med is a
great free service. A good example of our tax dollars at work (so it isn't really free, is it?).
c. Search
Medica, http://www.searchmedica.com/ is another wonderful source of medical information.
This allows you to focus on journal articles plus a number of sites that would not be found on the basic pubmed listings,
such as eMedicine (www.eMedicine.com) and various other informative sites and databases. It does not appear to
find books and, similar to the others mentioned so far, it does not help you find full text articles.
d. The
TRIP database, http://www.tripdatabase.com/index.html is relatively new. It focuses on "evidence
based medicine." I put "evidence based medicine" in quotes because this term has now become
so widely used (really overused) that it can mean almost anything. If there is one article somewhere, no
matter how bad, that supports your viewpoint you can say your opinion is "evidenced based." But in this case the TRIP
database pulls up a lot of seemingly "official" guidelines that have been reviewed by "experts" to insure
that the information is relatively solid. It will also find journal articles, again only rarely free full text. There are
separate settings to find images and patient oriented information for handouts and leaflets that a physician might keep in
the office.
e. The
Cochrane reviews, http://www.cochrane.org/reviews/ comprise a specific "evidence based"
collection of reviews and guidelines. In this case, "evidence based" has a definite meaning and if you go to their
site and follow enough links you can find specific statements about their methodologies. The Cochrane organization even supplies
its reviewers with its own statistical programs so that everyone does their evidence based reviews in much the same way. I
think that is very commendable though not every medical outcomes professional agrees that Cochrane does it the best way. Nonetheless,
this gives you a very widely accepted set of evidence based information about a wide variety of disease.
f. Scirus,
http://www.scirus.com/ is a more general scientific information data base searching tool. It is
not limited to biology and medicine but also includes chemistry, physics, geology, etc. It works quite
well for medical information though. One feature it includes that I have not seen in the others is that it helps you search
patent information related to your topic.
g.
Ingenta Connect, http://www.ingentaconnect.com/ is yet another scholarly search engine. Like the others, it
is quite good. It does mark the ones that are free full text. But, as is true of the others, most of what
it finds are those for which you can get no more than an abstract (summary).
h. Science.gov, http://www.science.gov/index.html finds pubmed listings, government reports, and
sometimes other literature.
3. Listing of free (or partially free) online journals. Here are a number of sites that maintain
lists of journals that offer their articles free. Quite a number of these are only partially free. For the first 6
months or a year you have to be a subscriber to get the articles (or pay a high fee per article). Some
of these are actually lists of lists and there is quite a bit of redundancy in the various lists.
a. Biomedcentral is
a group about 200 full text online journals.
http://www.biomedcentral.com/browse/journals/
Freemedicaljournals.com says it has >430 journals. Somewhere else there
is the claim that it is more like 1500. I believe the larger number. Actually, they are not all totally
free. Some have delays of 6 month to a year before a given issue becomes free access. Find it at http://www.freemedicaljournals.com/
b. Here
is a big listing of free full text online journals. Again, some of them are only free for issues published at least 6 month
or one year ago.
http://www.gfmer.ch/Medical_journals/Free_medical.php
c. .Resource
Central, another listing of free journals (including some that are only partially free).
http://www.resourcehelp.com/qserjournal.htm
d. The
highwire press journals are generally free full text with online access. This is actually a subset of Resource Central above.
But these are published by Stanford University and, thus, are quite high profile. So I am listing this group separately.
http://highwire.stanford.edu/lists/freeart.dtl
4. How to LEGALLY get free full text articles from journals that are not free.
a. In some cases the best way might be to wait 6 months or a year and
then many of them will become free, as noted above. If you can wait, that is not such a bad idea.
b. http://www.merckmedicus.com/ Merck Medicus is a medical information site which
has offerings of interest both to the public and to medical professionals. For physicians, and possibly other medical professionals
who can appropriately identify themselves as such, it offers a few nice perks such as access to a selection of good medical
journals and books. At last count it offered 181 full text journals and about 170 textbooks.
For the journals, a lot of the 181 "free" journals are actually free anyway using the
other links that I have listed. MerkMedicus appears to have a relationship with MDConsult which provides them with 23
full text journals that are not otherwise easily obtainable for free. One can also subscribe to the
paid version of MD consult which costs $349/year. Does that give you anything more? The advertisement
for MD consult says that it gives you 81 full text journals, but I do not know if that counts some you can get free
otherwise. I would hope that for $349 a year one would get something beyond the 23 journals that MDConsult provides
to doctors free through MerckMedicus. Among the textbooks found on MerkMedicus, some are easier to use
than others. All of them are in a form that gives you little excerpts, one except at a time in response to an inquiry or as
a result of going through an outline and then following the flow of information along. So, do not think that you can just
download the whole book. It would take a huge investment of time to piece the whole book together by downloading the little
excerpts. For the books, I would much rather have the whole book either in the old fashioned print form, as a pdf file, via
Kindle or some other electronic reader. But for free this is pretty good.
c. www.medscape.com also offers a selection of several hundred full
text journals to medical professionals who register. Again, many of the journals are
ones that are already free. But it does give you some that are not otherwise free. In many cases,
for the journals that you would ordinarily have to buy, Medscape gives you a selection of their articles, rather than all
of them. Medscape also links directly to eMedicine which offers a huge number of articles on a wide range
of medical topics. Emedicine is sort of a combination of a textbook, medical encyclopedia, and a journal
of reviews. Medscape also has much additional medical information. Some of it free to anybody and other
features are restricted to registered medical professional subscribers. Find it at www.eMedicine.com.
d. Schools, libraries, and other large organizations. You may already
belong to some organization which provides full text journal access. The usual way is through a library to which your organization
is linked. If you are a college student or medical student, this would be your college library and then you can get the exact
instructions from your school librarian. No library has online access to every journal in the world. Most of them pay to have
packages of online journals provided via private companies. Large libraries frequently subscribe to several such packages
from several companies. In general, a private individual cannot purchases one of these packages (perhaps you could if you
contacted them directly and negotiated but I bet it would cost you something like $50K a year). One of the most popular companies
is EBSCO. They offer many types of informational packages to libraries all over the world. Ovid is another
provider. JSTOR provides packages for the more humanistic subjects. PROQUEST is another provider that I
have more commonly seen with the smaller libraries but it may also service larger ones. I will mention PROQUEST again below
with respect to alumni associations. A good medical school or university library has arrangements with several providers plus
some direct relationships with publishers and professional organizations to give its members wide access to full text journals
and other online information. But don't think this is really "free." They pay a lot for this and you, the student,
pay indirectly in the form of your tuition (and the taxpayers and university benefactors pay as well). But someone has to
pay. It cost a lot of money to run a journal. Advertising in the journal generally is not nearly enough. On
top of the wonderful access you get from such libraries, most of them will get you articles that they do not subscribe to
if you ask them for help. Sometimes the library will charge you a fee, but this fee will almost always be less than what it
would cost to buy the individual article directly. Here is a link to an organization that gives some additional information
about getting such things as intralibrary loans: http://libraryresearch.org/ Of course, this assumes you have access to a library.
What do you do if you do not have such access? Today a large percentage of people are college graduates. So many
people see if they can re-institute their old college or university library privileges. Most educational institutions
do not offer off campus online access to the prime library databases by alumni. Why? Because they are charged by the
number of people who might use the service. These libraries are usually barely solvent anyway. The cost of their journal contracts
would go up astronomically if they provided such a service to all their alumni. Possibly there are some colleges that do provide
such a service, but most do not. However, you certainly could approach the university or college librarian individually. They
may be able to do it on a case by case basis. After all, if they have 50,000 students, I doubt the fees would go up much by
making it 50,001. But if they advertise that it is available to all 2 million graduates, that will surely trigger the companies
to raise the fees. I would be willing to bet that if you need access for just a few articles, the librarian at your
college library would be willing help you as long as he/she was not too overloaded with other work. But they probably won't
set you up with a carte blanche access code that you could use all the time unless you are a current student, faculty,
or other employee of the college or university. Also, your local college library may be willing to help you on a limited basis,
even if you are not a graduate.
But there are also some other ways:
1)
Some alumni associations do provide a
limited access to the school library facilities. For example, for one of my schools, the University of
Illinois, the alumni association gives its members access to a PROQUEST package. It is more of a general informational package.
It has lots of popular magazines and newspapers. But it does have some medical journal coverage. When I
searched under the term "neurology" I found the Archives of Neurology. But this was just the abstracts. I also found
the Journal of Pediatric Neurology. This seemed to have pdfs of most articles (but the pictures in the pdfs did not look very
clear). Searching under "brain" I found Behavioral and Brain Sciences, but this had a one year delay. This is not
intended to be a substitute for a medical library but I think it's a nice perk from my alumni association membership.
There are also a lot of consumer oriented health booklets and pamphlets. It's a lot better than nothing. Some alumni associations
include a much higher end package, Ebsco Academic Search Alumni Edition which includes 3200 academic journals including many
medical journals. (Stanford and University of Texas appear to offer this to their alumni).
2)
Consider joining your local public library.
Usually residents of a given municipality can join for a very small cost (such as free in some cases). Though these are not
medical libraries per se, they often do have access to some medical journals, including online access. For example, let's
look at what is listed for my local library in New Hampshire. This library subscribes to Ebsco. I am not
a member of the library and I do not know what particular Ebsco packages this library takes. Looking at www.ebscohost.com, I can see that even the most basic public library packages have a few full text medical journals. "Academic Search
Complete" gives a total of almost 7000 academic journal which includes a significant number of medical
journals. "Academic Search Elite" gives only a little more than 2000. So check your local library. You may be able
to get online access to a whole world of medical and other information for a very small fee. Also, your local public librarian
may be willing and able to help you get interlibrary loans.
3) Consider
joining a non-local library. This will cost you more, but you might find a better one than you have locally. For example,
a non-resident can get a library card at the mid-Manhattan branch of the New York Public Library for $100 per year. You can
subscribe via internet. I do not know if its online collections are any better than those of all small community
libraries. But I would bet that it is better than many of them. This is just an example of something that you can do for a
relatively modest fee to get access to online literature.
4) Consider
some fee based information services. I know that this is not free, but various amounts of money mean different things to different
people. As previously mentioned, one can buy a year's worth of MDConsult for $349 per year. For a successful physician
in private practice, this might be a very acceptable cost of doing business. I do not know how much better this is than Merckmedicus
and Medscape, which are free to doctors. Also, eMedicine provides loads of free information though it does
not give free journals. Another online information service is Uptodate. Uptodate seems to make it very hard to find its price
unless you go through the whole process and give them a lot of information, but I found a listing on an OB-GYN site that said
it costs $495 for a first year subscription and $395 for renewals. Do you get more for that charge than you get for free in,
say, eMedicine? I have used both (because I can get Uptodate through work) and I think that generally Uptodate gives more
of a quick answer on what to do but it has less depth and breadth than eMedicine overall. There are also specific specialty
oriented services such as Medlink Neurology, which costs $399 per year. There is also a way that doctors can get it "free"
by taking market research surveys. I have never had access to this but I have heard that it gives a lot
of information about neurology. Insofar as I know, it does not give you "free" access to journals that are not otherwise
free, but I am not sure about that. Below are links to these services:
www.uptodate.com
www.medconsult.com
www.medlink.com
www.emedicine.com
5) Textbooks. Some textbooks have an online service that is similar to Medlink Neurology
or Uptodate. For example, if you go to www.expertconsultbook.com you will see a number of medical textbooks, including several neurology books, that have an online presence. These books
are generally quite pricey, e.g. $300 to $500 or even more. But you should consider that you will get, in addition to online
access, a real (enormously heavy) book to tote around. Also, your online access usually will last at least until the
next edition of the book (e.g. two or three years). So, for example, you might pay about $395 for Neurology in Clinical Practice.
You would get two large bound volumes plus about 3 years of online access.
