The Open Access initiative in scientific and biomedical publishing: fourth in the series on editorship.

PURPOSE: To provide basic information about the Open Access concept and its historical development, define the benefits and challenges inherent in this new model, and identify the value of the traditional print model and its movement towards more open access.

DESIGN: Review of current information on the subject from numerous sources.

METHODS: Medline search and Internet search engines on the topic of Open Access Publishing.

RESULTS: The Open Access initiative derives from several premises: medical libraries can no longer afford journal subscriptions; society benefits from the open exchange of ideas; society has in large part already paid for this research; the Internet provides an available venue. The traditional journal publishers model, however, has functioned well over many years with a robust peer review system and increasing Internet digital components permitting search and cross referencing, including elements of the Open Access model.

CONCLUSIONS: It will be difficult to maintain the costs of both the traditional journal system and the fully implemented Open Access model. Any decisions that are made must ensure that the archive of prior medical knowledge is not lost, that financial barriers do not restrict publication, and that research continues to be available to those who need it, in the media that they prefer.