Part 2: Creative Commons: the best medicine?



In Part 1: A rising tide floats all boats, I took my position on the side of Us v Them – free open access sharing v the old established order. Naive you may think but that’s led me to more discussions (and ranting) about Copyright and Creative Commons (which is healthy isn’t it?).


As a former commercial photographer I took part in numerous debates around copyright and protecting our work from the thieves who would use us to make their own money. I didn’t ever really flatter myself to be honest, but I have seen others being taken advantage of by big and small businesses. I would get grumpy when clients used their phones to shoot my printed proofs in order to stick them on Facebook. One day though, I had a call from a client’s friend who had seen such posted pictures and wanted their own. It led to work, directly to work, passing Go and collecting way more than two hundred pounds. That’s what happens when, as a creative, you share.


Medical research though, is not a photograph. Yes, OK, let’s get dreamy eyed for a second: a picture can say a thousand words, we all love a good image but photographs are not medical research. Dare I say it, they aren’t quite as important (in this context of course). Preventing access to important research by making it inaccessible to those who can’t pay should not be the future of healthcare in any economy.

The far reaching consequences of keeping research behind paywalls, using scarcity and inaccessibility in order to profit, is I would say, questionable.


Sure, photographers, creatives, medics, publishers, we all have to put food on the table. I understand that. Be that as it may, I want my work to be seen and shared as far and wide as possible, shared and discussed…that’s what leads to new work and in medicine, that is what could lead to better outcomes. If you want the best of both worlds, of sharing and protection, you could always turn to a Creative Commons license.


Creative Commons was the brainchild of Lawrence Lessig – a prof at Harvard Law School. The idea was actually to protect the laws of copyright. You can use Creative Commons licenses for your work and set conditions of your choosing. You could say…Sure, I am happy for you to use my work, just say where you got it from, make sure you acknowledge the source. Seems reasonable. Again, does this accessibility make it less worthy? Not solely on the grounds of being free it doesn’t. Does a CC license then infer some credibility? Maybe not.



If you are splashing the creative commons logo on everything and feeling good about it, well done. Forgive me a second for getting all idealistic but you are still slapping rules and caveats on it that are there solely to protect yourself…if you’re a photographer that is. If you are a researcher, I would disagree. It seems a good start in a move towards open access and I suppose it does make everything feel a bit more legit, for now. It’s a start.

Having been shared and having been acknowledged, that’s when your discussions, your collaborations, the joining forces, the arguments, the further sharing can get going. That’s when the magic can start to happen that leads to better outcomes for patients. That is after all, why you did the research isn’t it?  Mmmm?

Copyright laws are about the protection of original material for the creator, to keep on feeding their family and that’s fair enough. Copyright and access though are different things. I’m not talking about profiteering from the hard work of others. I’m talking about access for decision making directly for treating patients. If that material is incorporated into education resources which are sold as courses then yes, we have a different problem, whatever your intentions.


It’s a tricky one.


We all might agree that it is all kinds of moral badness to deny treatment to people (or whole countries of people) on the grounds that they can’t afford it. Yet we are happy for this to continue in medical research and education. I would argue that it is just as unjust.

Keeping information behind paywalls is leading directly to the pirates, the copyright rule breakers, the ones who think it is right they should have all the information to make decisions for their patients. It is making criminals of those wanting to do right by their patients. Is it worse to be the one breaking copyright or to be the one denying access to people who could potentially benefit – and easily so in this new economy of easy sharing? Simon Carley answered my comment in his recent post about pirate platforms by saying you are distinguishing only between two evils. I strongly believe which one is the greater of those two evils and it is not the one breaking somebody else’s copyright rules in an age of world wide access and new economy publishing.

We need to put an end to journals who use scarcity in order to increase their own wealth – to the detriment of those who can’t join in. I haven’t yet quite figured out how (believe me, I’m working on it) but creative commons licenses and copyleft ideas might be a good place to start. A compromise on the way to Open Season.


So we should choose wisely how our research is shared and what can be done with it…or question why we did it in the first place.




I have just been challenged on all this though and here’s a new question I have been asked…

If you are so outspoken about free/open access to everything, what about your medical data? Should that be freely accessible?

Now there’s a question…and one for part three.


Some linked interesting-ness…


Creative Commons

Open Educational Resources Commons

EMJ Blog: What’s the future of medical journals?

Richard Smith: What will the post journal world look like?

Link tax is a thing? Seriously?


Please add your thoughts to the comments section below….





A rising tide floats all boats.



I was having a discussion about disruptive technology in medical education (as you do) and in a reply one particular line stood out for me…

I think the world is now mature enough to be sceptical about what we see and hear on the internet.

Sure, that is true for those of us who happily embrace the internet and internet 2.0 but there are still many who are not happy that we are out there, sharing our thoughts and having free open discussions with a global audience. We can’t be trusted, you see, to think for ourselves.

I still feel like the world is split into us and them – those who want to share and collaborate openly and freely and those who see value only in what they have to pay for and what they are told to read. As a commercial photographer, I spoke at numerous business group meetings and events about the beauty of collaboration and sharing using social media – only to split rooms in two. It is the same in the world of medicine.

I’m baffled that we still need articles like that in the BMJ this week bemoaning the tweet-dodgers at conferences, complaining that their data will be stolen or misinterpreted if anyone tweets from such private gatherings. It goes on to the suggest guidelines for conference tweeting…yawn…still needed in 2016? Clearly so. I have a colleague studying for a Masters in Medical Education to whom I recently had to explain the term FOAMed. His response was an eye-roll and a “whatever”. I think he and others are massively underestimating the power that online sharing and teaching will have in the future (and even now). Imagine a world where we no longer have to make sacrificial offerings to the gods of publications, to the gatekeepers of the journals who decide whether or not our careers are worthy of their ink. Judging academics by where they are published is just a ludicrous idea isn’t it? Yet my portfolio and my job applications would have it otherwise.

Until we can break free from the current outdated system, there will always be us and them. For many, what is seen as cheap will be seen as worthless. Anything that is hidden behind paywalls must therefore be far better? I disagree. Data/information/anything that we create – it can all be copied and shared on a massive scale on the internet – but that doesn’t make it worthless.

What we need to move towards appreciating is that the value comes not from what can be easily copied but from what comes with it, those things that can’t be easily copied or stolen – what is instant or timely; what is personal; analysis based on the experience and the validity and the accessibility of the authors. I’m talking about our ideas, our conviction, our experience and excellence – essentially, ourselves and what we bring with our data.

“I don’t have enough followers to bother” is a false predicament – you only need one or two followers who share your interest, who see something in your work and who will engage – this is all you need to get your work and ideas out there because there will be people who care enough about your vision to join in and to share. Maybe if there is one person reading my blog today who feels strongly enough they will share and discuss – that may be all I need. There is a phrase I have stolen (from someone who shared it with me) and I believe it strongly: a rising tide floats all boats. Information should be free to be shared in order to raise the collective up together and further. If you are on your way up, take others with you.

Open access for freely available research, data and even opinion undermines the established order – but we don’t want to do it to piss people off (maybe) we do it because we don’t need the established order anymore. It wasn’t working for us. It only ever worked for itself.

For research and education in the world of medicine, it is such an exciting time and it is time to accept that there is another way.


Part 2: Creative Commons : the best medicine? (watch this space)

We’ve always done it this way


There is not a phrase in existence that I could despise more.

Please don’t get me wrong, as a junior doctor it is a phrase that has helped me out of a few sticky situations when uttered by an experienced nurse who’s watching my back. I’m talking about the other context though, the one where we’re trying to improve, innovate or are daring to hope to make things better and when we are met by this giant, immovable, smug, grinning brick wall of “always”.

I can remember, in all detail, the very moment this intense hatred began. In the summer of 2001 I had just graduated with an Honours degree in Medical Molecular Biology and was waiting to start Med School. I got a job in the University bookshop. Perhaps I should have realised beforehand that my exuberance was not suited to such an endeavour but at least it taught me so, and quite quickly. I worked in the back office, selling books to libraries (not a tough job as it turned out, as books were all libraries seemed to buy).
The shop’s systems were laborious and complicated and there wasn’t a computer in sight. For the student who had started the first tentative websites for the University clubs and sports societies, this was hard going.

I arrived at work one day to find a new batch of deliveries. It was periodicals day. The publishers sent them out to us and it was my job to sort them out, figure out who they were destined for and make arrangements for delivery.

After an age of time-wasting I couldn’t take the system any longer. I made a suggestion to the boss— Margaret. I didn’t whine, I simply made what I thought was a useful suggestion. I gave a solution to this time-wasting problem and I set out an argument for implementing it. Margaret, who glared at me over the top of her glasses, was not impressed. She lifted the tatty old notebook marked “periodicals” from the shelf, opened it up and handed it to me across her desk.

“This is how we have always done it” she said

and that was the end of that.

As I turned to leave I looked down at the notebook, to the page that she had handed me. What I saw stopped me in my tracks. The very first entry in the book was dated 14th December 1978. The day that I was born. Even more striking was that it was written in Margaret’s own distinctive handwriting and she had written in it, the same way, every month since.

She was happy with that. Some people just are. This was a battle I wasn’t going to win. I didn’t stay long in the back office selling books to libraries.

That bookshop is no longer there. Those periodicals are online now.

So here’s how it makes me feel when you utter those words. You take all creativity, innovation, excitement and hope and you stamp on them, kick them, punch them in the face and bury them in a box. You draw a line in the sand and you take your place on the wrong side of it.  There are two types of people on that sandy beach of yours. Those that proclaim we’ve always done it this way and those who move with the dunes.


Related Posts Plugin for WordPress, Blogger...