Dear Neil,
I would like to respond to the question you pose "What evidence do you have that few people read the full text of research papers?" Re article downloads, journals that use Altmetrics display those statistics, but those refer only to the article on the site, not other versions of the article available on repositories, so there is no good measure of total downloads that I'm aware of. However, how does one measure the value of full text access -- by the number of people who read it, or the importance of the information to the individual reading it? I would say both.
Rather than providing evidence to support your hypothesis, I'll describe the importance of full text access to me. I'm sure others have their own suggestions and experiences, but as a patient and caregiver, former practicing physician, former medical journal editor, and current medical editor newsletter author and eLearning Program director, I need access to full length manuscripts to learn the study details that are not included in the abstract. Such details can help determine whether the study applies to the particular patient or situation, the overall quality of the study, and other issues that might be important when considering the veracity of the study results. The abstract is too short to address these issues, and the amount of detail provided in abstracts varies by article and journal.
The full text reveals (for example):
- population studied and when, how individuals were identified, and inclusion and exclusion criteria
- specifics regarding any intervention and length of treatment and followup
- how study outcomes were defined
- actual effect sizes
- adverse effects and how they were evaluated
- confounding variables included in any models
- introduction, which can provide useful context for the problem
- reference list, which can point me in the direction of other useful studies
- discussion, which can help summarize and contextualize the study results
- completeness of study reporting, overall quality of reporting, evidence of bias in analyses and/or study interpretation
- author conflicts of interest and funding (not always provided in the "free" part of the study data)
There are many more examples, but in sum, in my experience, the full text is necessary for any thorough evaluation of a study. An additional consideration is that full text produces better search results (see https://pmc.ncbi.nlm.nih.gov/articles/PMC2695361/) -- Google only indexes text that is freely available, and with any search engine you need to be able to access the flagged text to assess whether the study is relevant.
Finally, while the general medical guidance to which you refer is essential for a busy generalist and can be a useful place to start, it often lacks sufficient detail or does not address the problem at hand. Evaluating the evidence base for that guidance is necessary for informed decision making -- as you found yourself when trying to use a study to answer your question.
Best wishes,
Margaret
Margaret Winker, MD
eLearning Program Director
Trustee
World Association of Medical Editors
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HIFA profile: Margaret Winker is Secretary and Past President of the World Association of Medical Editors in the U.S. Professional interests: WAME is a global association of editors of peer-reviewed medical journals who seek to foster cooperation and communication among editors, improve editorial standards, promote professionalism in medical editing through education, self-criticism, and self-regulation, and encourage research on the principles and practice of medical editing. margaretwinker AT gmail.com