Carolina Solis once went to incredible lengths for, well ... poop.
"One community was a two-hour ride away on awful dirt roads, very muddy. At one point we couldn't keep going because our tires kept slipping, so I got out and walked another hour uphill just to get there," she says.
Now a fourth-year student at Harvard Medical School, Solis spent a summer doing research in San Juan del Sur, Nicaragua. Before the sun rose each morning, she boarded an old school bus bound for some of Nicaragua's most remote regions. When she finally arrived, farmers would be waiting for her, clutching small cups. The cups contained samples of their own stools, which Solis would check for evidence of certain parasites. Gathering up the samples, she then made the long trek back to San Juan del Sur.
"It smelled great," she laughs. "I was happy to be done my last day."
Her results were startling. Up to 80 percent of some communities were infected. Contaminated well water was a likely culprit.
Like many researchers, she plans to submit her findings for publication in a medical journal. What she discovered could benefit not just Nicaraguan communities but those anywhere that face similar problems. When she submits her paper, though, she says the doctors she worked with back in San Juan del Sur will probably never get a chance to read it.
"They were telling me their problems accessing these [journals]. It can be difficult for them to keep up with all the changes in medicine."
In most cases, unless a medical professional or researcher works for an organization that can afford subscriptions to medical journals, much of that research remains beyond their reach. There are thousands of different journals, and access to just the most well-regarded can run thousands of dollars a year.
Now, with Washington rushing to transform health care, a debate often limited to hospital wards, medical schools and Internet forums is pushing to the fore. It's a debate deeply rooted in beliefs about access to information -- medical research. Increasingly, a generational gap is emerging.
On one side of the gap are those who say such research should be free to all, that it's too valuable to keep firmly planted in the walled gardens of the prestigious journals that publish it. And for research that's taxpayer-funded, the public that paid for it, at least, deserves access.
On the other side of the gap are those who say the copyright interests of the journals come first. And that they're private entities spending their own money to sift through hundreds of studies, plucking the wheat from the chaff. Making more research freely available could dilute their influence, ultimately hurting genuine scientific inquiry.
"Even the old school docs who rave about 'the good old days,' still admit that having access to information at our fingertips has, essentially, made our brains bigger," says Andrew Sauer, a second-year resident at Massachusetts General Hospital. Where he works, he says, the Internet's almost as common as stethoscopes. He can even pull up journal research on his phone, thanks to the subscriptions paid for by Mass General. But outside of the hospital system, he says, "I'm going to have a hard time affording access."