Objective:

To highlight the financial barriers faced by authors in open access publishing and its implications for equity in scholarly publishing, including representation and access to knowledge.

Key Findings:

• APCs can limit participation in scholarly publishing for researchers in low- and middle-income countries.
• The cost disparity between countries can be significant, affecting global representation in scientific literature.
• Major medical publishers report high revenues while many authors face financial barriers.
• Transformative agreements have supported the publication of over 1 million OA articles, but may still impose caps on APCs.

Interpretation:

Equitable access to publishing is crucial for scientific representation and patient care, as current systems may reinforce inequities.

Limitations:

• Challenges in defining minimal fees and preventing misuse of authorship.
• Need for transparency in waiver policies, including clear guidelines and monitoring mechanisms.

Conclusion:

The current open access model risks creating a two-tier knowledge economy, limiting voices to those who can afford publication costs, which has serious implications for scientific representation and patient care.