It remains a matter of debate whether or not iTunes from Apple has resulted in a greater diversity of musical offerings. It is less controversial that Apple has created a market force which has enabled consumers to buy affordable single tracks from an album without digital rights restrictions that are often inconvenient, if not onerous. This has caused a shift of power from the recording industry to Apple and perhaps the consumer. So, is there an player equivalent to Apple in the sphere of biomedical publication? Will it be one of the current open access publishers or a "player" as unanticipated as Apple was for music distribution?
For example, Google could host a full peer-review and dissemination/annotation publication ecosystem if it wished. Or the AAMC could host a distributed biomedical research press. Or the NIH could spend less than 5% of its total budget and create a high quality peer-reviewed system that would hew to the highest standards and directly bring the output of NIH-funded biomedical research directly to the consumers without any additional cost.