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I have a dream – A change of generations – Communication channels
– Book vs. internet – Pioneer projects – Traditional publishing house
or the author as publisher? – Cash flow – 100 doctors
Just imagine:
1. A medical textbook is available on the internet, accessible for
everyone at all times.
2. Even better: it is already on the internet although sales of the print
version have not even begun yet.
3. Furthermore: the book is updated every year.
4. And hard to believe: access on the internet is unrestricted, 800
pages just waiting for readers.
Utopia?
Reality! It has been possible to read free of charge on
www.HIVMedicine.com for a number of years now. In future, the
textbook will be updated annually and made available on the internet.
HIV Medicine: written by doctors, edited by doctors, published by
doctors – for doctors. You are among your own kind. The advantage:
unparalleled dedication from the authors and extremely short
production times, which means that there is hardly any other book
project in existence where up-to-date medical information is processed
as quickly as in HIV Medicine. This has far-reaching consequences.
The continuously updated specialised knowledge which is published
in the duo of book + internet becomes a kind of permanent advanced
training course, free of charge, prompt and ubiquitous. All thanks to
the internet.
HIV Medicine 2005 is a so-called Flying Publisher text. Flying
Publisher texts exist 1) in book form and 2) simultaneously as a free
internet site. So a Flying Publisher text has two physical conditions, a
fee-based form (book) and a free-of-charge form (internet). Flying
Publisher texts speed up the flow of information.
– Book vs. internet – Pioneer projects – Traditional publishing house
or the author as publisher? – Cash flow – 100 doctors
Just imagine:
1. A medical textbook is available on the internet, accessible for
everyone at all times.
2. Even better: it is already on the internet although sales of the print
version have not even begun yet.
3. Furthermore: the book is updated every year.
4. And hard to believe: access on the internet is unrestricted, 800
pages just waiting for readers.
Utopia?
Reality! It has been possible to read free of charge on
www.HIVMedicine.com for a number of years now. In future, the
textbook will be updated annually and made available on the internet.
HIV Medicine: written by doctors, edited by doctors, published by
doctors – for doctors. You are among your own kind. The advantage:
unparalleled dedication from the authors and extremely short
production times, which means that there is hardly any other book
project in existence where up-to-date medical information is processed
as quickly as in HIV Medicine. This has far-reaching consequences.
The continuously updated specialised knowledge which is published
in the duo of book + internet becomes a kind of permanent advanced
training course, free of charge, prompt and ubiquitous. All thanks to
the internet.
HIV Medicine 2005 is a so-called Flying Publisher text. Flying
Publisher texts exist 1) in book form and 2) simultaneously as a free
internet site. So a Flying Publisher text has two physical conditions, a
fee-based form (book) and a free-of-charge form (internet). Flying
Publisher texts speed up the flow of information.
if there were not only textbooks on HIV and AIDS, but also on other
subjects, such as immunology, rheumatology, cardiology, antibiotic
therapy, tropical medicine. Or – why ever not? – even for every
possible medical field, as well as for the most important sub-sections
(see the overview given on www.amedeo.com). In an instant, we
would have an extensive virtual library with all the relevant
information needed for day-to-day use. 100 books, 50,000 pages, free
of charge, updated yearly. 99% of the questions which crop up in our
daily medical routine would be covered.
Would this be a contribution to the improvement of medical care?
Yes, indeed it would.
Change of generations
Sceptics express concern that doctors already have enough work to do
and thus can’t cope with being writers and publishers of free internet
textbooks at the same time.
First of all, they underestimate us. Secondly, the sceptics – especially
if they are not doctors themselves – are not quite in step with the
times. In the last five years, the internet has drastically reduced costs
and time involved in the production and marketing of information of
every kind. Nowadays, doctors can pass on their knowledge directly to
colleagues and students, whether by e-mail, PDF files or through their
own websites. Doctors no longer have to work together with
publishing companies.
It is time, once more, for a generation change. Until recently, those
who published textbooks – mostly 45 and older – were too old to
understand the internet. Those, on the other hand, who had some idea
of the possibilities offered by the internet were too young and
inexperienced, and therefore not ready to write textbooks yet. But, as
time passes, people get older and the old ones, too old for the internet,
take their leave and the young ones, young enough for the internet, get
older and reach the age at which they can write textbooks.
In the following chapters, we will work our way step by step through
the process of how an idea becomes a text and how we get this text to
our readers. The individual stages of this adventure are:
subjects, such as immunology, rheumatology, cardiology, antibiotic
therapy, tropical medicine. Or – why ever not? – even for every
possible medical field, as well as for the most important sub-sections
(see the overview given on www.amedeo.com). In an instant, we
would have an extensive virtual library with all the relevant
information needed for day-to-day use. 100 books, 50,000 pages, free
of charge, updated yearly. 99% of the questions which crop up in our
daily medical routine would be covered.
Would this be a contribution to the improvement of medical care?
Yes, indeed it would.
Change of generations
Sceptics express concern that doctors already have enough work to do
and thus can’t cope with being writers and publishers of free internet
textbooks at the same time.
First of all, they underestimate us. Secondly, the sceptics – especially
if they are not doctors themselves – are not quite in step with the
times. In the last five years, the internet has drastically reduced costs
and time involved in the production and marketing of information of
every kind. Nowadays, doctors can pass on their knowledge directly to
colleagues and students, whether by e-mail, PDF files or through their
own websites. Doctors no longer have to work together with
publishing companies.
It is time, once more, for a generation change. Until recently, those
who published textbooks – mostly 45 and older – were too old to
understand the internet. Those, on the other hand, who had some idea
of the possibilities offered by the internet were too young and
inexperienced, and therefore not ready to write textbooks yet. But, as
time passes, people get older and the old ones, too old for the internet,
take their leave and the young ones, young enough for the internet, get
older and reach the age at which they can write textbooks.
In the following chapters, we will work our way step by step through
the process of how an idea becomes a text and how we get this text to
our readers. The individual stages of this adventure are:
Selecting and narrowing down a theme, structuring the material
and putting together a team of authors (Page 2) Writing the text and guiding the authors (Page 37) Preparations behind the scenes, while the authors are writing
(Page 45) Talks with sponsors (Page 54) Refining and polishing work on the chapters until we have a
version ready for press Advance publication of the texts on the internet Advertising and
marketing Advertising and marketing Copyright clearance for translation into other languages
Before describing these points in detail, we have to go back to basics.
What is communication? What do I want to achieve by writing this
text? How many readers am I writing for? What is the difference
between books and internet sites? What is more important: money or
readers? Does it make more sense nowadays to publish a text in a
traditional publishing house or as my own publisher? What is the cash
flow like in a book project and what cash flows where?
Communication
Communication is the transportation of thoughts, ideas, wishes,
images or visions from one brain to another. When you stand up in
front of a group of students in a lecture theatre, some things are only
in your head, but not in the heads of the students. You speak for an
hour and remedy this situation.
If we want a message to reach more people, we need media other than
language. In the course of history, people have invented cuneiform
writing tablets, papyrus, manuscript, books, radio, television and the
internet. The first three media are no longer modern, and radio and
television are generally not available to us. This leaves us with books
and the internet for the communication of our knowledge.
The number of people we can reach with a message mainly depends
on the subject. The number of people interested can range from 6
thousand million (Message: „the 10-kilometre meteorite is expected to
hit three days before Christmas”) to a few hundred (Message: “total
mesorectal excision and urogenital dysfunctions”). But regardless of
and putting together a team of authors (Page 2) Writing the text and guiding the authors (Page 37) Preparations behind the scenes, while the authors are writing
(Page 45) Talks with sponsors (Page 54) Refining and polishing work on the chapters until we have a
version ready for press Advance publication of the texts on the internet Advertising and
marketing Advertising and marketing Copyright clearance for translation into other languages
Before describing these points in detail, we have to go back to basics.
What is communication? What do I want to achieve by writing this
text? How many readers am I writing for? What is the difference
between books and internet sites? What is more important: money or
readers? Does it make more sense nowadays to publish a text in a
traditional publishing house or as my own publisher? What is the cash
flow like in a book project and what cash flows where?
Communication
Communication is the transportation of thoughts, ideas, wishes,
images or visions from one brain to another. When you stand up in
front of a group of students in a lecture theatre, some things are only
in your head, but not in the heads of the students. You speak for an
hour and remedy this situation.
If we want a message to reach more people, we need media other than
language. In the course of history, people have invented cuneiform
writing tablets, papyrus, manuscript, books, radio, television and the
internet. The first three media are no longer modern, and radio and
television are generally not available to us. This leaves us with books
and the internet for the communication of our knowledge.
The number of people we can reach with a message mainly depends
on the subject. The number of people interested can range from 6
thousand million (Message: „the 10-kilometre meteorite is expected to
hit three days before Christmas”) to a few hundred (Message: “total
mesorectal excision and urogenital dysfunctions”). But regardless of
how many people are interested in a subject, the following rule
applies: if I write and spend days and even weeks formulating a text, I
want as many people as possible from the group theoretically
interested in my text to read what I have written. I want the maximum
conceivable audience for my text.
Book vs. Internet ? – Book + Internet !
Books and the internet are the forms of communication media
available to us doctors (Table 1 and 2). The most important difference
is that we pay for books, but not for internet sites, and, in addition: Readability: books are easier to read and more versatile in their
application Number of readers: for 1000 book-readers there are 10,000 and
more internet readers How up-to-date are they?: internet sites are more up-to-date than
a book
Table 1.1: Advantages of a book
Books can be sold easily by publishers are prestigious are tangible can be read easily in very different situations
(beach, bath-tub etc.) have authority
Table 1.2: Advantages of internet sites
Internet sites cost the reader nothing are more up-to-date than books reach a lot of readers speed up the flow of information
At first glance, books and the internet are very diverse media, at least
when pitted against each other. However, they give a different
applies: if I write and spend days and even weeks formulating a text, I
want as many people as possible from the group theoretically
interested in my text to read what I have written. I want the maximum
conceivable audience for my text.
Book vs. Internet ? – Book + Internet !
Books and the internet are the forms of communication media
available to us doctors (Table 1 and 2). The most important difference
is that we pay for books, but not for internet sites, and, in addition: Readability: books are easier to read and more versatile in their
application Number of readers: for 1000 book-readers there are 10,000 and
more internet readers How up-to-date are they?: internet sites are more up-to-date than
a book
Table 1.1: Advantages of a book
Books can be sold easily by publishers are prestigious are tangible can be read easily in very different situations
(beach, bath-tub etc.) have authority
Table 1.2: Advantages of internet sites
Internet sites cost the reader nothing are more up-to-date than books reach a lot of readers speed up the flow of information
At first glance, books and the internet are very diverse media, at least
when pitted against each other. However, they give a different
impression when put side by side and combined (Table 1.3). A text
which is produced as a combination of “book + internet” leaves little
to be desired.
Table 1.3: Book + Internet sites
Book + internet sites are easy to sell + up-to-date prestigious + have a lot of readers suitable for the bath-tub + the computer representative + around the world in an
instant
In addition, books and the internet benefit from each other. A book on
its own is immobile – it takes internet sites to set the text in motion.
Only then is it to be found standing on every street corner of the
internet, calling “Please take me with you!” In return, a book is the
best possible publicity for an internet site. It is only through books that
internet sites are archived correctly and given authority – among other
things, because the authors have no choice but to commit themselves
in black and white. The result is that internet sites and books
complement each other, and nowadays a text is only represented
adequately in the combination, book + internet.
Anyone who doesn’t understand the complementary nature of book
and internet sites should think very hard about whether writing still
makes sense for him. There is little doubt: out of two equally
competent and detailed medical textbooks, the one available free of
charge on the internet will be the one to win favour with the readers.
In a direct confrontation between “book only” and “book + internet”,
“books only” have a remote chance of survival. This fact means that
the book with the free internet version ultimately gains market shares.
The surprising twist is that the free internet version promotes the sale
of the fee-based book version. The financial result of a well-planned
parallel publication (book + free internet counterpart) can thus be very
satisfying in the middle-term. We will come back to this point in more
detail later.
which is produced as a combination of “book + internet” leaves little
to be desired.
Table 1.3: Book + Internet sites
Book + internet sites are easy to sell + up-to-date prestigious + have a lot of readers suitable for the bath-tub + the computer representative + around the world in an
instant
In addition, books and the internet benefit from each other. A book on
its own is immobile – it takes internet sites to set the text in motion.
Only then is it to be found standing on every street corner of the
internet, calling “Please take me with you!” In return, a book is the
best possible publicity for an internet site. It is only through books that
internet sites are archived correctly and given authority – among other
things, because the authors have no choice but to commit themselves
in black and white. The result is that internet sites and books
complement each other, and nowadays a text is only represented
adequately in the combination, book + internet.
Anyone who doesn’t understand the complementary nature of book
and internet sites should think very hard about whether writing still
makes sense for him. There is little doubt: out of two equally
competent and detailed medical textbooks, the one available free of
charge on the internet will be the one to win favour with the readers.
In a direct confrontation between “book only” and “book + internet”,
“books only” have a remote chance of survival. This fact means that
the book with the free internet version ultimately gains market shares.
The surprising twist is that the free internet version promotes the sale
of the fee-based book version. The financial result of a well-planned
parallel publication (book + free internet counterpart) can thus be very
satisfying in the middle-term. We will come back to this point in more
detail later.
1. Flying Publisher
Pioneer projects
The number of readers is one of the most important variables which
define the success of a text. We are investigating the extent to which
this number is influenced by the publication of a free internet version
in three pioneer projects, and can already anticipate the result. Texts
on the internet have at least ten times as many readers as books only.
HIV.NET
The pioneer project for medical textbooks in the German-speaking
part of the world was HIV.NET. As early as Spring 1996, the 460
pages of “AIDS 1996” were available on the internet. This practice
has been continued until today (http://hiv.net/2010/buch.htm). The
reader figures for 2004 have been compiled in Table 1.4.
Table 1.4: HIV.NET 2004-Readers*
Readers**
Book, long version (712 pages)1,000
Book, pocket edition2,000
PDF version of the long version 5,500
(14th July to 31st December)
HIV.NET-Homepage>120,000
Chapter
Drug Profiles24,000
HIV Therapy22,000
HIV Testing12,000
Acute HIV Infection10,000
Natural History6,500
Pathogenesis5,500
Side Effects5,000
Lipodystrophy2,500
Mitochondrial Toxicity4,500
Routes of Transmission4,000
Resistance Testing1,500
* The internet access figures have been rounded off
** or rather: “potential readers”, as not everyone who owns a book actually
reads it and not everyone who accesses an internet page reads it.
Pioneer projects
The number of readers is one of the most important variables which
define the success of a text. We are investigating the extent to which
this number is influenced by the publication of a free internet version
in three pioneer projects, and can already anticipate the result. Texts
on the internet have at least ten times as many readers as books only.
HIV.NET
The pioneer project for medical textbooks in the German-speaking
part of the world was HIV.NET. As early as Spring 1996, the 460
pages of “AIDS 1996” were available on the internet. This practice
has been continued until today (http://hiv.net/2010/buch.htm). The
reader figures for 2004 have been compiled in Table 1.4.
Table 1.4: HIV.NET 2004-Readers*
Readers**
Book, long version (712 pages)1,000
Book, pocket edition2,000
PDF version of the long version 5,500
(14th July to 31st December)
HIV.NET-Homepage>120,000
Chapter
Drug Profiles24,000
HIV Therapy22,000
HIV Testing12,000
Acute HIV Infection10,000
Natural History6,500
Pathogenesis5,500
Side Effects5,000
Lipodystrophy2,500
Mitochondrial Toxicity4,500
Routes of Transmission4,000
Resistance Testing1,500
* The internet access figures have been rounded off
** or rather: “potential readers”, as not everyone who owns a book actually
reads it and not everyone who accesses an internet page reads it.
Pioneer projects
In 2004, about 1,000 books of the complete 712-page edition o
HIV.NET were sold, as well as 2000 copies of the abridged “pocke
edition” with the central chapters HIV Therapy, Drug Profiles, Side
Effects, Lipodystrophy, Resistance Testing, Opportunistic Infections
and Lymphomas.
The PDF version of the complete edition, which was freely available
th
as of 14
July, was retrieved more than 5000 times in 6 months. Some
chapters (Acute HIV infection, HIV Testing) were read 10 times more
often on a computer monitor than in a book.
HIV Medicine 2003
HIV Medicine 2003 (www.HIVMedicine.com) roughly corresponds
to the pocket version of HIV.NET (see above). 3000 copies of HIV
Medicine 2003 were printed and handed out to the participants at an
IAS congress in Paris by a pharmaceutical company.
Table 1.5: Readers of HIV Medicine 2003
Readers*
Book (340 pages)3,000
PDF version
June-July 2003: 8,500
August-December 2003: 4,000
January-December 2004: 12,000
Chapter
Acute HIV Infection25,416**
HIV Therapy13,751**
Pathogenesis8,000**
Drug Profiles7.051**
Side Effects6.926**
Lipodystrophy5.599**
Resistance Testing5.394**
* “Readers“ should say “Potential readers“ as not everyone who owns a book
actually reads it and not everyone who accesses an internet page reads it.
th th
April to 16 November 2003; the figures correspond approximately to the
** 8
st st
January to 31 December 2004.
number of readers from 1
In 2004, about 1,000 books of the complete 712-page edition o
HIV.NET were sold, as well as 2000 copies of the abridged “pocke
edition” with the central chapters HIV Therapy, Drug Profiles, Side
Effects, Lipodystrophy, Resistance Testing, Opportunistic Infections
and Lymphomas.
The PDF version of the complete edition, which was freely available
th
as of 14
July, was retrieved more than 5000 times in 6 months. Some
chapters (Acute HIV infection, HIV Testing) were read 10 times more
often on a computer monitor than in a book.
HIV Medicine 2003
HIV Medicine 2003 (www.HIVMedicine.com) roughly corresponds
to the pocket version of HIV.NET (see above). 3000 copies of HIV
Medicine 2003 were printed and handed out to the participants at an
IAS congress in Paris by a pharmaceutical company.
Table 1.5: Readers of HIV Medicine 2003
Readers*
Book (340 pages)3,000
PDF version
June-July 2003: 8,500
August-December 2003: 4,000
January-December 2004: 12,000
Chapter
Acute HIV Infection25,416**
HIV Therapy13,751**
Pathogenesis8,000**
Drug Profiles7.051**
Side Effects6.926**
Lipodystrophy5.599**
Resistance Testing5.394**
* “Readers“ should say “Potential readers“ as not everyone who owns a book
actually reads it and not everyone who accesses an internet page reads it.
th th
April to 16 November 2003; the figures correspond approximately to the
** 8
st st
January to 31 December 2004.
number of readers from 1
1. Flying Publisher
By the end of the year 2004, the PDF version of HIV Medicine 2003
had been downloaded from our servers more than 24,000 times The
chapters “Acute HIV Infection” and “HIV Therapy” had an additional
25,000 and 13,000 readers, respectively (see Table 1.5).
A novelty with HIV Medicine 2003 was the copyright removal
(http://hivmedicine.com/textbook/cr.htm, see details on page 70). The
simultaneous message to colleagues all over the world was
“Colleagues, translate HIV Medicine 2003 and publicise the
translation. If you want, you can even publish it under your own
name. Sell the book, earn money from it. Whatever you do: we don’t
want a cent.”
The result: HIV Medicine 2003 was translated into Spanish,
Portuguese, Italian, Russian and Romanian
(http://hivmedicine.com/textbook/lang.htm).
SARS Reference
SARS Reference appeared between May and October 2003 in three
th
editions (www.SARSReference.com). The reader figures up to 5
May 2005 have been compiled in Table 1.6.
The PDF documents of the three editions were accessed more than
50,000 times; the most important chapters were opened more than
30,000 times each.
As in the case of HIV Medicine 2003, we removed the copyright for
SARS Reference. The book was then translated into Chinese, French,
Italian, Portuguese, Romanian, Spanish and Vietnamese (see
http://sarsreference.com/sarsref/lang.htm). The two Chinese
translations were also published as printed booklets and handed out to
7,000 and 10,000 Chinese doctors, respectively, at the peak of the
SARS epidemic (see Fig. 1.1).
SARS Reference had more than 200,000 readers in 20 months,
because it was free of charge. It was translated into 8 languages
because it was free of charge and the copyright had been removed.
SARS Reference is in third place on the Google list after the CDC and
the WHO, because it is known throughout the world. SARS Reference
was reviewed twice, in Science and in the British Medical Journal
(Page 70), because it showed new ways of publishing medical
information.
By the end of the year 2004, the PDF version of HIV Medicine 2003
had been downloaded from our servers more than 24,000 times The
chapters “Acute HIV Infection” and “HIV Therapy” had an additional
25,000 and 13,000 readers, respectively (see Table 1.5).
A novelty with HIV Medicine 2003 was the copyright removal
(http://hivmedicine.com/textbook/cr.htm, see details on page 70). The
simultaneous message to colleagues all over the world was
“Colleagues, translate HIV Medicine 2003 and publicise the
translation. If you want, you can even publish it under your own
name. Sell the book, earn money from it. Whatever you do: we don’t
want a cent.”
The result: HIV Medicine 2003 was translated into Spanish,
Portuguese, Italian, Russian and Romanian
(http://hivmedicine.com/textbook/lang.htm).
SARS Reference
SARS Reference appeared between May and October 2003 in three
th
editions (www.SARSReference.com). The reader figures up to 5
May 2005 have been compiled in Table 1.6.
The PDF documents of the three editions were accessed more than
50,000 times; the most important chapters were opened more than
30,000 times each.
As in the case of HIV Medicine 2003, we removed the copyright for
SARS Reference. The book was then translated into Chinese, French,
Italian, Portuguese, Romanian, Spanish and Vietnamese (see
http://sarsreference.com/sarsref/lang.htm). The two Chinese
translations were also published as printed booklets and handed out to
7,000 and 10,000 Chinese doctors, respectively, at the peak of the
SARS epidemic (see Fig. 1.1).
SARS Reference had more than 200,000 readers in 20 months,
because it was free of charge. It was translated into 8 languages
because it was free of charge and the copyright had been removed.
SARS Reference is in third place on the Google list after the CDC and
the WHO, because it is known throughout the world. SARS Reference
was reviewed twice, in Science and in the British Medical Journal
(Page 70), because it showed new ways of publishing medical
information.
Traditional publishing or self-publishing?
Table 1.6: Readers of SARS Reference*
Reader**
1st edition, PDF-File
th th
11,000
to 14 May 2003
8
th th
May to 6 July 2003 15,200
15
nd
2 edition, PDF-File
th th
July to 15 October 20039,200
8
rd
3
edition, PDF-File
th st
6,000
October to 31 December 2003
16
st st
January to 31 December 2004 12,000
1
SARS Reference Homepage232,426
Chapter
Virology42,214
Treatment39,581
Timeline36,482
Transmission33,351
Summary31,648
Other Languages25,689
Epidemiology22,855
Diagnostic Tests22,574
Diagnosis18,994
Case Definition17,550
Paediatric SARS10,826
Copyright Removal9,572
th th
* Access numbers, 8 May 2003 to 5 May 2005
** “Readers“ should say “Potential readers“ as not everyone who owns a book
actually reads it and not everyone who accesses an internet page reads it.
Traditional publishing or self-publishing?
The decision has been made: we are going to write a medical textbook
and publish it both as a book and on the internet. But how precisely
do we set about approaching this project? Do we have the publishing
skills to achieve success? How do we organise it? Can we cope
financially?
Let’s start by taking stock. In the last few years, doctors have seen
how amazingly self-sufficient they have become in spreading medical
Table 1.6: Readers of SARS Reference*
Reader**
1st edition, PDF-File
th th
11,000
to 14 May 2003
8
th th
May to 6 July 2003 15,200
15
nd
2 edition, PDF-File
th th
July to 15 October 20039,200
8
rd
3
edition, PDF-File
th st
6,000
October to 31 December 2003
16
st st
January to 31 December 2004 12,000
1
SARS Reference Homepage232,426
Chapter
Virology42,214
Treatment39,581
Timeline36,482
Transmission33,351
Summary31,648
Other Languages25,689
Epidemiology22,855
Diagnostic Tests22,574
Diagnosis18,994
Case Definition17,550
Paediatric SARS10,826
Copyright Removal9,572
th th
* Access numbers, 8 May 2003 to 5 May 2005
** “Readers“ should say “Potential readers“ as not everyone who owns a book
actually reads it and not everyone who accesses an internet page reads it.
Traditional publishing or self-publishing?
The decision has been made: we are going to write a medical textbook
and publish it both as a book and on the internet. But how precisely
do we set about approaching this project? Do we have the publishing
skills to achieve success? How do we organise it? Can we cope
financially?
Let’s start by taking stock. In the last few years, doctors have seen
how amazingly self-sufficient they have become in spreading medical
1. Flying Publisher
information. Whether we wanted to or not, we have all become
experts in word processing. Think back: how many doctors were
familiar with the layout of letters on a typewriter 20 years ago? Back
then, we had secretaries, and anyone who was able to touch-type kept
this to himself and didn’t give it away to his assistant until after he
retired.
Better still: we are not only adept at word processing but have also
become practised layout designers. Anyone who has published
scientific articles in medical journals has learned that he must
“format” his texts in accordance with strict regulations. After all, the
work performed in the medical publishing houses must be reduced to
a minimum.
information. Whether we wanted to or not, we have all become
experts in word processing. Think back: how many doctors were
familiar with the layout of letters on a typewriter 20 years ago? Back
then, we had secretaries, and anyone who was able to touch-type kept
this to himself and didn’t give it away to his assistant until after he
retired.
Better still: we are not only adept at word processing but have also
become practised layout designers. Anyone who has published
scientific articles in medical journals has learned that he must
“format” his texts in accordance with strict regulations. After all, the
work performed in the medical publishing houses must be reduced to
a minimum.
Figure 1.1: Cover of the second Chinese translation
And finally: today, we can transform a text into a PDF document
within seconds with just one mouse-click and then position it – once
more, within seconds and with another mouse-click – on a website.
What is left for medical publishing houses to do in this context? 20
years ago, a text was sent to the publishers and
And finally: today, we can transform a text into a PDF document
within seconds with just one mouse-click and then position it – once
more, within seconds and with another mouse-click – on a website.
What is left for medical publishing houses to do in this context? 20
years ago, a text was sent to the publishers and
Traditional publishing or self-publishing?
1. typed
2. proofread
3. typeset
4. printed
5. distributed
And today, in 2005? We type, our word-processing software typesets,
PDF prints and the Internet distributes the online version. Which
brings us to the conclusion: if proofreading is the only thing that stays
in the hands of the publishers, why don’t we just take over the whole
production process? The only problem left would be distribution,
which – as we will see later on – is a problem which can be solved for
medical textbooks, 90% of which are sold in a relatively small number
of specialised bookstores. So, let us put the question more precisely:
what do we do if we have a finished manuscript? Do we go to a
traditional publishing house or is it more beneficial to produce the
book in our own garage?
There is sometimes a sense of shame at the idea of publishing a
written text ourselves. “Self-published” or “author’s own publishing
house” gives off an aura of cheap goods, discount stores and home-
made socks from the post-war era. The argument: publishing houses
are seen as a supervisory body, and it is this supervision that awards
our texts the seal of approval, sanctifies our work, and renders sacred
our Opus urbi et orbi.
This was not true in the past – and is even less so today. In the
medical publishing houses, more and more doctors are being replaced
with economists. This may make sense within the business, but are
economists the right people for us to talk to?
Secondly, some medical publishing houses have suffered from
globalisation, philosophy of efficiency and lean production structures.
In the past, bestsellers existed to bring in enough money to help
finance books which were not highly profitable but represented a
meaningful supplement to the range. The tendency today, not
surprisingly, is to avoid having to keep any exotic types on the payroll
if at all possible, and to play safe and secure the financing of a new
title right from the start by selling part of an edition to a
pharmaceutical company.
Thirdly, and this is perhaps the saddest point for doctors: morals are
becoming rougher, the rules of courtesy are sinking into oblivion. One
1. typed
2. proofread
3. typeset
4. printed
5. distributed
And today, in 2005? We type, our word-processing software typesets,
PDF prints and the Internet distributes the online version. Which
brings us to the conclusion: if proofreading is the only thing that stays
in the hands of the publishers, why don’t we just take over the whole
production process? The only problem left would be distribution,
which – as we will see later on – is a problem which can be solved for
medical textbooks, 90% of which are sold in a relatively small number
of specialised bookstores. So, let us put the question more precisely:
what do we do if we have a finished manuscript? Do we go to a
traditional publishing house or is it more beneficial to produce the
book in our own garage?
There is sometimes a sense of shame at the idea of publishing a
written text ourselves. “Self-published” or “author’s own publishing
house” gives off an aura of cheap goods, discount stores and home-
made socks from the post-war era. The argument: publishing houses
are seen as a supervisory body, and it is this supervision that awards
our texts the seal of approval, sanctifies our work, and renders sacred
our Opus urbi et orbi.
This was not true in the past – and is even less so today. In the
medical publishing houses, more and more doctors are being replaced
with economists. This may make sense within the business, but are
economists the right people for us to talk to?
Secondly, some medical publishing houses have suffered from
globalisation, philosophy of efficiency and lean production structures.
In the past, bestsellers existed to bring in enough money to help
finance books which were not highly profitable but represented a
meaningful supplement to the range. The tendency today, not
surprisingly, is to avoid having to keep any exotic types on the payroll
if at all possible, and to play safe and secure the financing of a new
title right from the start by selling part of an edition to a
pharmaceutical company.
Thirdly, and this is perhaps the saddest point for doctors: morals are
becoming rougher, the rules of courtesy are sinking into oblivion. One
1. Flying Publisher
generation ago, old people say, courtesy and reserve ruled over any
contact between doctors and publishers. This too is a thing of the past.
In the age of rapid production, the doctor is becoming a supplier of
raw material, has to meet delivery deadlines more than ever and is
treated the way many people tend to treat delivery men: rudely.
But to come back to the point mentioned at the beginning, that
publishers are an important supervisory factor for the quality of our
texts. In principle, supervisory bodies make sense, but are publishers
the right ones for the job? Furthermore, which member of a medical
publishing house should have been allowed to decide at the beginning
of May 2003 – when even the specialists had only been aware of the
extent of the SARS epidemic for six weeks – whether it was a sensible
move to publish SARS Reference or not? Who has the right to decide
whether something written by someone who has been practising his
profession for 20 or 30 years should be published?
Back to the question: “Publisher or garage?” Two reasons essentially
speak in favour of an author’s contract with a traditional publishing
house:
1. The short-term image boost is stronger if your book is published
by an established publishing house.
2. You don’t need to bother with the marketing of the book.
The arguments that go against an author having a contract with a
traditional publisher are: as a rule, you have to cede the rights to your own text; it is seldom possible today to persuade publishers to present a free
parallel publication of the text on the internet; producing your own book can be considerably more lucrative.
Thus, the following speak in favour of publishing your medical
textbook by yourself:
1. The better long-term remuneration.
2. The better establishment of your textbook in the long-term, since
the parallel publication of a text both as a book and an internet
version is still rare today. This gives you a selective advantage
over authors who continue to publish their texts as books only.
3. And of course, most important of all: you keep hold of the power.
You never know what the future may bring. Just imagine if I had
generation ago, old people say, courtesy and reserve ruled over any
contact between doctors and publishers. This too is a thing of the past.
In the age of rapid production, the doctor is becoming a supplier of
raw material, has to meet delivery deadlines more than ever and is
treated the way many people tend to treat delivery men: rudely.
But to come back to the point mentioned at the beginning, that
publishers are an important supervisory factor for the quality of our
texts. In principle, supervisory bodies make sense, but are publishers
the right ones for the job? Furthermore, which member of a medical
publishing house should have been allowed to decide at the beginning
of May 2003 – when even the specialists had only been aware of the
extent of the SARS epidemic for six weeks – whether it was a sensible
move to publish SARS Reference or not? Who has the right to decide
whether something written by someone who has been practising his
profession for 20 or 30 years should be published?
Back to the question: “Publisher or garage?” Two reasons essentially
speak in favour of an author’s contract with a traditional publishing
house:
1. The short-term image boost is stronger if your book is published
by an established publishing house.
2. You don’t need to bother with the marketing of the book.
The arguments that go against an author having a contract with a
traditional publisher are: as a rule, you have to cede the rights to your own text; it is seldom possible today to persuade publishers to present a free
parallel publication of the text on the internet; producing your own book can be considerably more lucrative.
Thus, the following speak in favour of publishing your medical
textbook by yourself:
1. The better long-term remuneration.
2. The better establishment of your textbook in the long-term, since
the parallel publication of a text both as a book and an internet
version is still rare today. This gives you a selective advantage
over authors who continue to publish their texts as books only.
3. And of course, most important of all: you keep hold of the power.
You never know what the future may bring. Just imagine if I had
What is financially feasible?
ceded the rights to AIDS 1991 to a publishing house in 1990. 5
years later, the internet comes up with possibilities we had no
way of anticipating. But the rights are gone, my hands are tied.
There would have been no HIV.NET, no Amedeo, no Flying
Publisher – all because of one bad decision.
We therefore advise all colleagues to produce and market their
textbooks themselves.
What is financially feasible?
The final price of a book, i.e. the price paid by the purchaser in a
bookshop, is essentially made up of the items printed, distribution and
profit.
1. Print: the share that print costs have in the retail price depends on
the size of circulation and the price. At a fair price (e.g. HIV
Medicine 2005: 50 Euro for 800 pages), at a circulation of 500
copies, the printing costs amount to 14 Euro per copy, or 28% of
the retail price, for 1000 copies 10 Euro, or 20%, and for 2000
copies 6.75 Euro, or 13.5%.
2. Distribution: the share of distribution costs amounts to
approximately 45% of the retail price. This percentage is
irrespective of the distribution channels (book wholesaler,
sponsors).
3. Profit: depending on circulation, profit is somewhere between 27
(100% - 45% - 28%) and more than 40% (100% - 45% - 13.5%).
27 to 40% are considerably higher than the authors’ royalties, which
are generally between 6 and 10% of the retail price.
Figure 1.2 illustrates how cash flows when the authors (A) have ceded
their rights to a traditional publisher. The future reader (R) goes into a
bookshop (B) and pays the retail price (yellow arrow). The bookseller
or wholesaler pays the publishing house (X) after deducting a sales
margin of 30 to 45%. The publisher has previously transferred
payment for the printing costs to the print shop (P) and pays the
authors off over several months or years.
ceded the rights to AIDS 1991 to a publishing house in 1990. 5
years later, the internet comes up with possibilities we had no
way of anticipating. But the rights are gone, my hands are tied.
There would have been no HIV.NET, no Amedeo, no Flying
Publisher – all because of one bad decision.
We therefore advise all colleagues to produce and market their
textbooks themselves.
What is financially feasible?
The final price of a book, i.e. the price paid by the purchaser in a
bookshop, is essentially made up of the items printed, distribution and
profit.
1. Print: the share that print costs have in the retail price depends on
the size of circulation and the price. At a fair price (e.g. HIV
Medicine 2005: 50 Euro for 800 pages), at a circulation of 500
copies, the printing costs amount to 14 Euro per copy, or 28% of
the retail price, for 1000 copies 10 Euro, or 20%, and for 2000
copies 6.75 Euro, or 13.5%.
2. Distribution: the share of distribution costs amounts to
approximately 45% of the retail price. This percentage is
irrespective of the distribution channels (book wholesaler,
sponsors).
3. Profit: depending on circulation, profit is somewhere between 27
(100% - 45% - 28%) and more than 40% (100% - 45% - 13.5%).
27 to 40% are considerably higher than the authors’ royalties, which
are generally between 6 and 10% of the retail price.
Figure 1.2 illustrates how cash flows when the authors (A) have ceded
their rights to a traditional publisher. The future reader (R) goes into a
bookshop (B) and pays the retail price (yellow arrow). The bookseller
or wholesaler pays the publishing house (X) after deducting a sales
margin of 30 to 45%. The publisher has previously transferred
payment for the printing costs to the print shop (P) and pays the
authors off over several months or years.
Figure 1.2: Book production is outsourced to a traditional publishing house.
Example for an impression of 1000 books. The thickness of the yellow arrows
reflects the volume of money which flows.
The circumstances in Figure 1.3 are simpler, and more beneficial for
the author.
The publishers are out of the game and the authors market the books
directly through the most important specialised medical bookshops.
The future reader (R) goes into the bookstore (B), pays the retail price,
and the bookseller remits 70% of this to the authors (A). The authors
have previously transferred payment of the printing costs to the print
shop (P).
Example for an impression of 1000 books. The thickness of the yellow arrows
reflects the volume of money which flows.
The circumstances in Figure 1.3 are simpler, and more beneficial for
the author.
The publishers are out of the game and the authors market the books
directly through the most important specialised medical bookshops.
The future reader (R) goes into the bookstore (B), pays the retail price,
and the bookseller remits 70% of this to the authors (A). The authors
have previously transferred payment of the printing costs to the print
shop (P).
Figure 1.3: Book production with the author as publisher. Example for a
circulation of 1000 books. The thickness of the yellow arrows reflects the
volume of money which flows.
The circumstances in Figure 1.4 are even simpler than this. In this
diagram, we have replaced the bookstore with a sponsor, such as a
foundation (S). The sponsor pays the authors for the discounted books,
and the authors in turn pay the printer (P). The reader (R) generally
receives the books free of charge and is grateful (blue arrow).
circulation of 1000 books. The thickness of the yellow arrows reflects the
volume of money which flows.
The circumstances in Figure 1.4 are even simpler than this. In this
diagram, we have replaced the bookstore with a sponsor, such as a
foundation (S). The sponsor pays the authors for the discounted books,
and the authors in turn pay the printer (P). The reader (R) generally
receives the books free of charge and is grateful (blue arrow).
Figure 1.4: Book production with the author as publisher. One or more sponsors
have taken on a circulation of 1000 books and give the books away to doctors
who are interested. The thickness of the yellow arrows reflects the volume of
money which flows. Blue arrow: gratitude
In chapters 2 and 4 we go on to develop the thoroughly fascinating
subject of financing and we will see that it is by no means ruinous to
manufacture and market books. We also investigate the sales figures
needed to make book production financially interesting. You already
know that profits from book production can be two to six times higher
than an author’s royalties.
100 Projects
We would like the most important medical fields to be covered in
freely available textbooks on the internet by the year 2010.
Medicine is not an unlimited area. The most important subjects can be
covered in 100 textbooks. 100 doctors are wanted. 100 doctors can
have taken on a circulation of 1000 books and give the books away to doctors
who are interested. The thickness of the yellow arrows reflects the volume of
money which flows. Blue arrow: gratitude
In chapters 2 and 4 we go on to develop the thoroughly fascinating
subject of financing and we will see that it is by no means ruinous to
manufacture and market books. We also investigate the sales figures
needed to make book production financially interesting. You already
know that profits from book production can be two to six times higher
than an author’s royalties.
100 Projects
We would like the most important medical fields to be covered in
freely available textbooks on the internet by the year 2010.
Medicine is not an unlimited area. The most important subjects can be
covered in 100 textbooks. 100 doctors are wanted. 100 doctors can
make the decision that up-to-date medical information will be
available free of charge. 100 doctors who, because they have their ears
to the ground, can use their project to push aside all comparable texts
which exist in book form only. We need 100 clever, dedicated and far
sighted doctors. 100 doctors to revolutionise access to information.
Whoever starts running now might be first past the post, and whoeve
gets established first will have a head start which will make it hard fo
competitors to catch up. And that is only the beginning. If you keep
your copyright, you are your own master and can enjoy previously
undreamed of liberties. This freedom makes things possible which
would have been considered utopian just a few years ago. Copyrigh
removal is one of the magic words you have come across in
connection with HIVMedicine.com and SARSReference.com. Just say
the word, and your texts will emerge in half a dozen differen
languages.
Summary
What have you learned from this chapter? And what should you stil
remember tomorrow? That depends on whether you are an editor, an
author, a doctor, a student or an interested bystander.
available free of charge. 100 doctors who, because they have their ears
to the ground, can use their project to push aside all comparable texts
which exist in book form only. We need 100 clever, dedicated and far
sighted doctors. 100 doctors to revolutionise access to information.
Whoever starts running now might be first past the post, and whoeve
gets established first will have a head start which will make it hard fo
competitors to catch up. And that is only the beginning. If you keep
your copyright, you are your own master and can enjoy previously
undreamed of liberties. This freedom makes things possible which
would have been considered utopian just a few years ago. Copyrigh
removal is one of the magic words you have come across in
connection with HIVMedicine.com and SARSReference.com. Just say
the word, and your texts will emerge in half a dozen differen
languages.
Summary
What have you learned from this chapter? And what should you stil
remember tomorrow? That depends on whether you are an editor, an
author, a doctor, a student or an interested bystander.
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