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Issues in Science and Technology Librarianship
Summer 2005

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To Print or Not to Print Medical Textbooks: Is That the Question?

Barbara Amelia Nace
Manager, Electronic Publications, The Merck Manuals
Merck & Co., Inc.
Blue Bell, PA 19422

For at least the last decade, the publishing industry has discussed and debated the concept of publishing. Is a published product a physical item found on a bookshelf, or is it a virtual item existing on a server in cyberspace? Is it both?

Much of the discussion has centered around journals, little around textbooks. Journals and textbooks have different focuses: textbooks present a community's best practices, that which has been deemed the gold standard. Journals are forums for the latest and greatest and the cutting edge. The organization of the two differ: textbooks are organized around a central focus; journals are (usually) not topic specific. Textbooks are typically presented hierarchically in sections and chapters; journals are often divided into departments.

What is happening in traditional print publishing of medical textbooks? Readers are seeking out other formats for such information. Why? One reason may be that textbooks are often out of date by the time they go to print. (Producing a textbook can require years for the editorial process; it is not unusual for printing and binding to take months.) Other reasons may concern portability and accessibility of textbooks.

What are readers requiring? They certainly want information that's up to date. They want information in easily accessible formats. They want to be able to find such information quickly. They also often want information illustrated with sound, animation, and videos. These requirements may be satisfied by electronic publications.

What is happening in electronic publishing of medical textbooks? More and more medical textbooks are online. Some are published in both print and online versions; some are strictly an online product. Some are free to everyone; some are restricted to subscription holders and are quite expensive. Some are published in other electronic formats, such as on CD-ROMs, for PDAs, and for small web-enabled devices.

Publishers may be recognizing that readers want more than a print product and are even willing to pay for it. In fact, some years ago, a Wall Street analyst speculated that "as online readership increases in the next few years, print readership will contract." The analyst also stated that professional and scientific publications are leading the way to new forms of publishing because their readers are demanding information in a more timely manner (Reimers 2000). An ISTL author made similar points in a recent review of an encyclopedia (Flaxbart 2004).

Print and electronic publications are indeed different, yet they both serve a need for readers. Readers who want to browse a topic large or small most likely prefer to do that in a printed textbook. Readers who want specific information, who want it now, and who don't own a print version of a medical textbook may choose an electronic version. (In fact, online readers may not even begin their search in the textbook itself, but rather come directly to what they're looking for through a search engine like Google.) For example, readers who want to read as much as possible about the biology of the thyroid gland and disorders affecting it will likely prefer the print version. On the other hand, readers who want only information on thyroid cancer may not care about the thyroid gland's relationship to the pituitary gland or want to know about thyroiditis; these are the readers who will appreciate an electronic version that speedily delivers their topic of interest.

What would a new model for publishing medical textbooks look like? Consider the concept of a "bound" and an "unbound" book. Consider a print version (the "bound" book) with the traditional hierarchical organization (sections and chapters) and an electronic version (the "unbound" book) of the same book that is not simply a reproduction of its print form, but rather is organized for easy access to information, unbound from a section/chapter structure.

Does the advent of electronic publishing predict the demise of print? Not likely, at least not in the near future. However, electronic publishing offers the possibility of a continuum -- a process rather than an event. Editions then become history, and currency becomes the future.

Flaxbart, D. 2004. Death of an Encyclopedia Salesman? The Fate of Science Reference Resources in the Digital Age. Issues in Science and Technology Librarianship 40. [Online]. Available: [Accessed August 9, 2005].

Reimers, BD. 2000. New technologies transform publishing industry. Information Week Online (March 27). [Online]. Available: {}. [Accessed August 9, 2005].

A note about the author:
BAN is a full-time employee of Merck & Co., Inc., the pharmaceutical company that publishes The Merck Manuals.

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