Books in medicine: is the juice worth the squeeze?

By: Madhukar Pai

Published on 28, February, 2018

Don't get me wrong. I enjoy good books. In my academic career, I have done my share of editing books and contributing chapters to textbooks. I know it is a big deal in some fields to publish books and careers get decided by books. But for those of us working in medicine or public health, are books and book chapters worth the effort? Is the juice worth the squeeze??

Based on my experience of contributing over a dozen book chapters, and serving as an Associate Editor of one textbook, my answer is no. I can give you half a dozen good reasons.

My first concern is timelines. Traditional book publishing is still in the dark ages as far as timelines go! By the time a book comes out in print, the content is already dated, by at least 2 – 3 years, if not more! I recently contributed to the third edition of Textbook of Pleural Diseases, by CRC Press, and it took 3 years for the book to be published, from the time I submitted my chapter! Hang on, it can get worse! I contributed to a Handbook of Global Tuberculosis Control, published by Springer. I was first invited to contribute in 2010. The book was published in 2017! When I read my chapter, I can see that it is dated.

A delay of 2 – 5 years might not matter in some fields (e.g. anthropology or history or statistical methods), but it matters in medicine and science! And it matters for early career researchers who need to show productivity. So, given the long timelines of book publishing, I ask myself – can I not submit the same book chapter to an e-journal and get it published in a matter of weeks, instead of waiting for years for the book to come out? Electronic medical journals today are doing a great job of reducing publication delays, and many are open access, giving instant access to anyone who wants to read the content. Of course, e-books and self-publishing are other ways to overcome the problem of traditional publishing. I have done that - see my free, online book on TB for GPs. But academics still cling to the old-fashioned idea of a hardback book on the bookstore shelf. Self-publishing will raise many an academic eye brow!

Affordability is my second concern. When the Handbook of Global Tuberculosis Control finally saw the light of day, I was stunned to see the final sticker price - $299! As an author, even I cannot afford my book! And I seriously doubt any tuberculosis researcher or student can afford this price. So, I ask myself – why did I volunteer my time to write something that is completely unaffordable?

When the editors contacted me, they never mentioned anything about pricing of the book, and I never asked. Maybe I should have. But then we know traditional publishers enjoy staggering profit margins and are never transparent about pricing. Indeed, they never make any guarantees, even to editors and authors, about affordability of the final product. As academics, we generally tend to stay out of pricing and issues relating to affordability, since we don’t understand the business model. But we should care – if we want our work to be read! What is the point in spending a year writing a book, only to discover that it costs $300 per copy?

That brings me to the next concern – access. Given the outrageous pricing structures and lack of an open access culture with traditional book publishers, I wonder is anyone reads my books and chapters? I never get any data from my publishers on how many copies were sold. But I have a bad feeling that very few people read my books. Libraries in rich countries might buy these medical books, but who is using libraries these days? I also worry that those who really need my book can never get hold of it. In my case, this is a big issue for me, since I work on tuberculosis, a disease that primarily affects people in low and middle income countries.

What about getting paid for our contributions and time? Well, the quick answer is authors (even editors) of book chapters generally get nothing! I suppose we are expected to do this as part of our ‘scholarly service’ to the community. I served as an Associate Editor of Tuberculosis -  A comprehensive clinical reference by Saunders/Elsevier. I put in a lot of time into this, over a 3-year period. Did not get paid, and did not ask for it. The only publisher that has compensated me for my contributions is UpToDate, owned by Wolters Kluwer. But UpToDate keeps me busy by asking me to update my chapter periodically.

Will we get paid with free copies? All authors love to get copies to give away to others (and we secretly hope our avid readers will ask for our autographs!). Generally, medical publishers will send you 1 hard copy of the book. That’s it! Sometimes we have to chase them to get even 1 free copy! Some publishers are so cheap, they don’t even send free book copies to all authors who contributed! I co-authored a chapter for a book called Essentials of Tuberculosis in Children by Jaypee, and they never sent me a copy, despite my request! Apparently, I did not qualify, since I was not the first author of the book chapter. Another publisher asked me to pay to publish in their e-book! It's bonkers!

Do books matter for tenure and promotions? I have been through the tenure process, and I have also served on tenure committees. In medicine, peer-reviewed publications matter much more for tenure and promotion, than books and book chapters which are not seen as ‘peer-reviewed’ and generally don't get cited much. My work is well cited and the H-index is not shabby, but none of my highly cited work are from books.

When I review tenure dossiers, I rarely look at the section on books! So, I seriously doubt if any of my book contributions had the slightest impact on my own tenure and promotions. As I mentioned earlier, I realize this is different in social sciences and arts, where books might be critical for tenure.

In summary, my experience tells me that books take a lot of time and effort that is not compensated, they are rarely read, they cost a lot, and they don’t matter much for tenure and promotion in medicine. There are much better, faster and easier ways to get our work out. But my colleagues in medicine may have had better experiences.

But here’s the kicker – although I am convinced the juice is not worth the squeeze, I continue to accept invitations to author book chapters! I suspect I am not alone. Like me, most academics in medicine will continue to waste their time on books and chapters. Hey, we are academics. We are vain, and have big egos. And we love to see our names in print and sign autographs! 


If we really must contribute to books, I think we should:

1) Ask the editors and publishers about timelines and hold them accountable to reasonable timelines

2) Ask that we be compensated in some way - money, free book copies (hard as well as e-book versions), discounts on other books, etc.

3) Ask publishers and editors about the final sticker price and have a say in pricing.

4) Demand faster dissemination electronically, even if the print version will take time.

This article was originally published on Nature Research Microbiology and has been republished here with permission.