Books and book chapters in medicine: is the juice worth the squeeze?

In my academic career, I have done my share of editing books and contributing chapters to textbooks. But for those of us working in medicine or public health, are books and book chapters worth the effort? I don't think so.
Books and book chapters in medicine: is the juice worth the squeeze?

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.

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Go to the profile of Niels Peter Thomas
almost 6 years ago

Dear Madhukar,

In the interest of transparency: I work for Springer Nature, the publisher of one of your books. Thank you for your post. While I understand your arguments, I do believe we have already found solutions for the most important issues that you raise, and we are continuing to work on improving the book, be it in print or electronic. 

Books are an interesting topic, also from a scientific perspective. They are much more diverse than journal articles, and the reasons why researchers write books or contribute to them, or the reasons why readers read them differ very much from each other. Books have also seen a lot of change in the last couple of years. We have new business models that we didn’t know ten years ago, we have open access books, we have daily electronic updates in reference books, just to mention a few. I believe the changes will be even more fundamental in the near future, but let me come to that a bit later. 

You mention the unfavorable timeliness of books. I totally agree that it is not acceptable if an author contributes to a large handbook which will only be published many years later. We have introduced for large reference works (where there is a very large group of contributors with a high likelihood of delays) the possibility of publishing the early contributions in a “living” reference book online. Later, the book can be updated on a daily basis, either with additional chapters, or with updates for existing ones if a chapter gets outdated. Once a final stage is reached, the book is of course available in print as well as in electronic form. We therefore can combine the speed of a journal with the concept of a self-contained reference book.

Then, you are concerned about the affordability of books, and, related to it, accessibility. The books you mentioned are typically bought by institutions, not by individuals. Institutions to a large extent buy our books as eBook collections, and therefore pay a much lesser price per individual title as the “retail” price for a print book. These eBook collections also allow us to charge different prices for the same eBook collection depending on the buyer institution. Your wish that smaller, less wealthy institutions pay less for the book is already reality. Accessibility of these books for researchers in Africa and Asia is much higher today than it ever was (and in many cases accessibility is higher for certain books than for journals, because a library with scarce resources will not easily commit to long-term subscriptions of all journals of interest).

Additionally, we offer now the possibility to publish books in an open access business model, very similar to how it works in the journal world. Funders are more and more supportive for OA books, so I believe we will see much more of them in the near future. 

When it comes to usage and impact data, at least Springer Nature is very transparent. Please check out for all of our books and book chapters. You will find data how often the book was downloaded, cited, tweeted about, mentioned in other social media, mentioned in the news and many more indicators. Your Springer handbook was just published this June, and therefore could not collect any citations yet, but by browsing the database you may find out that books are actually much more used, downloaded, and cited than you probably thought. And this usage is brought in by libraries who subscribe the eBook collections that are used by millions of researchers and students all over the world – even if they are not aware that the book they are using online was bought by their library.

Don’t get me wrong. I will definitely not advocate that everything should be published as a book. I totally agree that some chapters would benefit from being published as journal articles. I also agree that authors should not work with a publisher who requires payments as a precondition to accept a book manuscript. But books still are the publication of choice if you want global accessibility & usage, long shelf life, self-containedness, and individuality. At least if publishers continue to develop books further, integrate print & electronic books, find appropriate and affordable business models for individuals and libraries, and continue to make full use of technology.

But if we do so, I would also like to see that books one day will count for tenure or promotions. Once we publishers make the societal and scientific impact of books transparent and comparable to a journal article, it should make a difference if you are a successful book author or not! Would you agree?

You say you enjoy good books, I do as well. Let’s then identify and reduce the flaws in books together and make books better. If you want to discuss further, I am happy to go more into detail.

Best regards


Dr Niels Peter Thomas

Chief Book Strategist, Springer Nature

Go to the profile of Madhukar Pai
almost 6 years ago

Hi Niels

Thanks a lot for the detailed and helpful response to my concerns about the medical book publishing business. Springer Nature is a major publisher and I am glad that you are listening to your author/user base!

When I shared my post via this blog, social media and email, I received a large number of responses, nearly all agreeing with my post. Many colleagues in medicine had similar stories to share! Clearly, I had articulated what everyone already knew and perceived.

This response from a Dean of a top-ranked medical school summarizes things nicely: 

"I have been saying things like this for years but never so clearly.  The age of the codex as a means of specialized communication in medicine and science is over.  It’s time that everyone accepted this and stopped providing fodder for a part of the publishing industry that primarily serves the owners of the publishing houses."

I am glad to hear that you are worried about the concerns that I have raised and are actively working to fix them. They will definitely improve the current situation, but a growing number of academics in medicine now think that the medical book/journal publishing business primarily benefits publishers, while much of the hard work is done by researchers, editors and reviewers (who are largely not compensated) who are mostly supported by public funds, while public access remains limited. So, I hope your strategy will address this erosion of trust in the current publishing model.


Madhukar Pai, MD, PhD
Canada Research Chair in Epidemiology & Global Health
Director, McGill Global Health Programs
Associate Director, McGill International TB Centre
McGill University, Montreal