Who Owns the Content? The Future of Medical Publishing.


Education is one of MedCrunch’s favorite topics. These are great times to talk about education. The internet and mobile devices have liberated knowledge and democratized its distribution. Up until now, medical knowledge was owned or distributed by several entities: the experts who produce it, the universities, the publishers and the various medical societies. Moreover, the pharmaceutical industry also has a major stake at educating physicians. In most countries, the majority of CME education is sponsored by pharma with educational sessions serving to enhance the pharma-physician relationship. However, this landscape is about to change and this is good news for the customer – we think.

Let’s examine some reasons why we think that the game of learning is changing. Just look at the publishing industry. These large brick and mortar companies are facing the same risks as the music industry back in the 1990’s. Books are becoming digital, someone will eventually figure out how to share them with others. The natural impulse in our opinion would be to make digital books inexpensive and very easy to download and share on social media; the reduced product margin could be compensated by an increase in copies sold. However, publishers seem to head the opposite direction: they are selling us their e-books at 12-30$ – a price way above the perceived value for something that takes 20 seconds to download, has no major production costs associated with it and whose content is essentially locked inside the device.

Suppose you were an expert in some clinical arena and you wanted to write a book together with a major publisher. Should your book proposal be accepted by the publisher, odds are that you won’t make a lot of money with it. Most of the revenue will go to the publishing company. You will be left with honor and reputation. “What are they getting the money for?” you ask. They get it for editing, production and distribution. With the distribution part being their major asset in the olden days. However, times have changed. You can easily find a freelance editor on Elance, read about self publishing on Quora and distribute your book through your blog or social media outlets. There is a lot of information on book publishing out there and if you made it through medical school or university, you would have no problem to run through this process as well. Your profit margin per book will be much higher than with a major publisher and you will have to sell way fewer copies to make the same amount.

Another major shift in the field of postgradual medical education is triggered by a massive tectonic shift in the pharmaceutical industry. Over the next two years, more than 20 major block-busters are running off patent (so-called patent cliff). A cumulative revenue of 104 billion $ will be gone, over 60,000 international sales reps will be sacked and the way pharma marketing is done will have to change for good. This shift primarily impacts the medical societies with their scientific meetings – a multimillion dollar industry: leading to empty exhibition halls and fewer sponsorships of doctors. The result: cluelessness. Too many stakeholders are involved in these societies to come up with an innovative solution to their problem.

What to make out of all this? It is pretty obvious that the current “owners” of medical knowledge are in a fundamental crisis. This will be a huge opportunity for people and companies innovating in the knowledge arena. Companies like Widescript and The Domino Project will revolutionize publishing. Experts will produce their own e-learning materials, webinars, podcasts or videos. Books will be “freed”, sharable and viral. The connectors and innovators will win and best of all: knowledge will spread like wildfire. We are very excited – hopefully you are too.


  1. Well put.

    I too noticed the irony:  Medical publishers are now in the business of keeping information from the public – the precise opposite of distribution.  Unless you shell out $35 for the article you’ve been baited on, you’re stopped cold by the un-publishing companies. These companies face an ever-greater challenge in proving their value to both readers and the academics producing content.

     I’ll watch with curiosity to see who or what replaces Elsevier.  (Meanwhile they better get Lars Ulrich on retainer.) Will the digital version be something organic, like file-sharing? A start-up?  iTunes?  Widescript and Domino look pretty cool – can they woo the academics?  The format change must come with the assurance that peer-review quality won’t suffer – there is some strong branding in those old paper journals.  That’s a difference from the record-industry analogy, in fact. Any listener knows when he/she likes a song, so the brand (Epic, Virgin, etc.) is hardly relevant. However, most readers of journals judge the quality of the content not on p-value, but on the reputation of the journal.

    As my start-up, OnSurg, grows, we’ll be trying various models of getting quality content to our users. Check us out – http://onsurg.com

    I dig your site – very clean design and thought-provoking content.

  2. I totally agree with you Chris. We judge the quality of a paper partly on the basis what journal it was published in. However if you are a surgeon and want to write a book on it, the peer-review process is much less important. A colleague for proof reading and an editor will do. The point we are trying to make is that there will soon be no need for a middle man like a publisher for publications like that. Research and new findings are a different point in case. I looked at your site onsurg.com and I really like it. We should talk about how we can help you get traction.


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