In late June, Doody Consulting held a Luncheon of Gratitude for Chicago-area clients and friends from the 15 years Dan Doody and I have worked as a consulting practice. In addition to thanking these people for their support, the occasion offered a chance for me reflect on my 48 years in medical publishing. The title of the talk was “Where We’ve Been, Where We Are, and Where We’re Going”.  This post, the third of three adapted from that talk, is a reminder of the impact that digital technologies have had on medical publishing.

To a significant degree, books are being replaced by born-digital products. By far the most successful of these is UpToDate, which is the go-to digital reference for virtually all younger physicians in internal medicine and its subspecialties. It even has traction among older docs – my 77-year-old general internist swears by it. Even societies are getting into the born-digital textbook game – for instance, American Pediatric Surgical Association is developing its so-called Pediatric Surgery NaT (Not a Textbook) explicitly to displace the couple of very expensive, very cumbersome print textbooks in pediatric surgery – which, thanks to mergers, are both published by Elsevier. It’s worth noting that UpToDate, NaT, and other well-regarded, born-digital products were conceived and started as businesses by physicians, not by publishing companies.

Digitization of content is most apparent in the journals world, which became fully digital in the early 2000s. This has facilitated the relentless growth in the quantity of published research and the number of journal titles, has made Open Access possible, and has enabled unscrupulous operators to create predatory journals. A concern for journal publishers, however, is that the identity of journals is breaking down. Most users find articles through search rather than browsing the journal’s homepage. By the way, do you notice that we now talk about users rather than readers?

At first, the digitization of books moved more slowly than it did for journals, but at this point it’s far along. Most health science books are available digitally, and when used digitally they often lose their identities, just as journals do. However, the best-known books, just like the most prestigious journals, still retain their identities. I know that Doody’s Core Titles is still an important tool for medical librarians, which means that the individual book still means something to some readers.

Whatever the challenges, the giants in scientific, technical, and medical publishing still make enormous profits from their journals. I wonder how long this will last. The economist Herbert Stein said in 1976, “If something cannot go on forever, it will stop.” There may be harbingers of the end: When the University of California system, one of the great research and scholarly institutions in the world, decides it isn’t going to pay for access to Elsevier content, that certainly foreshadows something.

Digital technologies are complicated. Sure, the old printing presses were complicated, but they were machines — you could see how they work, and you could sometimes even tinker with them. When you look at a digital platform, you see (if you’re allowed) thousands and thousands of lines of code, and it takes a lot more than one guy with a wrench to tweak code. This means that publishers no longer own their publishing tools – instead, they partner with technology vendors.