Textbooks are everywhere in medicine. They are heavily used at all stages within a medical career and the range of textbooks is massive. A quick glance at any medical library will show healthcare professionals of all ages and modalities deep in textbooks.

With the introduction of the iPhone, iPad and Android systems, there is a new medium for publishers to target. It is a natural progression for textbooks to adapt to and make use of this new expanding market and a number of developers such as Modality Inc, MedHand Mobile Libraries and Skyscape have launched themselves into porting hundreds of books to iOS.

It is interesting to examine this process and see how successful it really is. Initial thoughts are highly positive as having reference books in app form allows many to be carried around at once. This instantly gives physicians easy access to a massive range of information which inherently carries its own problems.

Which source of information is correct if there is a difference in opinion? Before the advent of electronic textbooks, junior doctors often only carried around one reference handbook and used that each time. Nowadays, specialist textbooks are easily accessible and so doctors run the risk of information overload.

The actual act of converting textbooks to electronic format has been highly successful. Textbooks can be easily searched and topics are hyperlinked so it is easy to gain a detailed understanding of a particular procedure or disease process in a short period of time. There are also companies like Inkling, who are making waves by making textbooks interactive.

However there are some key questions that need to be asked of electronic textbooks;

  • why are there limits on the depth of information contained within?
  • why are the prices often more expensive than their paper counterpart?

The first question is related to the fact that these apps are based on real life books which have to be of a finite size to be practical. However, this constraint does not apply to electronic textbooks. Electronic pages do not weigh anything and so it is inconceivable why some textbooks do not contain enough detail. Surely the authors are pushing to get more detail into their books?

The second question is relevant to the survival of medical handbook apps. For companies such as MedHand and Modality to continue porting books to iOS, they must ensure they make a profit doing so. However with Apple taking a 30% cut of app store sales, the price of these apps is often inflated to a point where the paper version is cheaper. There are obvious pros and cons to owning a paper copy of a book but many healthcare professionals will often opt for the cheaper option – particularly when the content is identical.

I don’t have access to sales numbers for reference textbook apps but I would be willing to bet that these sales would drastically increase if the prices were reduced. That is not to say the content contained within is not worth the current price of the app but to say that the app store economy is such that cheaper is often better. In a world where an ‘expensive’ app is $10, who is willing to pay $100 or $80 for a handbook on a specific topic?

Maybe in time, we will see a move to freemium apps where the core content is free and extra chapters/detail can be purchased as an in-app purchase. Inkling has already started this by allowing users to purchase individual chapters rather than whole books.

An alternative (and equally interesting idea) would be for a publisher to develop the first ‘proper’ electronic textbook. Ideally this would be an app which combined a wide range of reference handbook apps together to form a single app which could contain the deepest, darkest, depths of modern medicine.

The closest we have to this so far is UpToDate which we reviewed earlier this month. This knowledge source could even be combined with a Jeopardy style AI which suggests diagnoses and treatment options. This is certainly some way off but an interesting idea which could revolutionize modern medical practice.

Overall the introduction of electronic textbooks has been highly successful. The ability to carry around a mobile library on a pocket sized device is a fairly impressive technological achievement. In addition, the ability to have a well referenced handbook accessible and available at any time is very attractive. It will be interesting to see how this section of the textbook market grows as the number of smart devices increases. For this market to remain successful, publishers and developers alike are going to have to work hard to adapt their texts and marketing strategies to current economic conditions.

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