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1. Doctor = Publisher

2. One hundred doctors

3. Train on the track

4. Behind the scenes

5. Home stretch

6. Playground

7. The seventh day

8. Appendix

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since 13 May 2005


2. One hundred doctors
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No.1 vs. mediocrity - Fart in a teacup - Commitment - Schedule - Structuring - Internet supplement - Language - Editorial team - Mentor - Time frame - Deadline - Team of authors - Budget

The decision has been made. You intend to take on one of the 100 important medical topics and contribute to the task of making medical information available without restriction and free of charge. As you know, if your book project is well-organised, it can be completed in 9 months, 12 at the most.

Before you begin to structure your topic and put together the group of authors, here are a few brief comments concerning your own personal qualifications.

Personal qualifications

Firstly: in order to write a medical book, you need expertise (Table 2.1) and time (Table 2.2).

Secondly: you can't write a clinical Flying Publisher textbook all by yourself. Standard textbooks are joint efforts. You should therefore know enough experienced colleagues who can take on a chapter of your project and deal with it competently. This assumes that you know your way around the national scene. This requirement can usually only be fulfilled if you come from a university institute or one of the big teaching hospitals.

The time factor needs to be considered. Getting a textbook on track - i.e. writing the first edition - is not for the faint-hearted. A rule of thumb is: most texts are produced between 9 p.m. and 2 a.m., and evolve at the expense of family and friends. This means that at least a minimum level of enthusiasm is necessary. Sometimes, the thought that the sacrifice is only temporary and the subsequent editions will require considerably less work can help. In addition, youth is an advantage. The fifth decade should be exactly right. You push the project through and then say "never again!", because that's life. Some things you only do once, but once they are done, they are done. Think of Andy Warhol: "It's work, the most important thing is work."

Table 2.1: Expertise

You should

  • be 40 to 50 years old
  • have reason to believe that other people will listen to you
  • be prepared to update texts regularly
  • be creative
  • be persevering
  • be generous

Table 2.2: Time

You will need for

  • the first edition: 9 to 12 months
  • the second edition: about a third to a quarter of this time
  • proof-reading: days to weeks
  • co-ordination: 100 to 200 hours
  • the internet version: a day for the PDF document, two weeks for the HTML version
  • marketing: hours (PDF) to weeks (book)

If the basic conditions are favourable, you can begin planning the project. Set aside a month for this task. But first, here are two thoughts which will help you to avoid wasting time:

  • Your should only write if your book can become the No. 1. There are as many mediocre books out there as there are rats in the sewers of Paris. It is a waste of resources to write yet another mediocre book, which no-one will even notice and which will not be remembered later.
  • Medicine is in flux. Anyone who writes medical textbooks should be prepared to have to make a number of editions over the years. Annual updates are ideal. Don't forget: writing only one edition of a textbook is as if it had never been written at all (vulg.: fart in a teacup).

Are you still on board? Good. Then lay down the keel of the project. The following items have to be taken into consideration:

  • Contents and structuring
  • Internet supplement
  • Spelling
  • Language
  • Editorial team
  • Timeframe
  • Deadline
  • Budget
  • Team of authors

Contents and structuring

A lot has been written in the past, and anyone who writes wants to do it better. What evolves does not do so in a vacuum but builds on proven material. You are not building a castle like Neuschwanstein, but are being permitted to add a few bricks to existing walls. Thus you should:

  • Obtain the existing standard textbooks and analyse them carefully. Every book has its own strengths. Identify them and distil the best ideas. The synthesis of the best existing ideas plus your own new ones are the backbone of your project.
  • Structure the material and draft the working titles of the individual chapters.
  • With clinically orientated topics, plan a chapter for "drug profiles". The evaluation of drugs can change from year to year. The readers will appreciate finding up-to-date assessments.
  • Decide which chapters are essential for the first edition and which can wait until the second edition. There's no need to put everything you have in the first edition. The readers really appreciate it if work is done between the editions and the subsequent editions have new chapters.
  • Make sure the book is innovative and related to practice.
  • Plan the volume of the book. Most standard textbooks have 500 pages and more.
  • Define the length of the individual chapters. You, the editor, plan the whole "work of art" and have to balance out the individual chapters. Some authors provide twice as many pages as agreed without thinking about it. Don't go along with this.

A Word document with most of the elements which make up a book (Credits, List of collaborators, Contents, Tables, Charts, Index) can be found on the internet under www.HIVMedicine.com/textbook.doc Download it onto your hard disk and change the title page, credits, foreword and list of collaborators.

Internet supplement

With regard to the planned internet publication, the following points must be taken into consideration:

  • Diagrams should be designed in colour. They then appear in their original form on the internet, whereas for economic reasons, they are usually printed in black and white in the book.
  • A text can have supplementary chapters in the internet version which don't appear in the book. The reason: additional pages in a book increase the printing costs, while additional pages on the internet barely incur any costs.
  • For the same reason, you should spend some of the initial planning stage thinking about whether you wish to supplement individual chapters on the internet with photos. As before, barely any additional costs are incurred, since the disk space which is made available by the provider contracts is usually large enough. Therefore, you should ask your co-authors if they have the time and the inclination to work on an illustrated book for publication on the internet only.


If English is your mother tongue, you write and publish in English. If not, as a rule, you should first write the text in your mother tongue. If you happen to have the available capacity and/or uncommitted items in your budget, you should also plan an English version in the mid-term. The reason: a text that goes around the world has 10 to 100 times as many readers as a text that does not exist in English.

Furthermore, you can only remove the copyright for other languages if you translate your text into English. It is usually not sufficient to remove the copyright in the native language alone - you are then considerably restricting the circle of possible translators. Therefore, the road to multilingualism leads via the English version.

The editorial team


The editors structure the material, define the chapters and choose the authors. As soon as the authors have supplied their texts, the editors review the contents, discuss any questions not yet clarified and send the chapter to be proof-read.

This all sounds very easy - but it isn't.

The number of doctors who only write moderately well is higher than you would think. This is not surprising, for a doctor does not need to be a brilliant writer in order to be a good doctor. Thus, the editors have to guide their authors. Someone who writes a textbook has to put the contents in order and then write it all down in simple sentences. A textbook editor who has skilled authors who present their material in an inadequate order and in a form that is barely comprehensible, has to take the revision of the chapters into his own hands. In some cases, he will edit texts very carefully indeed.

But what if the editor is not able to absorb the stylistic and didactic finish, and achieve the linguistic harmony of the chapters? Or if he doesn't have the time? Then revision is delegated to external assistants, usually to medical editors. This incurs additional costs which need to be allowed for at the planning stage.

Over and above the textual and stylistic supervision of the project, the editor has an additional sacred duty. He has to bring the texts submitted by his authors into the public domain. Everyone who has ever been involved in writing a medical textbook knows from stories or from his own experience about those exasperating cases where good texts evolve during long nights of work and then are published either years later or not at all.

This means that as soon as an author submits a text, you are under obligation. You must publish the text and increase the fame and reputation of your authors to the best of your ability. If you have decided to publish finished texts on the internet before publishing them in a book, you should put them on the internet very quickly, preferably within 4 weeks of submission. If, moreover, the budget is assured and the project accounts are well-filled, it would be a graceful gesture to pay the authors their agreed fee, or at least an instalment. Editors should be grateful to their authors and demonstrate this gratitude freely.

The editor is not only there to organise and delegate: the third duty of the editor is to bear a part of the work on his own shoulders. This doesn't have to be the exemplary commitment of HIV Medicine's Christian Hoffmann who writes 350 pages himself and proofreads 450 pages, but the editor should reserve a pivotal chapter for himself. Young colleagues, in particular, don't wait to be asked twice and take the pickings while they can. They are perfectly entitled to do so. The more the editors write, the better they understand their authors and the more qualified they are to give advice.


A young editor profits from discussing his textbook project with an experienced colleague; an older editor should seek the advice of a good friend and colleague. It is possible to publish a book as a lone wolf, but it is easier to lose your way alone than in pairs.

The role of the older mentor has gone out of fashion lately, and that's a pity. It is not only the younger colleagues who refuse the help of the older ones; sometimes the older ones no longer possess the mellow goodwill to watch their younger colleagues working on projects for which they themselves are too old.

Medical Readers

In the section on editors, we saw that medical readers may be needed to help with the stylistic and didactic finishing of a book. Medical readers are often doctors themselves, and a proof-reader with 20 years experience can be a valuable addition to an editorial team. The additional financial burden should be allowed for in the budget, but it is worth every penny when editors are unable to perfect texts for the final print version due to lack of time.


There is no such thing as an error-free book, but you should make every effort to produce as perfect a text as possible - gifted proofreaders can help you. Proofreaders are the last ones to work on the chapters before they are put together as a whole. It is not easy to find good proofreaders. Make sure you attend to this as early as possible.


A text passes through several stages before it is published. The stages which it must complete before it is incorporated in HIV Medicine are shown in Table 2.3.

For each text, a careful account is kept of the stage it has reached. In the production of HIV Medicine, this task is performed by the editors; other projects have a project secretariat.

Table 2.3: Stages of a text




Author confirms that he has received the e-mail with the go-ahead


First text version from the author


Correction and revision by editor 1


Correction and revision by editor 2


Text version which is returned to the author (with questions, suggestions, etc.)


Corrected text of the author


Text version in which the author's corrections have been checked and accepted


Back from the proofreader


Final version, released for publication


Time frame

We have defined the time frame for a new book project in Table 2.2. If all the authors get to work straight away, a textbook project can theoretically be completed in 6 months. 9 months are more realistic. 12 months should be the longest time accepted.

The workload of the editors depends on how many chapters they write themselves and how deeply they are involved in the textual and stylistic correction of the authors' chapters. For the first edition, this can be anything from 100 to 400 hours. However you organise it: the first edition means work and stress. It is not until the second edition, and more so in the subsequent ones, that the workload is reduced to between a third and a quarter of the initial number of hours.


The co-authors have to read up on their subject, structure the material, write and correct the text. This needs to be organised and fitted in to the full schedule of a busy hospital doctor. If the circumstances are good - the colleague is highly motivated, happens to be on holiday and throws himself enthusiastically into his work - it is realistic that a chapter of 20 pages can be written in 6 weeks. So do not be afraid to ask your co-authors if they can submit their text "at the end of next month".

In other cases, more time may be required, but it does not make sense to set a deadline too far in the future. If you give someone 12 months, he will rarely start work before the last four weeks. Therefore, a deadline of four months should only be extended to six months in justified exceptions (post-doctoral lecture qualification, work on an important publication, etc.) Someone who cannot deliver 20 pages within six months will not deliver them in 12 months either.

Perhaps you should give your co-authors the option of choosing a deadline of between six weeks and four months. Make sure that the deadlines are spread evenly over this period, so that the texts do not all arrive at the editorial office at the same time.

Point out, once again, that a deadline is just that - a dead line - and not a midsummer night's ball. If you sense that this unsettles your author, you can always modify the date for text submission, but insist that a deadline is deadline, and that means the new deadline too.


The budget you require for your project is made up of the items printing costs, webhosting and authors' fees.

Printing costs

The printing costs for a book comparable in size (24 cm x 15 cm) and length (800 pages) with HIV Medicine 2005 are listed in Table 2.4. The relatively high costs for small editions are due to the fact that print preparation (construction and setting up of printing plates, adjustment of the printing machine, test printing, etc.) are unchanging cost factors, regardless of the size of the edition. Once the printing machine is up and running, the costs are reduced dramatically. While for an edition of 500 copies each print costs 14 Euro, every book over and above the 1000th costs only 3.50 Euro (see Table 2.4).

Table 2.4:Printing costs for varying numbers of printed copies *


Printing costs


7000 Euro


10000 Euro


13500 Euro


17000 Euro


20500 Euro


24000 Euro

* Calculation for an 800-page book; dimensions: 24 cm x 15 cm; printed in Germany

So you see: printing costs are not just trivial amounts. In chapter 4, we have to make sure that we recover this money.


Compared with the printing costs, the cost of placing your text on a computer with internet access is relatively low, at between 10 and 30 Euro a month.

Author's fee

There are two possible concepts:

  1. The editors have certain financial reserves and can finance the project from their nest egg. In this case, they can offer their authors a fixed fee. For example, the authors are guaranteed 13 Euro per page, plus a further 13 Euro per page if book sales cover the printing costs.
  2. The editors have no financial reserves and cannot offer their authors a fee. In this case, it is a good idea to form a financial partnership. If book sales and entries from company logos displayed on the internet site generate a profit, this will be split according to the number of pages written. The authors bear the whole risk - for the whole profit.

Team of authors

Concept, structuring, editorial team and scheduling make up the framework of a project. What is missing now are the people you need to press ahead with the project. It is not easy to find them, especially as you have to acquire between 15 and 30 co-authors for a large medical textbook. What are the criteria for assembling a team of authors?

The following should be regarded as rough guidelines:

  • Your colleagues should be experts in their field
  • They will generally be younger than you, because older colleagues usually don't have the time
  • Your co-authors should enjoy writing and be good at it. They should also enjoy imparting their knowledge to other people.
  • And - perhaps most important of all: the editors must be able to get their authors to commit themselves to a deadline. This is usually only possible via friendship or authority. You must decide whether at least one of these conditions is fulfilled.

E-mail is the modern method, but the telephone is better. Call your preferred candidates and explain your project. Emphasise the fact that it is an Flying Publisher project and that you could publish the individual chapters on the internet within a few weeks. If the candidates are not familiar with the principle, refer to this book. Discuss the following items:

  • Subject and title of their contribution
  • Length
  • Fee
  • Deadline
  • Word processing software (mostly Word)

The most important message to put across to your authors during this discussion is: "You will be No. 1". The authors need to know that they are not working on just any old project, but on an adventure with exciting and successful years ahead.

Immediately after the phone call, send an e-mail summing up the details discussed. Set a time limit within which you expect a final decision about the candidate's participation in the project.



  • Only write if you want your book to be No.1.
  • Plan annual updates right from the beginning.
  • Consider whether an internet supplement offering pictorial and other information not available in the book would make sense.
  • The stylistic finish of the chapters is important to make the textbook pleasant to read. Those who cannot perform this task themselves should delegate the job to a professional reader.
  • Agree on differing deadlines with your authors so that the chapters don't pile up at the editorial office.
  • Try to find out how many books you can sell. Calculate printing costs and think about whether foundations or sponsors might be interested in taking on part of the edition.
  • Try to sell more than 1000 copies.
  • Find out whether you should produce an English version.


  • Books which are not freely available on the internet are like cars without wheels.


  • As you can see, publishers who take their task seriously and want to be more than just a figurehead have plenty to do.


  • If you have heard of Flying Publisher projects and have basic skills in the management of HTML sites, go ahead and offer your services. Don't be surprised if your work doesn't pay off financially at first. By collaborating on a textbook project you will learn things from which you will benefit for the rest of your lives.


  • The printing costs for books may be lower than you thought. If a printing machine is set up and the first 1000 copies have been printed, it costs 3.50 to print every 800-page book after that. The number is misleading. In fact - as we will see later on - a publisher can only pay his authors an appropriate fee of 25 Euro per page, for example, if he sells more than 1000 copies.





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