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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


4. Behind the scenes
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Securing financing - Profit margins - Sponsoring the website -Opening and closing credits - Founding a publishing house - ISBN numbers - Internet domain - Project Center - Spell verification - Negotiations with sponsors

The authors are hard at work and you yourself are working on your own chapters. There are other things to be done on top of this:

  • Financing
  • Opening and closing credits: Imprint, Foreword, Contents, Index
  • Cover design and text for the back cover
  • Founding a publishing house
  • Setting up a website
  • Negotiations with sponsors
  • Checking the deadline
  • Accepting texts, passing them on to the readers, sending them from there together with questions and comments back to the authors, receiving corrections, sending the text to be proofread.


As you are writing Flying Publisher texts, you can earn money both from the sale of the books and through sponsorship of your internet site. The financial result of this book-plus-internet adventure varies:

  • The minus variation: the income from the project does not cover the printing costs, let alone the authors' fees.
  • The zero variation: the income covers printing costs and authors' fees, but there is nothing left for the publisher.
  • The plus variation: after payment of all fees, the publishers also earn some money.

Even financial minus variations can be attractive if the work is enjoyable. SARS Reference, for example, was a project where it was clear right from the start that it would only incur expenses without bringing in any profit. Free Medical Information is evolving in the same spirit. It is not about money, it is about the cause. The writer becomes convinced of what he is doing, asks himself: "What do I want? Money or readers?" and knows the answer.

Just for fun, you should ask yourself this question: what would you prefer:

  • 1,000 book readers plus a 2,500 Euro fee


People are of two minds here. A suggestion in the interests of mediation: write with enthusiasm and put your project out into the world. A lot is achieved by doing that alone. Temporarily declare money to be of minor importance. If there should be any money lying by the wayside during the rest of your journey, pick it up and pay your authors an appropriate fee.

Sale of the books

Profit equals income minus expenditure. This rule also applies to book production. On the expenditure side, we have printing costs and authors' fees; on the income side, the sale of books either through the book trade or to sponsors.

The printing costs for a book such as HIV Medicine 2005 (800 pages, 24 cm x 15 cm, see page *) have already been shown in Table 2.4. In Western Europe, 500 books cost 7,000 Euro, 1,000 books 10,000 €, 2,000 books 13,500 € and 3,000 books 17,000 €. Table 4.1 shows how high the profit is depending on the number of books printed and sold. The printing costs for 500 to 3,000 copies are stated as deficits in the line "Sales = 0". The calculations are based on a retail price of 50 Euro with 45% deducted for middlemen and shipping costs, leaving 27,50 Euro per book sold.

Table 4.1: Profit with different numbers of copies *

Number of copies (bold) and profit (in Euro)






- 7,000

- 10,000

- 13,500


- 4,250

- 7250

- 10,750


- 1,500

- 4,500

- 8,000



- 1,750

- 5,250




- 2500
























* Calculations for an 800-page book, retail price 50 Euro, 27.50 Euro profit per book after deduction of 45% for middlemen and shipping
** Number of copies sold


These figures show that, for 500 printed copies, the profit zone begins between 200 and 300 copies sold. For 1,000 printed copies, it is between 300 and 400 copies. The exact figures for this so-called break-even point are shown in Table 4.2.

Table 4.2: Break-even Point and maximum profit*


Break-even Point**

Max. profit (in Euro)***

Profit per page (in Euro)













*Calculations for an 800-page book, retail price 50 Euro; 27.50 Euro profit per book after deduction of 45% for middlemen and shipping
** Number of copies sold
*** Upon sale of the whole edition

Table 4.2 also shows:

  1. Producing books does not ruin you. With 500 printed copies, the printing costs are covered by selling as few as 250 copies. But: you can barely earn anything with 500 printed copies.
  2. Book production only becomes financially rewarding if you sell more than 1,000 copies, very rewarding if you sell more than 2,000 copies.
  3. The column "Profit per page" shows that you cannot pay a proper author's fee of, for example 25 Euro per page, from the profits of book production until you have sold more than 1,000 copies.

If you update your book every year, you need to ask yourself: "How many books can I sell in 12 months?" The answer depends on the subject. Neuropathology does not sell as well as antibiotic therapy. In some cases, it can be decisive whether a sponsor (foundation, pharmaceutical company) buys a few hundred or - less often - a few thousand copies in bulk.

Book production can be lucrative, but you can't always get yourself out of the red. Fortunately, even this does not have to mean the kiss of death for your project. You can tolerate a deficit in the bookshops if you manage to make money via a second financial source. This second source is your website!

Sponsoring the website

The second source of income for a Flying Publisher project takes the form of sponsoring contracts for an internet site. The entry of a company logo on your homepage can balance your budget by several thousand Euro - yet another reason to set up your website as quickly as you can. It even makes sense to publish some texts there in advance, although the book hasn't been printed yet. It is common practice in the internet business to publish in advance, as negotiations become easier if you have something to show.

The same rules apply to the sponsor's entry on your homepage as those for book texts. Sponsors cannot be allowed to influence or even change the core statement of your texts in any way. You will find important details about this and about the criteria for selecting sponsors at the end of this chapter. But first, there is still some detailed work on the agenda:

How do we shape the first and last pages of our book? How do we found a publishing house, how to we reserve the domain name for our website and how do we set it up?

Opening and closing credits

Every book has "opening credits": empty or almost empty pages upon which only the title is repeated, and an imprint, foreword, list of collaborators and contents are printed. In order to reduce work on the opening credits to a minimum, we have prepared a Word document (http://HIVMedicine.com/textbook.doc). Open the document and remain in standard view (View->Normal), so that you can see the horizontal lines "Page break" and "Section break". Make sure that you do not delete these lines; they contain important information regarding page number, header and footer.

You can rewrite the opening credits for your project within only 10 minutes. Change title and publisher, enter your address on page 4, write 3 sentences in the foreword and enter the first colleagues in the list of collaborators. Name the first chapters from page 11 onwards and, finally, update the contents in page 9. Procedure: position the cursor anywhere in the Contents and press the right-hand mouse key. From the menu which appears, select "Update field" and, in the next window, "Update entire table". Take good care of this document. Later, you will copy the chapters from your authors into it.


You should draft a foreword very early on - even if nothing is left of it in the final version. Drafting forewords helps to present a concept more precisely.

List of collaborators

You asked your authors to supply you with the details for the list of collaborators in your first letter. Enter these details.


The index is at the back of the book. You can only compile one if, within the individual chapters, you have already defined which words will be recorded in the index. You will not edit these so-called index entries until you reach the final stages.


The cover consists of a front and a back page. Ask a professional artist to design it.

In the HIV Medicine book, the title is followed by the current year. In addition, the book is a different colour every year. The reason: you should be able to tell from the new colour that you are looking at the current edition, in which the texts are less than 12 months old. In addition, it shows who is carrying the new edition in their coat pocket.

The back cover should be planned just as early as the graphic design of the front cover. The text which appears there must be able to convince a potential but as yet undecided buyer. Do not be afraid to sing the praises of your book. This is not the place for false modesty. For once, self-praise is allowed.

Founding a publishing house

Founding a publishing house is very easy in some countries. In Germany, for example, all you need is to register a business with the appropriate local authority. Take along your ID papers and 22 Euro and the formalities are taken care of in half an hour.

ISBN Number

Books need an ISBN number. This number guarantees that your book will appear in the electronic registers of the booksellers.

The allocation of these numbers is regulated differently in every country, so that we cannot give you any detailed information here. The annual costs are low.

Setting up a website

The foundation of a publishing house is followed by the setting up of a website. First, you must reserve an internet domain and find a service provider upon whose computer your texts can be connected with the internet. This service provider is called a "web provider" or "internet provider", the service is known as "webhosting". In addition, you need someone to maintain your website.

Internet domain

Almost a decade after the gold-diggers' age on the internet, it is not easy to find good domain names that are still available. Almost all the catchy names have been reserved by people who were in the net before you. So we have to switch to longer names, which doesn't do any harm, thank goodness. www.FreeMedicalJournals.com isn't elegant at first sight, but that doesn't seem to have bothered the more than 20 million visitors who have visited our site since February 2000. www.SARSReference.com was also a makeshift solution, because the title we wanted was already taken. It also did no harm: >200,000 visitors in 18 months.

If you are in search of domain names, you should make sure that you reserve both the *.com and the appropriate country-specific domain (*.fr for France, *.es for Spain, *.it for Italy, etc.). *.com domains were originally intended for commercial enterprises, but today they are the gold standard. Do not reserve a country-specific domain for which the *.com domain is already taken, nor a *.com domain, if the country-specific domain is no longer available.

You can find out at www.netsol.com if *.com domains are still available.


It is wise to make webhosting contracts with companies in your own country. The advantage here is that you can get an answer quickly and easily if you have any questions or problems. It only makes sense to make webhosting contracts with companies abroad if you have a good command of the language. In addition, the difference between the time zones should not be too large - so that the hotline is not asleep when you are having problems.

Maintenance of the website

As soon as the domain names have been reserved and the webhosting contract signed, you must decide who is responsible for maintaining the website. The initial design should be left to an experienced graphic designer. For all subsequent work, student assistants should be your first choice - it is motivating to be involved in a prestigious project and everyone benefits from this collaboration.

Your website is brought to life by the texts you publish there: whether further information (daily or weekly news, congress reports, calendar of events, "frequently asked questions", and address lists) is offered, is dependent on the time you have and the dedication of your students. But remember: regular maintenance is the name of the game. A website where nothing happens for weeks will moulder and die.

In addition, you should offer your visitors the chance to join a mailing list. This is where readers can show their interest in being informed by e-mail about new or updated texts in the future. This direct contact to the readers is eminently important for the success of your project!

The deadline is approaching

A deadline is a deadline. It is not always easy to make it into a real dead line, because the publisher is dependent on the contributions of his authors. These things are generally of help:

  1. A first reminder e-mail (or phone call) 30 days before the deadline;
  2. A second reminder e-mail 10 days before the deadline;
  3. A telephone call 1 day after the deadline if the article has not arrived.

As a publisher, you should not be afraid of the fact that this is an annoying procedure. On the contrary: most authors are grateful to be reminded in good time of the task they have taken on.

And as for the authors - we already mentioned it earlier: anyone who worries or knows that he can't meet a deadline should not become involved in book projects.

Project Centre

In Chapter 2, we indicated how important it is to know the current status of every text. The project centre - which is sometimes one and the same person as the publisher - keeps account. This is where the texts arrive and are passed on.

What must be considered?

  1. Ideally, every text should be read by two qualified colleagues with a good sense of literary style.
  2. After being read twice, the text should be returned to the author with any unanswered questions. The corrections of the authors must be recorded using the function "track changes" (click Tools->track changes ->highlight changes + highlight changes while editing).
  3. The authors' corrections are checked by both readers and the chapter subjected to Word spell verification (see next section).
  4. The text is checked by a professional proofreader.
  5. The proofreader's changes are checked once again by one of the medical readers.

Microsoft Word spell verification

Word spell check is a valuable tool and should be used by the authors, the readers and the proofreaders. You start spell verification with F7. As soon as the dialog window opens, check that the window shows correctly "Spelling < your mother tongue >".

This is the procedure if a different language is given: mark the whole text with CTRL-A, then define the language: Tools->Language->Set Language + your mother tongue + OK)

When you subject the text to spell verification, words which are unknown to the system are shown in red. If the spelling is correct, type ALT-A in order to add the word to the supplementary dictionary. If you do not want the word to be included (e.g. in the case of proper names, foreign words and unusual words) type ALT-G and the entry will be ignored.

The final version of the texts

The individual chapters gradually pass though the stages of reading and final proofreading and assume their definitive form. You are on the verge of publishing the first chapters on the internet and the authors are waiting impatiently to see themselves on the net.

Suddenly, a potential sponsor calls and asks to talk. What do you need to bear in mind?

Negotiations with sponsors

Foundations and pharmaceutical companies can be considered as possible sponsors for your project. Foundations will generally subsidise your project, while pharmaceutical companies will buy up part of the printed version in order to distribute the books to interested doctors. As every type of co-operation between doctors and pharmaceutical companies must remain free of any conflict of interests, there are a few rules you should know.


When you wrote, you wrote the truth and did not formulate your texts with company X or company Y in mind. This is an extremely important point. The standards regarding independence of statements and recommended therapies cannot be set high enough. Any doctor who writes something against his own convictions for his own benefit is guilty. Doctors who practise accommodating journalism quickly end up on a par with drug barons and arms dealers. May anyone who practises this kind of accommodating journalism in medicine be struck down by leprosy so that he can no longer write!

Selection of potential sponsors

The chances of reaching an agreement with sponsors from the pharmaceutical industry depend on various factors. Both personal and internal company factors play a role here. One of the golden rules of a colleague who had 30 years experience with the publication of medical textbooks was:

"The marketing budgets of pharmaceutical companies are structured according to drugs. There is more money for drug X than for drug Y. Budgets are generous when new drugs are being introduced to the market, very generous when a drug is being introduced and has to compete against an existing market leader."

When you approach the staff of a pharmaceutical company with your project, you are expected to "sell" your project. This is not meant in a derogatory way, it just means that you should ask yourself these questions before you approach the company:

  1. What good will it do this company to sponsor me?
  2. What can I offer this company with my book and/or my website that other media cannot?

If the answer to both questions is "nothing", you should perhaps rephrase your offer - or look out for another company. In this life, all you get for nothing is nothing.

What is allowed and what is not

Pharmaceutical companies live off the sale of their drugs, and the staff of their marketing departments have been instructed to increase the turnover of these drugs. In order to increase the turnover, arguments are collected to convince doctors of the superiority of the company's own products. The companies want to sell, pulling out all the stops: that is their job.

It is our job to distil the truth from the information available to us, especially from scientific literature. Regardless of the fact that you have a duty to write the truth and nothing but the truth, you should remember the following points when negotiating with possible sponsors:

It is allowed

  • for the potential sponsor to itemise the advantages of his product. It is your task to separate fiction from the truth.
  • for the potential sponsor to ask you if he may read and comment on the passages about his product. Upon this request, you should send him the passages as a PDF file, never as a Word document. Reserve the right to accept changes or not.

It is not allowed

  • to provide the sponsor with the original document so that he can make corrections to it.
  • to incorporate whole passages from the potential sponsor.
  • to permit the potential sponsor to influence the composition of your team of authors.

It is bad

  • to print the logo of your sponsor on the cover. Logos belong on the first inside page of the book.

It is dubious practice

  • to accept advertising for drugs in the book, such as full page adverts on the last few pages. This compromises your credibility.

If a potential sponsor does not accept these points, you must abstain from any further co-operation - even if this causes temporary difficulties with the financing of your project. Remember: the worst thing that can happen to you is loss of credibility. Everyone knows the jokes about the qualified university lecturers working as pharmaceutical sales reps. If you sell yourself you lose your credibility - a flaw which marks some people in our profession for the rest of their lives.



  • If you want to pay your co-authors a fee of 25 Euro per page, you have to sell more than 1,000 books.
  • If these sales figures are unrealistic, find out if additional income can be obtained through sponsoring of the website. A logo entry on a good website can be worth several thousand Euro a year.
  • Founding a publishing company is simple and cheap in almost every country.
  • You must allow costs of 15 to 30 Euro per month for the website of your project.
  • Websites should be maintained by dedicated student assistants.
  • You can compromise with potential sponsors on certain points, many points are non-negotiable.


  • Would you have believed that there is so much activity behind the scenes while you are preparing your chapter?


  • Go on, admit it: after reading this chapter, you almost feel like writing yourself. But please remember what we said at the beginning: clinical textbooks are written in large editorial teams. Do not try to play the lone warrior. If you are itching to write, try to gain access to an existing or developing team of authors.


  • Try to become involved in Flying Publisher projects. You will learn a lot - how book projects are financed, how a publishing house is registered, and how websites are maintained. Maybe the publishers will even let you in on the secrets of negotiating with sponsors one day.


  • You suspect conflicts of interest when doctors work together with pharmaceutical companies, don't you? As you have seen here, it doesn't have to be that way, but you must be aware of what is allowed and what is not. Also, it is true that someone who is corrupt can enrich himself in the short-term, but in the long-term, the incorruptible are more successful.





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