Wednesday, May 28, 2008

MD Consult: An illustrative story?

I'm studying for my board exams, so I'm treading ground little touched since I stopped seeing patients. Among other things, I'll eventually be updating my ancient web clinical notes (such as my ancient medical reference page, which I'm updating today).

One of the first places I visited was MD Consult: Books, which I can access through my U of MN account.

Alas, it is but a shadow of its old self. Of the three or four publishers who cooperated to launch the original site, only Elsevier is left. They have a reasonable number of texts, but many of my old favorites are gone.

I suspect there are interesting stories here. MD Consult peaked during the rise of the net, when publishers must have felt terrified that their business would be destroyed. It went into decline after the crash, when the threats seemed to be receding. The publishers, who were, after all, competitors, largely walked away. They hiked their journal subscription prices through the roof, and textbook costs rose quickly.

But did they relax too soon? On the textbook front UpToDate seems have filled the nice MD Consult once held, and it's not currently a part of any of the large publishers. On the journal front rapacious pricing empowered the miraculous open access mandate.

The lesson may be that while it's easy to overestimate the speed of social transformation driven by new technology, it's even more tempting to return to bad habits when the initial fear recedes.

I suspect the textbook companies were right to be afraid, a bit overanxious on timelines, and wrong to relax.

Update 5/28/08: Incidentally, MD Consult is available free of charge to anyone who qualifies to register with MerckMedicus. They also offer Harrison's Online. (So only the most virtuous of clinicians, those who have the discipline to refuse all pharmaceutical blandishments, would pay for MD Consult. Those people do exist, and I do admire them.)

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