Contributing Editor
Department of Dermatology
University of Oklahoma Health Sciences Center
Remarks to the Internet Dermatology Society meeting held in conjunction with the annual meeting of the American Academy of Dermatology, Saturday, March 22, 1997 at the Palace Hotel, San Francisco, CA.
The Electronic Textbook of Dermatology is and hopefully will continue to be one of the crown jewels of the Internet Dermatologic Society. It is both a unique information resource and a unique experiment in Internet publishing (as well as many other things).
QUESTION: What has the Electronic Textbook of Dermatology got in common with: Science, The Journal of the American Academy of Dermatology, The Journal of Investigative Dermatology?
ANSWER: They all use advertising to support themselves and their parent organizations
We should do the same.
Because it is published via the Internet, The Electronic Textbook of Dermatology is already and will continue to be one of the most widely read medical textbook ever written. This has obvious advertising potential, which will be increasingly clear to companies over the next several years. As long as this is done tastefully it is still consistent with a publication of the highest scientific standards (such as the peer-reviewed medical journals mentioned above).
example: The end of the sunscreen chapter "Sun Damage and Prevention" would be an appropriate location for an advertisement from a reputable manufacturer of sun protective clothing. Obvious exclusions would be advertising from companies not geared towards health, e.g., cigarette companies, brewers, etc.
The editors will need to judge the appropriateness of requests for advertising space, but I believe it can be done in such a way that we can raise money to support the educational goals of the IDS and still have a textbook that we can all be proud of.
Unlike hard copy textbooks, there is essentially no page limit to the size of the chapters. Because publishers don't want the cost of unwieldy multi volume textbooks, chapter sizes in traditional medical textbooks are severely constrained, and many chapters will simply not appear in a textbook because of this limitation. One approach to this problem with printed medium that has had some success is the Demis textbook, in which the user buys a subscription and initially receives several volumes of a notebook style textbook that can then be upgraded at intervals to keep it current. While this solves to some degree the problem of size limits and keeping the text up to date, it is still an expensive and somewhat unwieldy solution.
The Electronic Textbook of Dermatology will eventually exceed Demis in size and comprehensive coverage if for no other reason than it has no size-related limitations in scope that plague even the Demis textbook.
It is my wish (which I will personally work to help fulfill) that the Electronic Textbook of Dermatology would become the most comprehensive textbook of Dermatology ever written with chapters covering every aspect of clinical dermatology and cutaneous biology. Since there are no practical size limitations, there is no reasons that entire chapters can be devoted to issues related to therapy, something no previous textbook has ever dared to do because of the obvious problem of size. We obviously have a long way to go, but we are at least off to a pretty good start.
Another aspect of the lack of size limitations which I would like to see exploited is the ability to include chapters written by authors representing differing schools of thought, usually related to therapeutic issues. For example, a recent debate on RXDERM-L centered on whether atopics and people with xerotic skin should be treated with a less frequent bathing schedule (the barrier-oriented approach) or with more frequent baths designed to improve skin hydration (the active hydration approach). Those of us who have seen both approaches in action know that a knowledgeable dermatologist can be obtain good results with either method. A wonderful addition to the Electronic Textbook of Dermatology would be a chapter from a knowledgeable advocate of each approach, explaining the theory and rationale of therapy in each case. The readers (e.g., residents and therapeutic neophytes) could then choose the method they felt represented the best approach, or more likely use whichever approach seemed to best fit the clinical situation.
I am not advocating anarchy in the Electronic Textbook of Dermatology. Editorial control will be needed to keep this reasonable. I don't think that it would be desirable to attempt to include every hair-brained concept that's out there (e.g. "chelation therapy"), only therapies with a reasonable body of scientific and empiric evidence to support them. Graphics Because there are no practical size limitations in the same way that there are for hard copy textbooks, unlimited color illustrations are not only possible but easy to accomplish. In fact, full color JPEG images either captured directly with digital cameras or scanned from existing collections of color slides, are easier than making black-and-white illustrations. In practical terms, the major limitation is the number of suitable photographic images. This would be unthinkable in traditional publishing because of the high cost of reproducing high-quality color images on printed pages.
Links to other resources on the net are another unique advantage of Internet publishing. For example, the new papillomavirus chapter will include a link to a database of electron micrographs so that the reader can view images of virions. Getting permission to use materials in this manner should be easier than the formalized process typical of hard copy textbooks because you are not really borrowing the other authors' material, merely forwarding the reader to their original works.
One type of link that will be particularly useful for the clinical portions of the Electronic Textbook of Dermatology are links to RXDERM-L, providing the most up-to-date therapeutic suggestions possible.
One problem with traditional texts is that they are out of date as soon as they are published. This is particularly true for basic science textbooks. With electronic publishing on the Internet, chapters can be updated several times a year, and is only limited by the author's time to do so.
Feedback from Readers: E-mail links allow direct feedback with Internet publishing. This has its plusses and minuses. It may seem like a good idea from the point of view of having readers comment on errors that need fixing or suggesting additional appropriate material, but since the Electronic Textbook of Dermatology will be published on the Internet and read more often than not by the general public, this may generate a large volume of e-mail from would-be patients soliciting free medical advice, a point that Rhett has raised in his talk about web pages for physicians. We can either look at this as a problem, or be more constructive and view this as an opportunity to "put our best foot forward" for our specialty.
The Internet is one place that we can help to guarantee direct access for dermatologic care. If questions from patients triggered by the Electronic Textbook of Dermatology can be funneled into an artificial intelligence program that directs them both to patient-oriented pamphlets and information and dermatologists in their local area with whom they can schedule a visit (maybe even do the scheduling on-line!), then we and our would-be patients can all benefit from this. The challenge to the IDS membership and the American Academy of Dermatology to set something like this up is clear.
A final area I wanted to discuss related to the Electronic Textbook of Dermatology is its potential role as a resource for residency training. One of the chronic problems that continues to plague dermatology training programs is the lack of good source for basic science curriculum material. Several options that have been used include:
Read the Journal of Investigative Dermatology
Read Goldsmith Biochemistry and Physiology of the Skin
Read the Chicago Notes
Although I am a contributor to and a reviewer for the JID, I will be the first to admit that it is an extremely boring way to get a dose of basic science. What residents really need are reviews of basic science topics (which they rarely get, even at special courses such as the Saturday/Sunday courses put on by the Academy).
Goldsmith is an excellent basic science textbook for cutaneous biology, but it suffers from the same central flaw shared by all hard print media texts: it is out of date as soon as it comes off the printing press. This is even more true for basic science material than clinical material.
Because they can be revised often, electronic media publications should in theory have an advantage in being able to keep up to date with the latest information. The major limitation that the Electronic Textbook of Dermatology will face in this regard will undoubtedly be the getting our authors to revise their materials at least yearly (if not more frequently).
A major player that has appeared in recent years is the Chicago Notes service which provides timely basic science information to subscribers. While this is a viable alternative for basic science core curriculum information, the Electronic Textbook still has things to offer in terms of its ability to include better graphics and links to Internet resources. I would eventually like to see us attract a cadre of noted skin biologists who would be willing to write and maintain a series of core skin biology reviews related to immunology, carcinogenesis, cell biology, radiation physics and other appropriate topics that would function as a basic science core curriculum for dermatology training programs worldwide.
The Electronic Textbook of Dermatology is becoming one of the most widely read medical textbooks of all time. I would like to see it continue to develop along the lines of the Demis textbook in terms of it being comprehensive in scope, while maintaining a high standard of scientific excellence. It can serve not only as a clinical resource, but also as a basic science core curriculum, assuming that we can develop an appropriate series of chapters dealing with these topics.
Because the Electronic Textbook of Dermatology is in some ways more similar to a periodical than a traditional printed textbook, I believe it is possible to achieve all of this in conjunction with appropriate advertising similar to that seen in traditional peer-reviewed medical journals. This will generate revenue to support the Internet Dermatology Society's other educational activities while the Electronic Textbook of Dermatology remains something that we can all be proud of.