A commercial or trade publisher (a.k.a. a traditional publisher) purchases the right to publish a manuscript (usually together with other rights, known as subsidiary rights). Large publishing companies often pay an advance on royalties; the small presses often do not.  They are very discriminating in which books they publish.  They chose only a small percentage of the books submitted.  In medical publishing, the selection process is more demanding. The purposes of publishing for them is to make money and they are very chary about whom they will accept and why.  In other words, most books published in the medical field would have difficulty making money for the publisher.  These publishing houses handle all of the phases of editing, publication, distribution, and marketing. This is done to maximize profit and lessen the chance that a medical book will not succeed.  There are no costs to the author.

These publishing houses usually do not allow unsolicited submissions and if they do, the chances of publishing a book are slim, especially a medically related text.  The purposes of publishing for them is to make money and they control whom they will accept and why. Authors usually go through agents who receive a commission.  The smaller publishers afford themselves to “self-publishing”.  What is “self-publishing”? With this concept, an author comes up with an idea (in our situation, a medical treatise) and writes a book.  The trek to publishing includes not only writing the book, but proofreading, layout, cover design, marketing, and setting up an imprint and publishing. All these additive costs, whether done alone or with the help of these smaller publishers can be expensive.

A vanity or subsidy publisher charges a fee to produce a book, or often, instead of that, they may require the author to buy a certain number or books, pay for the editing or other services as a condition for publishing the book. These publishing companies work with different approaches, but it comes down to the fact that they have to make money to survive.  Some of the devices that they utilize  involve:  1. They only perform certain services such as print the book from his manuscript, 2. These companies may provide services such as editing the book, distributing and marketing  in addition to print and digital book production. Each of these efforts is additive in cost.

These publishers often are not selective comparable to a large publishing concern that prints books that are “state of the art” in medical knowledge.  The “vanity and subsidy publishers” tend not to be the “gate-keepers” for discrimination of the quality of material within the book.

Self-publishing services seem to exist between vanity publishing and true self-publishing. True self-publishing is a situation where the author does everything necessary to publish the book and it is then printed.  All the costs are born by the author, and these expenses can be very costly.  If one uses these self-publishing companies that offer packages which will guide and help the author, the author is limited by the services they agree to.  Each of the services is an added expense.  It appears, however, that these services are generally cheaper than those for vanity publishers.  The services and costs are more evident about what they do.  Authentic self-publishing requires the author to assume the entire cost of publication, and entrusts any marketing or selling schemes to the author. This includes design, editing, the cover, and marketing.