Buying Medical Books Online

by
Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today

 
accepted for publication in Medical Computing Today June 2000
 
Originally published in edited form April and May 2000 in Medical Software Reviews.


Sections
Amazon - Barnes & Noble - Fatbrain - MedBookstore - Powell's - Varsity - Other - Summary
Comparative Tests: Price - Shipping and Taxes


Online shopping has become an increasingly common alternative to searching for a parking space and browsing through stacks of books. Much of online shopping's success can be attributed to several recent technologic advances -- in the Web's displaying and ordering of products, in the use of secure servers for financial transactions, and in the ability of Web companies and third party shippers to use automation to keep up with the increasing demand.

The best products for purchasing on line are imperishable items that do not vary in individual quality or require inspection in person, and for which prices can be discounted to create a competitive marketplace. Heading this list are airline tickets, music CDs, computer equipmentĚand books. This NetView describes, in alphabetical order, the six major bookstores and concludes with several others that are of interest for various special reasons.


As compared to in-person shopping, online book shopping is a unique experience. Most significant, online bookstores allow for a bird's eye view and easy exploration of the store's entire inventory. From the customer's perspective, a store's inventory (database) can be approached in two distinct ways, depending on the shopper's intent: if a specific book is sought, the customer can search for it (by title, author, ISBN, and/or publisher) or the customer can browse the database to see what's new or featured. Web sites create pre-programmed subject or category lists for their customers to browse; to what extent publishers and other forces influence these browsing lists is a business (and some feel an ethical) consideration. Browsing can also be conducted using a keyword search, which can bring out rare books and other treasures hidden deep in the database. The disadvantage is that on some sites searching by keyword results in long, disorganized listings containing many extraneous book hits.

Bibliophiles are well-served by a number of site-sponsored features such as easy access to professional and reader reviews, links to book-related Web sites, discussion and chat groups, and email lists.

Most online stores nowadays accept credit card transactions using a secure server, which despite several recent hacking successes is still widely regarded as safe. Prices are competitive with mall shopping, especially when the purchaser avoids paying sales tax, but shipping charges need to be considered. One of the biggest headaches is comparison shopping among Web sites for the best price, which requires individual calculations reflecting discounts, any taxes, and shipping, even using third party sites that search multiple online bookstores. Good customer service is always a rare find, especially among the lower-end stores, but shopping on line can feel even more alienating with its impersonal interface and automated manner. The best sites employ toll-free phone numbers, chat help lines to answer questions immediately, liberal return policies with easy shipping instructions, and/or prompt personal attention to customer e-mail.


 
Sections Amazon

Since July 1995, Amazon.com has developed far beyond founder Jeff Bezos' innovative online bookstore. In addition to more than a million books, its present inventory targets some of the most lucrative markets on the Web, such as electronics and software, music and videos, and toys. Amazon.com has also entered the online auction market, and is a major investor in several other online stores including drugstore.com and Pets.com. Amazon.com was the first to institute 1-Click instant purchasing, and the marketing-savvy 400,000 strong Associates Program. Other site features include gift certificates; book promotions, original articles, and reader reviews; a Power Search that accepts any combination of book information; lists of top purchases by various groups and locales; free electronic greeting cards; and a new short story contest. Unfortunately, the site is painfully slow compared to others, essential navigation tools are not always available, and the online inventory status isn't always accurately reflected at time of purchase. Amazon.com is currently the largest distributor of books on line.

Book Search is best used for specific purchases, as it accepts exact and partial author and/or title in addition to ISBN and publisher information. It employs a subject (keyword) search, but like other bookstores it does not allow for Boolean searches or other advanced features, and there is little cross-referencing among synonyms. The resultant hit list is poorly sorted and contains many extraneous selections, but the subject search may be the only route into Amazon's extensive database. Browse for books by subject or by selected categories such as bestsellers, featured in the media, award winners, and bargain books, but be aware that these browse lists are not meant to be comprehensive; if what you're looking for isn't here, you'll need to consult the subject search engine. Note that there are special collections such as books discussed on Oprah; a John Grisham store; and Comic Books, Magna, and Anime.

For physicians and other health professionals, Amazon.com has an extensive offering of books. Book Search will bring up specific selections, or browse the Professional and Technical/Medical section for textbooks and other clinical references. The Medical Informatics subsection lists 67 "bestsellers" in alphabetical order, although most selections are geared for the general population or computer neophytes rather than medical or computing experts. The Administrative section is stronger from both a general interest and a practical perspective. It includes a Practice Management subsection containing 100 "bellsellers." With its many sections and subsections showcasing best sellers in attractive layout, online browsers will appreciate Amazon, especially if they appreciate mainstream literary promotions.


 
Sections Barnes and Noble

BN.com, the home of the national bookstore chain's Web site since March 1997, has the largest standing inventory and is the second largest online book distributor, as well as selling music and software. It highlights its eBooks section (Amazon carries eBooks but I was unable to locate a specific section for them) and an active Chat and Web Radio broadcast reportedly full of interviews with authors and other book-related promotions. Other products include Prints and Posters, and Magazines. Like Amazon, it offers free e-cards and a host of online features to promote its books.

Browse Subjects or special features such as Oprah's Pick, Award Winners, Bestsellers, Recommended, and New Releases. Special lists such as Dummies Books and the Independent Thinkers Series are fun. Its search engine accepts keywords, title, and author only, but otherwise has the same strengths and limitations common to most online bookstores. One nice search feature is the ability to limit searches to books within a subject, but this feature is not present on every subject's home pages. The Results page contains books listed in order of number of sales, which I found less helpful than listing books by publication date or even alphabetical order.

Among the Specialty Stores sits Professional Books, with its Medical subsection. The clinical sections are rich, as are listings for other health professions, but note that Medical/ Medical Education and Informatics is empty. By performing a limited search of "informatics" within the Medical subject, I obtained 334 hits, many which were relevant but even more of which were extraneous. Unfortunately, the Computer subject, which appears strong in depth and breadth, does not have a healthcare subsection or the limited search feature. Likewise, BN.com's extensive Business section does not have a healthcare subsection, and a number of books highlighted on Amazon as best sellers were not even listed. Those looking to browse a list of medical business, informatics, or computing books will not be pleased with BN.com, as opposed to those looking for a specific book on this or another medical topic.


 
Sections Fatbrain

Self-described as "the most comprehensive bookstore for professionals," Fatbrain.com specializes in books, training materials, and print-on-demand documentation for business, finance, math, science, and technology. From its origins five years ago as the Silicon Valley start-up CBook Express, then ComputerLiteracy.com, the one-year-old Fatbrain.com maintains its roots in computers and technology. Fatbrain.com is the first e-commerce provider to deliver secure digital publishing, eMatters, and in providing customized intranet bookstores to large corporations. It prides itself on individualized customer service and same-day shipping.

Fatbrain.com has the most straightforward and information-rich Web site. Browse Subjects or special categories such as New Titles, Bestsellers, Recommended, and What's Hot. As with most bookstores, a keyword search is a mixed blessing that brings up all permutations of a subject. But the same engine accepts searches by title, author, subject, publisher, or ISBN, and hits can be sorted by alphabetically or by date, availability, bestsellers, recommendation, publisher, title and subject. Both Browse and Search lists have a nice collection of features: links to more information (which varies from none to book excerpts, site reviews, and tables of contents), purchase, whether the book is in stock, and whether it has accompanying software. Of all sites described here, Fatbrain has the most generous and relevant information about individual books.

Fatbrain.com carries professional Medicine titles within its Science and Engineering section. While it appears comprehensive at first glance, the Clinical Medicine subsection Browse list has some curious omissions, such as Neurology, (though well over 150 books are located under Medicine/Neurosciences/Clinical Neurology). Its Computers in Medicine/Informatics subsection carries about 70 books, although many of those listed under General Informatics are on medical technology such as EKGs and ultrasound. Yet Fatbrain has perhaps the most extensive online resource in this area; most books related to medical computing are scattered throughout the site under different section headings, which makes sense from the perspective of Fatbrain as a computer bookstore. There is also a Medicine/Administrative section, with a Medical Practice subsection that is much smaller than Amazon but filled with juicy titles. From a browser's perspective other online bookstores will be more appealing -- but before making any purchase, check out Fatbrain for its information on each book, and for its competitive pricing.


 
Sections MedBookstore

Medsite offers a number of online services for physicians, primary among them Medbookstore, which sells medically related books, software, and supplies. Access the bookstore by clicking on the Book icon on top of the home page. Note that Medbookstore has an active affiliates program, so there are many bookstores co-branded with their partner's site name throughout the medical Web. For example, although Physicians' OnLine's Medbookstore sports a different interface, it is the identical database described below.

Browse by Specialty is divided into categories: Allied Health, Clinical, Consumer, Nursing, and Pre-Clinical. The Clinical category is further subdivided by medical and surgical specialties, interspersed with other topics such as business and medical ethics. Subcategories are presented as keyword search results in lists that vary from several dozen (47 lymphology entries) to hundreds (254 family medicine entries, 438 genetics entries) to thousands (1,958 neurology entries). Although extensive, lists are easy to navigate, as they can be sorted alphabetically or by author, media, publication date, or availability.

The Clinical category includes an Old, Rare, and Out-of-Print Health section. There are presently 133 entries, although no information about condition, print edition, illustrations, etc., is provided.

Visitors can also browse by Recommended Titles, selected by Medsite in association with various organizations and institutions. It's a good idea and in some cases the criterion is obvious, such as positive reviews from the New England Journal of Medicine. In other cases, however, the criteria for selection are not identified, and the selections are odd at best. Other browsing lists include New Titles, Upcoming Releases, and Best Sellers.

Features include a synopsis ÷ often more promotional than informative -- that accompanies many books. Visitors can vote and share comments on line, though these features did not appear very active. I don't know if votes and comments are shared among all Medbookstore sites.

Physicians looking for new or upcoming titles should enjoy those lists, but overall I found it easier to search for specific titles than to use Browse by Specialty. Medbookstore.com has competitive (although rarely the lowest) prices, but here's a potential deal breaker: for all methods of shipment: Medbookstore calculates shipping cost by weight. These shipments can be quite expensive, especially for weighty and multiple purchases or quick deliveries.


 
Sections Powell's

Anyone familiar with Portland, Ore.'s "City of Books" will recognize its Web site, Powells.com. Billed as "the largest used and new bookstore in the world," Powell's huge inventory ÷ more than a million and a half books ÷ and dedicated staff (see Staff Picks) are all on line, as is its merciful avoidance of commercialism. Its busy but well organized home page gives access to all site features, including sales, textbooks, eBooks, Rare Book Room, Other Voices, Lists, Author Events, specials, and interviews. Visit this bibliophile's heaven, and you'll never look the same at Amazon or BN.com.

Powell's is a browser's delight. It has over 3,000 subsections ÷ so many that its index has its own search engine! Unfortunately, there is little here for physicians; its health section is full of non-technical, non-professional books. Its computer section fares better, although there's little on medical computing or informatics beyond the most obvious titles. Use the search engine to locate specific books, but don't expect to find many professional titles.

For physicians, Powell's is best at used or rare books. The search engine calls up used books alongside new, as most Powell's customers appreciate this purchase option; Powell's is known for the quality and quantity of its used books. Collectors will find rare books and satisfying descriptions of each product grouped in their own section, with Health an active subsection.

Powell's is a wonderful real and virtual bookstore for non-professional needs. Unfortunately, it doesn't offer a good selection for new professional books but as the Comparative Test demonstrates, you may luck out with a used book for a fraction of the cost.


 
Sections Varsity

VarsityBooks.com, launched in August 1998, now ranks among the most visited college-oriented Web sites. It presently boasts an inventory of over 350,000 books and posts booklists from more than 400 colleges and universities. Varsity prides itself on customer service, good prices for new textbooks, and modest flat fees for shipping.

The site's home page is noisy, even confusing; Browse by Subjects is hidden at the bottom of the page although it is probably the best approach for browsers looking to access Varsity's full database. There are other browsing lists as well, such as Fiction and Literature, Business Bestsellers, Travel and Adventure, Computers and Technology, Certification Manuals, and Study Aids and Guides. Most books are presented with no information beyond title, author, publisher, ISBN, price, and availability, but the more popular titles are accompanied by synopses (which read as quotes from promotional material) and unimpressive lists of related books.

Under subjects for browsing, Professional Medical is divided into Clinical, Pre-clinical, Reference, Review, and Other. The Clinical section includes most medical specialties, along with medical student oriented topics such as ECG and Laboratory Medicine. With its academic emphasis, Browsing by Subject is a reasonable way to locate popular textbooks and study guides; for example, Neurology contains 40 selections. Prices are excellent, but Varsity's database doesn't have the same depth as, for example, Fatbrain, Medbookstore.com, or even Amazon or BN. Surprisingly, it also has no used books. The Computer Science section emphasizes professional and technical titles, and its prices are very competitive, but here too the database cannot compete with Fatbrain or Amazon. Keyword searches in medical informatics and related fields call forth a handful of books, but the search engine is the best bet for locating specific books. Unfortunately, search results with a large number of hits are clumsy to navigate, as titles are listed in alphabetical order only.

Varsity presents itself as a college bookstore, but it is a reasonably good online resource for professionals as well. The database is relatively limited and the site itself suffers in comparison to other online bookstores, especially Fatbrain and Powell. Visit Varsity after checking out more informative sites, to take advantage of its competitive pricing and shipping costs.


 
Sections Other

Doody Publishing's medbooksNOW.com has several nice features -- not the least of which is Doody Book Reviews and Ratings accompanying many of the more popular titles. The site also offers a listing of new books and electronic media, and recent Medline citations, both accessible by medical specialty (select All Available Specialties on the top of the left navigation panel). It's impressive that all selections listed in the Comparative Test were available (although not all were in stock). But even with all books discounted 10% below suggested retail, medbooksNOW.com never offered the best price, and in several cases were more expensive than the other bookstores. Worse, the only alternative to $4.50 standard shipping is air, at an expensive $20 for the first book. Doody Publishing has the same bookstore interface and inventory, but presented in association with a number of organizations and institutions. Despite its impressive medical inventory, Doody was not included in the main body of the review because it hides its book supplier, and the site is without basic customer services and information Web users have come to expect.

UK's Blackwell's Bookshops has an extensive online database, including many medical and computing selections. I've heard good things from other physicians about its European and international (including U.S.) shipments.

Used books, as Powell's demonstrates, can be an excellent resource, especially for dated or well-established books. Halftime Books buys and sells used books and other things without the auction hassle. The inventory has depth but professionals need to search for specific titles; the browsing sections are clearly for general public and popular books. Follett's efollett.com is a large seller of new and used textbooks. Note that the schools listed under Medical Textbooks are not medical schools. Best to search by author or ISBN, or perform a partial title search; a full title search may miss those that are abbreviated in the database. Textbooks.com, an affiliate of Barnes & Noble, also sells used (and new) textbooks.

Two options for the new millennium: NetLibrary distributes eBooks, which are digitalized books that can be downloaded to a desktop or handheld. Among its extensive offerings, browse the 200+ eBooks alphabetized under Internal Medicine and many hundreds more under Computers. Finally, Books Online, founded in 1993 by John Mark Ockerbloom, contains a database of over 10,000 books that can be freely read directly off the Web. An eclectic group of hundreds of less established booksis listed under Medicine and Mathematics and Computer Science.


 
Sections Summary

Amazon and BN are the two most popular online bookstores with the most extensive general databases. In particular, Amazon includes many professional and technical books on medicine and computing. But rarely does it offer the best book price and shipping cost, so in many cases purchasing elsewhere can result in substantial savings. Only in one case -- Fox & Levine's How to Join, Buy, and Merge a Physician's Practice -- did Amazon offer the lowest price of the group on a new book; this appears to be a publisher's discount, since it also offered an online interview with one of the authors.

Overall, Varsity has the most competitive prices for core medical and computing books, and it also has the best shipping rates and policy ÷ it ships an unlimited number of books UPS Second Day for the flat fee of $4.95. Varsity's inventory is surprisingly broad given its college bookstore motif, but its database lacks the depth ÷ and in some cases, the discounts -- of medical specialty bookstores such as Fatbrain, Medbookstore, or medstoreNOW.com, or even large general bookstores such as Amazon.

Fatbrain is the clear winner for professional/technical computer books, especially for books on medical computing, but it also has an extensive clinical medical section that rivals Amazon, Medbookstore, and MedstoreNOW. Fatbrain's prices are competitive, and it also has the second best shipping rates and policy of the group, including the lowest rates for UPS Next Day. Also, Fatbrain is the only bookstore that offers Saturday delivery. MedstoreNOW.com has an extensive online inventory, and Medbookstore prices look appealing at first glance, but both are more than balanced by high shipping rates; however, Medbookstore's discounts may be competitive for the lightest books shipped at the slowest rate.

Powell's is a bibliophile's dream but it has virtually nothing in its new book database for physicians. Still, it has a nice selection of used and rare medical books, and offers free standard shipping for purchases over $50. Those looking for general computing books may find what they're looking for as well, although Fatbrain or even Amazon have more extensive databases.

Powell's, Fatbrain, and Varsity pride themselves on their customer service, including personalized service by e-mail or telephone, so your inquiries regarding a specific book are welcome at these bookstores. I've had a good experience with Powell's, in that they located a relatively rare non-medical book within their stacks and shipped it that day for next-day delivery, when all neighborhood and other online bookstores failed. I've experienced unbearably long telephone queues with Fatbrain, but once connected their service was excellent. Amazon invites book requests via e-mail, but its customer service is notorious for being pedestrian at best (with one exception: Amazon is known for giving prompt, no-questions-asked attention to screw-ups or non-arrivals).

Dealtime: Books compares the cost (plus shipping) of a specific book, making it easy to find the best online deal. Search by title, author, and ISBN for specific books, including professional books. Dealtime is a very nice resource that covers the most popular online bookstores, but unfortunately it misses some of the best sites.

Whether through Dealtime or by visiting each site individually, one thing is obvious: purchasing books on line is an established and safe convenience, but with such differences in price and shipping costs, it clearly pays to shop around.


 
Sections Comparative Test: Prices

To test the different stores I browsed or searched for five books at each site. These are not recommendations -- my selections were made essentially at random and I'm not familiar with all of them. This test was designed to include popular and uncommon books; new, less recently published, and out-of-print classic texts; both large and small publishing companies; and clinical, medical computing, and medical business subjects. Just for fun, I also included Stephen King's latest, an eBook with a list price of $2.50, not available in print but only by download on the Internet. All books were searched for using both the full title and author(s) before determining the selection was not listed. Note that total cost at each store depends on applicable sales tax and shipping fees.

HARRISON'S PRINCIPLES OF INTERNAL MEDICINE (McGraw-Hill, 8/97)
Amazon: $125 (single volume), $149 (two volume set), no platinum edition or CD-ROM listed; usually shipped in 24 hours
BN: $125 (single volume), $149 (two volume set); $149 (platinum edition, which includes Internet subscription); $175 (CD-ROM), usually shipped within 24 hours
Fatbrain: $115 (single volume), $139 (two volume set), $149 (platinum edition, which includes Internet subscription), no CD-ROM listed; shipped same day
Medbookstore: $112.50 (single volume), $134.10 (two volume set); $157.50 (CD-ROM ÷ same price for both version 1.1 and 1.2, the earlier available without a warning or other reference to the more current version), no platinum edition (Medsite offers 10% discount for Harrison's Online alone); usually shipped within 1 business day.
Powell's: none of the above; $30 (used text, 11th edition (1986), shipped in 1-3 days)
Varsity: $97.75 (single volume), $118.15 (two volume set); $126.65 (platinum edition, which includes Internet subscription); no CD-ROM; ready to ship

PLUM'S DIAGNOSIS OF STUPOR AND COMA (FA Davis, 7/82)
Amazon: out-of-print (book listed as two separate entries)
BN: not listed
Fatbrain: $32.50; usually shipped within 2-3 weeks
Medbookstore: unavailable as it is out-of-print
Powell's: $21.50 (used ÷ standard condition); shipped in 1-3 days
Varsity: not listed

SMITH & EDWARDS' THE INTERNET FOR PHYSICIANS (Springer Verlag, 4/99)
Amazon: $29.95, usually shipped in 24 hours
BN: $29.95, usually shipped within 24 hours (error in listing year of publication)
Fatbrain: $29.95, usually shipped within 3-4 business days
Medbookstore: $26.96, usually shipped within 1 business day
Powell's: not listed
Varsity: $21.21; currently out-of-stock at the publisher, should be available in a few weeks

FINK'S HOW TO USE COMPUTERS AND CYBERSPACE IN THE CLINICAL PRACTICE OF PSYCHOTHERAPY (Jason Aronson, 1/99)
Amazon: $30, usually shipped within 2-3 days (found only by searching author)
BN: $35, usually shipped within 24 hours
Fatbrain: $28, usually shipped within 3-4 business days
Medbookstore: not listed
Powell's: not listed
Varsity: $34, ready to ship

FOX & LEVINE'S HOW TO JOIN, BUY, AND MERGE A PHYSICIAN'S PRACTICE (see below for different publishers and dates despite same ISBN)
Amazon: $26.95, usually shipped in 24 hours (publisher is Mosby-Year Book, 10/97) (site has an interview with one of the authors)
BN: not listed
Fatbrain: $31.95, shipped same day (publisher is Harcourt Health, 8/97)
Medbookstore: $28.76, usually shipped in 2-3 weeks (publisher is Mosby-Year Book, 1997; found only by searching author as title is missing apostrophe)
Powell's: $20.95 (used ÷ standard condition); shipped in 1-3 days
Varsity: $30.35, ship in 1-2 weeks (publisher is Harcourt Health (Mosby), 1998)

KING'S RIDING THE BULLET eBook (Simon & Schuster, 3/00)
Amazon: free
BN: free
Fatbrain: not listed
Medbookstore: not listed
Powell's: $2.00
Varsity: not listed


 
Sections Comparative Test: Shipping Costs and Taxes

To quote Tom Wait's song Step Right Up, "The large print giveth, and the small print taketh away." So it is with online shopping. The book price may look good, but before you buy, check out the differences in shipping costs and sales tax.

Prices don't vary much for standard shipment of one comparative test book via UPS Ground: Fatbrain, Amazon, and BN each charge just under $4; Powell's charges $5.00 (and offers free shipping for orders over $50), and Medbookstore charges $5.00 to $6.00, though its price-by-weight policy will be felt more with larger orders. Varsity doesn't offer standard shipping, but it has a great deal for UPS Second Day Air, shipping all books for a flat $4.95; all others charge between $8.00 and $9.00 for Second Day Air and extra for additional books, with the exception of Medbookstore, where the weight of Harrison's single volume brought total shipping to over $18.00. Fatbrain beats Amazon's and BN's $10.99 Overnight/Next Day Air by a dollar, so all three are best choices for quick delivery -- although Varsity's $17.95 includes an unlimited number of books. Note how shipping by weight makes a big difference here, with Medbookstore charging $22.50 for Fox & Levine's paperback and $41.00 for Harrison's. Other services are available at some stores.

UPSP Book Rate (10-14 business days, up to 8 weeks, uninsured):
Powell's: $3.50

Standard (UPS Ground 3-7 business days):
Amazon, BN: $3.99
FatBrain: $3.95
Medbookstore: by weight: $4.71 (Fox & Levine's paperback); $6.16 (Harrison's textbook)
Powell's: $5.00 (free shipping on orders over $50)

Expedited (2-3 business days):
FatBrain: $4.95

UPS Second Day (2 business days):
Amazon, BN: $7.99
FatBrain: $7.95
Medbookstore: by weight: $8.80 (Fox & Levine's paperback); $18.50 (Harrison's textbook)
Powell's: $9.00
Varsity: flat rate: $4.95

Overnight/UPS Next Day (1 business day):
Amazon, BN: $10.99
FatBrain: $9.95
Medbookstore: by weight: $22.50 (Fox and Levine's paperback); $41.00 (Harrison's textbook)
Powell's: $17.00
Varsity: flat rate: $17.95

Overnight for Saturday delivery:
FatBrain: $19.95

Sales tax is always added when shopping in person. But to encourage online shopping, Congress has placed a moratorium on sales tax for out-of-state purchases on the Internet. Tax is charged only if the books are shipped to states where the bookstore and/or its warehouse(s) are located, as listed below (accurate as of May 2000. Please check with site to confirm). Note that shipping costs are included when calculating tax:

Amazon: Washington
BN: Tennessee, New Jersey, New York, Virginia
Fatbrain: California, Kentucky
Medbookstore: New York
Powell's: Oregon
Varsity: Illinois, District of Columbia
 

 
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