So what does health care have to do with “open”? Much more than you might at first think. Let me illustrate a few of the ways…

• Innovation requires risk. Intellectual risk, for sure, but perhaps more importantly, risk to your finances, to your family, to your future. To do something new and innovative, and especially to go against the grain, as so much of open science, open education, and other similarly motivated ideas run, is to take on significant personal and professional risk. In America, that risk to individuals is unacceptably high, given that it often includes foregoing such basic guarantees as health care. Health care reform means that we have lowered the threshold for action by the innovators of tomorrow. Don’t be afraid to take a chance, we’ve got your back.

• The grand challenges we face as a society – climate change, public health, energy security, to name a few – these problems are big. They are burly. They resist simple reduction into a controlled study here, an opinion poll there. To get a handle on these issues, we need data – lots of data. And we need collaboration – massive, distributed collaboration. And we need cooperation, even among competing interests, where the system positively reinforces activities the reduce the risks to society even as it improves the bottom lines of the businesses involved. Health care reform holds the potential to shift the focus from profit to care, from rendering tests to preventing disease, all of which requires greater openness, and greater sharing. Look for a revolution in public health research and outcomes in the years to come.

• Health education is desperately needed around the globe. Many institutions are trying to share their medical education materials more broadly, but the costs are high, and there are thorny thickets of laws regarding health records, medical images, and other patient-oriented data which impede sharing. People are rightly reluctant to provide personal health information publicly for fear that the insurance companies can use it against them. Health care reform eliminates this fear, thereby opening the floodgates for public health data and associated educational materials to be shared, adapted, and localized the world over. The era of educational opportunities, personal genomics, and patient empowerment is here, and openness is a big part of the picture.

There will be people who will try to stop all progress. There will be those who will try to exploit the complexities in the system and throw obstacles in our way. But we have to seize this chance to catalyze a more open and effective society, in education, in science, in everything. Our health care “system” is so broken, it’s hard to believe there any defenders left. But as with our education “system,” which is similarly dysfunctional, change has proven more difficult to implement than it is to talk about. How refreshing to see action in Congress instead of so many words. Yes, there is still room for vast improvement, but enough dithering. The future awaits, and it looks more open than ever.

A subset of that movement has been focused on getting openly licensed textbooks into classrooms. Flat World Knowledge is often cited as being a leader in the commercial distribution of open content, relying on supplemental materials for sustainability. But until just recently, the concept of open (not just “free” or “digital”) textbooks hadn’t begun to creep into education policy discussions. But now it has, and as usual those organizations in a position to embrace and benefit from change make it their business to oppose it. Just as the music and movie trade associations went after innovative technology, textbook publishers are fighting innovation and change in their industry.

The Association of American Publishers (and its School Division in particular) are quickly becoming one of the main barriers to the adoption of open educational content in K12 and higher education. When the U.S. Dept. of Education wanted to require that any educational materials developed with Race to the Top funding (a $4.35 billion dollar state education grant competition) be made “freely available”, the School Division submitted comments opposing the requirements saying it would “compromise the intellectual property rights of third-party providers.” Basically, the AAP didn’t like that public money would fund public, rather than proprietary, content. And at least according to the AAP, the rule has been changed to allow for Race to the Top funding to go towards proprietary content.

But the AAP doesn’t limit itself to influencing policy at a high-level. They’re movings towards co-opting a desire for textbook reform at the grassroots level.

Take a look at this flier for an upcoming AAP briefing at Southern Illinois University on “New Textbook Technologies”. From the flier:

The goal for the Cost Effective Solutions for Student Success program is to begin a broader and more informed discussion between members of the academy, policy makers and publishers about course materials and the benefits they offer for:

• Improving students’ grades, pass rates and retention;
• Lowering students’ costs for course materials;
• Providing flexibility and efficiencies for instructors; and
• Lowering the postsecondary institutions’ cost per pupil for instruction.

The AAP frames their briefing at Southern Illinois University as an attempt to begin a “broader and more informed discussion” about textbooks. Apparently members of the academy, policy makers, and publishers (students notably absent) had been having a less than optimally informed discussion about course materials. But what we don’t know based on this flier is what kinds of information they will be providing.

Luckily for us, on the AAP-operated site TextBookFacts.org, they have a handy FAQ which hopefully will start this more informed dialogue. From the FAQ:

The cost of developing a new textbook and the accompanying materials can exceed $1 million. Most of this cost is attributable to paying for the work and original ideas of authors, experts, editors, researchers, reviewers and designers. Many other factors also contribute to the final retail price of textbooks, such as:

• Inflation, which accounts for the lion’s share of most years’ annual increases in textbook prices.
• Freight and transportation, which are driven by rising fuel costs
• Bookstore mark-ups, which are determined by bookstores and affected by a number of factors – such as staff and operational costs – that vary from store to store
• Paper, which is driven by the cost of raw materials
• Layout, typesetting and printing, which are driven by time-intensive labor costs
• Taxes by federal, state and local governments

The AAP falsely claims that inflation is a main factor in the rise of textbook costs. In fact, according to the Government Accountability Office, the costs of textbooks have increased by twice the rate of inflation.

They also misrepresent the costs associated with textbook development. According to a 2007 University of Wisconsin budget review (citing a 2006 College Store Industry Financial Report by the National Association of College Stores), 77.8% of the cost of a textbook goes to the publisher. Of that 77.8%, the break down is roughly:

Only 33.5% of the cost is due to the physical production and shipment of the book. The rest is marketing, profit, overhead, and unnecessary expenses avoidable through different models of knowledge production and dissemination (but more on that in a bit).

They continue:

Student Monitor, an independent student research service, found that the average four-year undergraduate spends approximately $650 a year on textbooks. That’s less than five percent of an average student’s total direct higher education expenses.

Not true. Even back in 2007 the Congressional Advisory Committee on Student Financial Assistance found that “Annual per student expenditures on textbooks can easily approach $700 to $1,000 today.” (Source: Turn the Page: Making College Textbooks More Affordable, A Report of the Advisory Committee On Student Financial Assistance, 2007) Today the cost is likely to be higher.

And even $700-1000 a year seems inexpensive to you, “affordability cannot be assessed by examining the absolute level of total expenses alone. It depends on how much expenses have risen over time, what share of family income they represent, and whether they are typically covered by grant aid for students from low- and moderate income families.” (Same source as above) That is, it isn’t the number that’s important in evaluating costs, it’s the percentage of overall budget and income, taking financial and sociological contexts into account. And the AAP doesn’t really take into account the financial contexts of students… or at least not in the way you might expect. Continue reading their FAQ:

What do college students buy? LOTS! But only a small percentage of these expenditures go towards important learning tools such as textbooks. [...]

This semester (Spring 2009) the average student bought 5.3 textbooks (2.2 new and 3.1 used) spending an average of $333 for both new and used textbooks. (Source: Student Monitor 2009)

Retail spending on new college textbooks last year was about $4.7 billion — significantly less than what college students spend on clothes and accessories and less than half of what they spend on electronic products such as iPods, laptops, video games, stereos and televisions. (Source: Association of American Publishers and the National Retail Federation)

Yes, you read the AAP right! Students are too busy buying iPods, shoes, and concert tickets to notice the high cost of textbooks. Just another drop in the bucket, right?

The AAP implies that college students spend so much on electronics, clothes, and accessories that their textbooks should be considered cheap. So what exactly are students and faculty getting for that low low price of $1,000 a year (roughly the equivalent of buying a high-end laptop a year)?

What is the role publishers play with students and faculty? Publishers serve the needs of students and faculty

Publishers’ primary focus is on meeting the needs of students. Today, a wider range of instructional supplements enable faculty to teach more students and empower students to achieve better results.

Colleges are being asked to serve students with diverse learning styles and a wider range of preparedness and skills. At least 50 percent of students who enter 2- and 4-year colleges drop out in their first year and never return

Only 54 percent of students who remain in college graduate in 4 – 6 years, increasing costs and debts for students and straining campus assets.

So publishers serve needs, help schools to pack diverse groups of students into classrooms, annnnd… not sure what those last two mean. Publishers cause students to drop out and increase cost and debt and strain campus assets?

Maybe the AAP is struggling with this question because they have no good answer. Of course publishers should be responding to the needs of students and teachers. But when it comes to spelling out the details of what those needs are, big publishers in the AAP fail on all counts:

What are the demands that students and faculty place on textbooks?

Today’s students and faculty demand choices

Students and faculty have become smarter, more demanding consumers, who value options.

In today’s challenging environment publishers are offering a broader range of textbooks and instructional materials at a wide range of prices.

Options available today include low-cost editions, one- or two-color editions, loose-leaf editions, split editions, black-and-white editions, custom books, books by the chapter, abbreviated editions, and electronic books.

College instructors adopt the textbooks and supplemental instructional materials that they believe best meet their students’ needs. They want their students to succeed by having the latest information and the most up-to-date learning tools.

Students and faculty want choice, customizibility, low cost, up-to-date, and optionally digital textbooks. Sounds exactly like what OER provide! Not only do you have the legal right to modify and redistribute OER, they are usually digitally provided free of charge. And given the completely public availability of Creative Commons licenses, there is little barrier to any individual, academic, or organization developing and distributing their own textbook at a small fraction of the cost that the AAP claims is required to develop a textbook.

The high-level message the AAP tries to convey is “we spend a lot of money on producing textbooks, but they’re actually cheap and students buy so much crap anyways they can afford it”. And to top it all off, they argue for innovative digital solutions that their own IP-centric business models discourage.

In the end, the AAP gets its numbers wrong, implies students are materialistic spend-heavies who care more about iPods and concert tickets than education, and makes a compelling argument against their own product.