Going, going, gone: The developing invisibility of classic challenging texts in health/medical academic libraries

HLG Nursing Bulletin Vol. 38 (2)

Dr Frank Houghton
Director, HEALR Research Group
Limerick Institute of Technology

This anecdotal account outlines how online purchases of second-hand classic and challenging texts in the health sphere began to evoke fears of their gradual disappearance from academic libraries. It discusses the crucial impact of such texts and argues against their removal. Rather than weeding out these texts, it is argued that they should be celebrated and marketed more vigorously. Particular attention is given to the ongoing relevance of books that have exposed the machinations of Big Tobacco.

I am, it must be acknowledged, a book lover. The reassuring tangible tactile weight of knowledge, combined with the particular appealing smell of old books (‘biblichor’) continues to exert a pull on my senses and emotions. Having reflected on and acknowledged my bias in this area, I am therefore hesitant to continue writing; however, the issue involved is so important that it demands attention.

Some years ago I decided to slowly build up my own personal library of classic texts in my areas of academic interest. These were broadly across the overlapping domains of health/medical sociology, public health, medical/health geography, psychiatry, psychology, and more recently tobacco control. Having only a limited budget to expend on this enterprise I continued my lifelong habit of buying the books second-hand (though I prefer the term ‘pre-loved’). In my youth this involved visiting stores physically, whereas now it can easily be done online.

Initially I was delighted to be able to purchase a host of inspiring seminal texts that disrupted standard academic discourse in health and medicine for almost nothing. Some could literally be purchased for as little as 1 cent, with the majority of the remaining cost paid ostensibly being towards postage and packing. Although a few of these were obviously personal copies, over time I have become increasingly alarmed by the growing number that formerly belonged to academic libraries. Any concerns I had that I might have been, albeit unwittingly, encouraging the theft of such books for resale were assuaged by the routine appearance of various university stamps stating that the item in question had been officially ‘withdrawn’. As I almost always purchase such texts that are described as being in either ‘Used – Like New, ‘Used – Very Good’, or ‘Used – Good’ the reason for their withdrawal cannot be attributed to simply ‘wear and tear’ and clearing valuable shelf space for freshly printed replacement copies.

My concern therefore is that crucial ground-breaking and often radical texts, that are so important to an informed and comprehensive debate, are slowly being weeded out of many health/ medical libraries. I would like to think that perhaps what I am seeing is simply the result of skewed sampling and is not representative of wider developments. However, my level of concern is such that I feel it is important to put pen to paper (or finger to keyboard) to explore this issue in more depth. After all, I could easily see how older texts could be assumed to be less relevant. In an age of increasing emphasis on the aesthetics of library spaces, budget constraints on physical expansion, and the ever growing number of texts to be housed on limited shelf space the dilemma is obvious. I could also see how junior faculty, who might often take such texts as both historical and a ‘given’, would be less inclined to recommend them. Particularly to busy students juggling work, school, personal lives, and loans who are thus forced to be brutally strategic in their coursework related reading.

I understand that ‘weeding’ decisions are never easy, and the issue I raise is one that probably gives collection, preservation and archive librarians sleepless nights. However, I do feel that on-line availability is not quite the same thing. Neither is keeping such texts in less immediately accessible locations such as inaccessible stacks or collaborative offsite locations. The gravitas of the kind of ground-breaking texts that I am referring to is undermined in electronic format. Similarly, remote storage prevents serendipity and the joy of discovery of these works. It is a faint hope that my anecdotal observations are merely the pruning of duplicates, but this offers only minimal comfort in relation to such important texts.  

It is interesting to note that the Bulletin of the World Health Organization has for a long time included an ongoing section on ‘Public Health Classics’. The kind of books that I am referring to are challenging texts such as Ivan Illich’s Medical Nemesis (Illich, 1975), Thomas Szasz’s The Myth of Mental Illness (Szasz, 1961), and Erving Goffman’s Stigma (Goffman, 1963). There are of course many more along similar lines. However, even if such powerful classic works are thought to be too polemic (Kelly et al, 2010) (Houghton, 2010), a more widely acknowledged body of literature of paramount importance in health/ medical terms must be that relating to the nefarious and perfidious activities of ‘Big Tobacco’. I am thinking specifically of texts such as The Cigarette Papers (Glantz et al, 1996), Ashes to Ashes (Kluger, 1996), the Golden Holocaust (Proctor, 2011), Doubt is Their Product (Michaels, 2008), and Merchants of Doubt (Orestes, 2010). These works detail ample evidence of ‘Big Tobacco’s’ history of wrongdoing. Industry documents obtained through whistleblowing and the Master Settlement Agreement (MSA) have clearly exposed an industry that has blatantly lied to Congress, targeted children and minorities, increased the addictive properties of its product, and attempted to muddy the waters of science to deny mounting evidence of the harmful impact of tobacco. Alarmingly, my more recent second-hand purchases in this field have identified a similar trend in the sales of former university texts.

Big Tobacco has been likened, quite appropriately, to the many headed hydra of Greek mythology (Henriksen, 2012). As one head is cut-off, two more grow in its place. It should be noted that there are one billion smokers globally and smoking remains the world’s leading cause of preventable mortality and morbidity (Drope et al, 2018) (GBD, 2015) (Öberga et al, 2010) (Lim et al, 2012) (WHO, 2013). Although it is true that the market for tobacco in countries such as Canada, Australia, New Zealand and the European Union has become increasingly more regulated, the tobacco industry has not given up its quest for new smokers. As well as mounting continual legal challenges to regulation in such countries, the tobacco industry has also simply turned its attention in a more focused manner to the more fertile sales opportunities in Africa, South America, Asia, and the former USSR (Gilmore et al, 2015) (Gilmore et al, 2004 [I]) (Gilmore et al, 2004 [II]) (O’Sullivan, 2000) (Stebbins, 2001). As such it is crucial that future health/ medical workers continue to be aware of the array of tactics and strategies used by ‘Big Tobacco’. Therefore, instead of selling off these, and other seminal works, more must be done to promote them.


1. Illich I. Medical Nemesis: The Expropriation of Health. London: Calder & Boyars; 1975.

2. Szasz, T. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Hoeber-Harper; 1961.

3. Goffman E. Stigma. London: Penguin; 1963.

4. Kelly BD, Bracken P, Cavendish H, Crumlish N, MacSuibhne S, Szasz T, Thornton T. The Myth of Mental Illness: 50 years after publication: What does it mean today? Ir J Psychol Med. 2010 Mar; 27(1):35-43.

5. Houghton F. Psychiatry, hegemony and the myth of mental illness. Ir J Psychol Med. 2010;27(2):103.

6. Glantz SA, Slade J, Bero LA, Hanauer P, Barnes DE. The Cigarette Papers. London: University of California Press; 1996.

7. Kluger R. Ashes To Ashes. America’s Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris. New York: Vintage Books; 1996.

8. Proctor RN. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. Berkeley: University of California Press; 2011.

9. Michaels D. Doubt is Their Product: How Industry’s Assault on Science Threatens Your Health. New York: Oxford University Press; 2008.

10. Orestes N, Conway EM. Merchants of Doubt: How a handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming. London: Bloomsbury Press; 2010.

11. Henriksen L. Comprehensive tobacco marketing restrictions: promotion, packaging, price and place. Tobacco Control 2012;21(2):147-153. doi:10.1136/tobaccocontrol-2011-050416.

12. Drope J, Schluger N, Cahn Z, Drope J, Hamill S, Islami F, Liber A, Nargis N and Stoklosa M. The Tobacco Atlas. 6th Ed. Atlanta: American Cancer Society and Vital Strategies; 2018.

13. GBD 2015 Tobacco Collaborators., et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017;389(10082):1885-1906.

14. Öberga M, Woodward A, Jaakkolac MS, Perugad A, Prüss-Ustüne A. Global estimate of the burden of disease from second-hand smoke. Geneva: WHO; 2010.

15. Lim SS  et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2224–60.

16. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2013: Enforcing bans on tobacco advertising, promotion and sponsorship. Luxembourg: World Health Organisation; 2013.

17. Gilmore AB, Fooks G, Drope J, Aguinaga Bialous S, Jackson R. Exposing and addressing tobacco industry conduct in low- income and middle-income countries. The Lancet 2015;385(9972):1029-1043.

18. Gilmore AB, McKee M. Moving East: how the transnational tobacco industry gained entry to the emerging markets of the former Soviet Union – part 1: establishing cigarette imports. Tobacco Control 2004;13(2).

19. Gilmore AB, McKee M. Moving East: how the transnational tobacco industry gained entry to the emerging markets of the former Soviet Union – part II: an overview of priorities and tactics used to establish a manufacturing presence. Tobacco Control 2004;13(2).

20. O’Sullivan B, Chapman S. Eyes on the prize: transnational tobacco companies in China 1976-1997. Tobacco Control 2000;9:292–302

21. Stebbins KR. Going like Gangbusters: Transnational Tobacco Companies “Making a Killing” in South America. Medical Anthropology Quarterly 2001;15:147–170. doi:10.1525/maq.2001.15.2.147

Dr Frank Houghton is a Public Health Geographer with experience of working in Public Health in Ireland and New Zealand. He was formerly a tenured Associate Professor & Chair of Public Health in the College of Health Science & Public Health at Eastern Washington University in Spokane, WA, USA. He is currently a postgraduate student on the MA in Information & Library Studies at Aberystwyth University.

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