A bit better than when I was in Grad school in the early 1980s. The profs would send us to the local Kinkos to get a xeroxed copy of their course agenda and quite often their textbook. Nope, no digital file that was printed at Kinkos like today. The profs would give Kinkos a printed copy on letter size paper and have them xerox and bind it. It still cost out the backside, usually had a few pages missing, upside down, out of order, or simply too screwed up to read. Of course few people had computers in those days.

But as far as today's textbooks and technical papers, there is no excuse for these being put in PDF format for ebook readers. PDFs are for printing, not for reading electronically. HTML has been around the better part of two decades, so if the publishers cannot figure out how to use it and convert it to different formats, they should not be publishers. If they would use HTML they could easily add hyperlinks and easily convert it to MOBI, ePub, or even PDF. Basically we readers are in the 21st century and the publishers are still in the 20th century--pre-1990s.