We live and work in an age where it is possible to create, edit, and distribute a new content without a physical copy ever existing, so it might surprise you to learn that not everyone uses the latest tools. Some, in fact, use tools that are positively Victorian.
Take Stephen Pastis, for example. As you'll see in the following video, he draws his Pearls before Swine comic strip in ink on paper. Just to put this in a writing perspective, this would be like a writer choosing to forgo even a typewriter and instead use a pen and a pad of paper to write stories. I have trouble picturing it; how about you?
And in case you're wondering, it doesn't have to be that way. This video, which was sponsored by Wacom (they make graphics tablets), also stars Scott Adams. He draws his Dilbert comic strip on a Cintiq Companion.
TBH, this video is a humorous advert for Wacom, but I thought it was worth watching just to show how dated some current tech really is. Sure, Pastis's method works, but it takes so much time and uses so much in the way of resources.
The next time that you think publishing is inefficient, just think of how much a comic can cost.