PUBLISHERS WEEKLY / APRIL 21, 1989
Books with a Bedside Manner
Bibliotherapy—helping readers with a range of health problems, and concentrating on wellness and sound diet—is on the rise
BY JOHN BETHUNE
Reflecting on the dramatic changes he has seen in health-care publishing in the last two decades, Nathan Keats remarks that the difference is like “night and day.” The owner of Keats Publishing, New Canaan, Conn., recalls that “back in the old days, you’d go to a health convention and all you could see were the halt and the lame. Now it’s a young people’s thing.” When he began publishing preventive health books in 1965, Keats says, “there were no health books to speak of in the general book trade except for a few oddball titles. Now any bookstore worth its salt has got a substantial section devoted to health, nutrition and related subjects.”
Fueling this substantial growth, according to many publishers, has been a profound cultural change in the attitudes of consumers toward health care. Where consumers once left health care almost exclusively in the hands of the family doctor, they now take increasingly active roles in looking after their own health. Doing so of course requires considerable education, which has been supplied largely by newspapers and magazines, radio and television and, above all, books.
If the lay public were once health conscious only when ill, medical research has since reoriented thinking about health. According to Bill Gottlieb, editor-in-chief of Rodale’s Prevention Magazine Health Books division, the public has gradually realized that “health is much more than the absence of disease; health is really a positive state.” Cheryl Woodruff, senior editor for Ballantine Books, argues that “readers are beginning to reject the crisis/disease orientation of traditional medicine. People are beginning to assert their desire to achieve full health and to understand that the individual plays a vital role in achieving full health.” At Crown, Betty Prashken, vice-president, associate publisher and editor-in-chief, asserts that “we all have to be more sophisticated about managing our health care. The days of the beneficent, god-like physician are gone. We’ve become medical consumers, and like all consumers, we have to know what we’re buying.” But “readers are not looking to be made into better health-care consumers,”
says Nancy Fish, publicity manager for Addison-Wesley, “they are looking to be empowered to take care of themselves.”
Patient, Heal Thyself
The popularity of health books no doubt reflects the fact that the cost of a book is considerably less than the cost of a visit to the doctor. Medical care has become so expensive, says Los Angeles publisher Jeremy Tarcher, “that people are looking for ways that they can help themselves, short of going to the doctor. In addition, the relationship between physicians and their patients has deteriorated a great deal, and therefore patients are seeking to heal themselves, because they do not feel that their physicians are doing their part of the job.”
Similarly, Prashker says that readers of health books “are increasing with the high cost of medical care. People are having to become more informed about their bodies and are trying to take more of a role” in their health care. “With the fragmentation of medical care and the fading of the general practitioner,” she adds, “it is necessary for the medical consumer to know what questions to ask.”
But while consumers are relying more and more on themselves for the management of health care, they are not by any means completely abandoning doctors in favor of books and self-help regimens. Joel Gurin, editor of American Health magazine, cites Gallup surveys that indicate that while people are interested in self-help approaches to their health, such as home testing kits and over-the-counter medications, “at the same time they seem to be pretty well satisfied with the care they are getting from their doctors, and in fact, most people say they are more comfortable with their doctors now than they were five years ago.”
Although physicians once may have been perceived as resisting the movement toward self-care, they are increasingly taking the lead in consumer education through books. Commenting on the “interesting trend” in publishing toward comprehensive health books sponsored by official medical organizations and institutions, Bantam executive editor Toni Burbank notes that “some of the medical professionals are very concerned about the flood of advice that is appearing at the lay level. For many years they tended to try to rise above it and pretend it didn’t exist, but now they are taking on a new educational function they did not envisage many years ago. It’s a tremendously positive thing.” Accordingly, Bantam will publish three volumes of child-care books produced by the American Academy of Pediatrics. According to Burbank, the project is the brainchild of Dr. Art Ulene’s Feeling Fine company, which is also working with Random House on similar projects. Burbank says Ulene convinced the Academy that the pediatrician’s role as educator “was being preempted by the enormous flow of consumer information in the child-care area.”
Raiding the Doctor’s Bookshelf
Among other notable publishing projects with official medical affiliations are Ballantine’s forthcoming series from the Duke Medical Center; Crown’s Columbia University College of Physicians and Surgeons medical guides; and Random House’s American Medical Association series. The success of such association books underscores the importance of credentials to readers. Bantam senior editor Coleen O’Shea observes that as consumers are becoming better educated about health issues, “they are looking for the top sources.” A striking example is the popularity among lay persons of two comprehensive health sources originally intended exclusively for a professional audience: the Physician’s Desk Reference and the Merck Manual of Diagnosis and Therapy.
Robert Berkow, M.D., editor-in-chief of the Merck Manual, acknowledges that it “has been an underground consumer book for years,” despite Merck’s resistance to promoting the book to the lay public. Merck in fact refused even to sell the book to lay consumers until 1975, when it abandoned the policy out of a desire not to censor information. Merck still will not promote or advertise the book to the public, according to Berkow, because it is written at a level of sophistication likely to confuse or mislead lay readers about the seriousness of symptoms. Nevertheless, Berkow, says, he does occasionally receive letters from “lay readers who have made a spectacular diagnosis or saved a life” through using the manual.
Despite recent competition from what Berkow describes as high-quality medical guides intended for the lay public, sales to nonprofessionals of the Merck Manual have increased. A recent ownership survey indicated that of 800,000 copies of the 14th edition sold, 128,000 went to lay persons. Berkow believes that its popularity results from word-of-mouth and from the greater depth of clinical information it provides.
Like the Merck Manual, the Physician’s Desk Reference is frequently purchased by lay consumers. Edward Barnhart, publisher of the PDR, says that while the book is sold in bookstores to make it available to allied health personnel, he assumes that a significant number are sold to lay readers. A compilation of official package inserts for more than 2000 prescription drugs, the PDR is distributed free to 500,000 physicians annually. The PDR sells an additional 200,000 copies each year in bookstores. Barnhart says that although the PDR is not promoted to the trade, people find out about it from seeing it in doctors’ offices and through word-of-mouth.
The American Medical Association Family Medical Guide, first published by Random House in 1982 and revised in 1987, is one of several comprehensive medical guides that provide the kind of officially sanctioned information found in the PDR and the Merck Manual at a level of writing accessible to lay people. One of 13 AMA books published by Random House, the Family Medical Guide has sold 400,000 copies in the trade and over three million through direct mail. Janis Donnaud, Villard vice-president and associate publisher, who also acts as publisher of the AMA books, points to two other notable AMA titles in the series, the Guide to Prescription and Over-the-Counter Drugs, which has sold over 800,000 copies through trade and direct mail, and the Encyclopedia of Medicine, just released to the trade. According to Donnaud, the Encyclopedia is intended to provide more comprehensive information about symptoms, diseases, drugs and treatments than the Guide.
Prashker explains that Crown’s Columbia University College of Physicians and Surgeons series of medical guides “really got started with me. I have a strong interest in medical books; in fact, I’m sort of the Crown doctor—I diagnose people and discuss their symptoms with them! For years I had been looking for a book that was between the very elementary home medical guides that various publishers had done and the Merck Manual, which is difficult to follow unless you have an obsessive interest in the subject.” In 1981, Prashker signed a contract for the Columbia Medical School Complete Home Medical Guide, which was published in 1985.
Prashker says that finding the appropriate tone and level of discourse is critical to the success of medical guide books: “You don’t want it to be Mickey Mouse and you don’t want it to be over-technical. The tone we looked for in the Columbia books was knowledgeable, reassuring, realistic and highly informative. It’s aimed at the intelligent lay person.” Burbank at Bantam notes that the firm has turned down “many books by well-qualified, informed doctors who do not understand what it is to sit on the other side of the desk. I think the tone and the general approach, the accessibility, are extremely important, as is the ability to convey extremely sophisticated information without talking down to the reader.”
You Are What You Eat
Perhaps the most revolutionary change in attitude toward health has been the gradual recognition of the impact of lifestyle on health. This change has shifted the focus of medicine from its nearly exclusive attention to illness toward an emphasis on preventive health care. It has also contributed to the shift in primary responsibility for health care from the physician to the individual.
One of the most important elements of lifestyle, and one that has been receiving much attention lately in relation to health, is diet. Bill Gottlieb perceives “almost a cultural revolution in peoples’ thinking about the influence of diet on health. Ten years ago the only place you would have read about oat bran and cholesterol was in Prevention magazine; today you can turn on the television or open any newspaper and that information is blaring out at you.” It is no coincidence, says Gottlieb, that Rodale is printing 300,000 copies of its forthcoming book, The Healing Foods.
Cookbooks and diet books that emphasize healthful nutrition have become an important segment of the health book market. Nathan Keats, who recalls that in the 1960s “doctors would just run in the other direction if you talked to them about diet having anything to do with cancer,” has as his current bestsellers the Nutrition Desk Reference and Mental and Elemental Nutrients. Demand for titles such as The Macrobiotic Way, which has sold more than 125,000 copies, and Foods That Heal, which has sold over 65,000, has greatly increased in recent years, according to Avery Publishing Group sales manager Ken Rajman. “Within the last three years,” he says, “the number of distributors and outlets showing interest in our titles has increased fivefold, the return rate has decreased dramatically, and our initial printings are three times what they were.” He attributes much of this interest to increased media coverage of chemical impurities in various foods and recent scientific findings that natural foods may reduce the risk of cancer.
The current trend in diet books, according to Prima Publishing’s director of publicity Laura Glassover, is away from “quick-fix dieting and constantly changing diets and toward lifestyle diets.” Prima’s representative titles include two Light and Luscious diet books and the company’s current bestseller, Good Cholesterol, Bad Cholesterol, by Eli Roth, M.D., and Sandra Streicher, which presents a comprehensive explanation of cholesterol problems and includes recommended recipes.
The most spectacular recent success in lifestyle diet books is of course Harper & Row’s The 8-Week Cholesterol Cure, by veteran medical journalist Robert E. Kowalski. Approaching two million copies sold, the book will be reissued in June in a revised and updated hardcover edition, according to Harper’s marketing director Steve Magnuson. ‘What really made the book work,” Magnuson states, “is that the diet really works.”
Ballantine/Fawcett has had a long-standing success with its American Heart Association Cookbook, which has more than one million mass market and 500,000 trade paperback copies in print. Bantam senior editor Coleen O’Shea reports that nutrition is an area the company is “pursuing both in the cookbook program and in health-food–related books.” Bantam Cookbooks, like Mediterranean Light and The Gourmet Gazelle, offer healthful diets with nutritional breakdowns.
The Mind/Body Connection
Possibly the most widespread trend in health publishing, and one that, according to many observers, may well revolutionize the practice of medicine, is what Bill Gottlieb describes as “the link between the mind and physical health.” Citing Harper & Row’s mega-bestseller Love, Medicine & Miracles by Bernie Siegel as “one of the greatest pieces of evidence” in support of this link, Rodale’s Gottlieb adds that, “in our surveys of titles and the acceptance of different kinds of products, we see very clearly that mental empowerment of all kinds and emotional upliftment, and their links to physical health, is a major trend. In the same way that people have realized that what they ingest influences their health, they now see that what they think and feel is another profound influence.” Gottlieb notes that although the mind/body theory is rapidly gaining acceptance, it is scarcely new. In 1970 the firm published Happy People Don’t Get Cancer.
A forthcoming author whose examination of the links between the mind and body is creating great anticipation is Deepak Chopra, M.D. Bantam just began selling his Quantum Healing, which Burbank describes as “a really deep look at the mind/body connection, much deeper than the popular idea that thinking happy thoughts helps you get better.”
Quantum Healing, Burbank notes, is a presentation of theory rather than a how-to or self-help book. Practical applications of the theory will be offered in the fall in Perfect Health from Harmony Books. Editorial director Peter Guzzardi notes that Chopra is one of three authors of that book, which offers the ancient Indian practice of Ayurvedic medicine as a practical application of the ideas presented in Quantum Health. Guzzardi is hoping that as Dr. Chopra becomes known for Quantum Healing, “people will ask him, ‘Well, this theory is very exciting, but what can we do to get practical help?’ And I know he will steer them to Perfect Health once it is out.”
Chopra is one of several physicians who have been cited widely as bridging the gap between what have been viewed as alternative or, less charitably, fringe approaches to health care, and traditional Western medicine. Burbank observes that “the lines between what we used to see as alternative health and establishment medicine are becoming less and less fixed. The younger generation of doctors, and many of the older generation who are stuffed full of technological medicine, are actively seeking new routes.” Burbank explains that the authors for Bantam’s New Age list are generally “people who have the scientific credentials and have come from an establishment background and are moving outward.” As an example, in addition to Chopra, she offers Gerald Epstein, M.D., whose book Healing Visualizations offers “75 very specific visualizations for different ailments.” Epstein is a psychiatrist affiliated with Mt. Sinai Medical Center in New York.
The Issue of Medical Credits
Likewise, publisher Jeremy Tarcher requires his authors on health topics to have medical or scientific credentials. “I’m very concerned,” he explains, “about medically oriented books that are based on inadequate research and offer statements that are more hopeful than verifiable.” Moreover, Tarcher’s authors amend rather than reject traditional medicine. “Books that are simple attacks on establishment medicine,” says Tarcher, “give people the wrong impression of what they may be able to get from alternative procedures. My authors don’t reject established ideas; they say, rather, ‘There is more to it than that.’”
Benjamin Shield, coauthor with Richard Carlson of Healers on Healing (Tarcher), a book of original essays by such New Age luminaries as Shakti Gawain, Louise Hay and Bernie Siegel, notes that “many mainstream physicians, having developed from healers to curers, are now seeking not to abandon their powerful approaches to medicine, but to revive their healing function and examine their patients in the context of their mental and spiritual circumstances.” In a similar vein, Cheryl Woodruff offers Ballantine’s New Medicine Guide by Ralph Golam, M.D., as an example of “the synthesis of alternative and traditional medical treatments from the perspective of a doctor.” Woodruff predicts that “in the ‘90s it will be this kind of synthesis that people will be looking for.”
The new openness of both physicians and the lay public to the potential benefits of alternative healing has both given credibility to and increased the demand for books explaining alternative approaches to health. Harmony Books has just released a trade paperback series of four books called New Ways to Health, which, Guzzardi explains, “demystifies homeopathy, acupuncture, osteopathy and chiropractic and shows with very candid color photography how these alternative medicines work. They are primers, really, for people who are coming to these alternative therapies for the first time.”
Jeremy Tarcher states that “it’s quite clear that the attitude of the general public about what constitutes an acceptable source for medical information and healing has grown tremendously.” By way of example, he observes that “nobody was terribly interested when we first published Homeopathy at Home in 1983,” but in recent years the title has sold over 75,000 copies.
Offering such recent titles as Homeopathy: From Alchemy to Medicine, a historical study, and Homeopathic Medicine, a self-help guide, Inner Traditions’ Healing Arts Press is actively publishing material on alternative therapies. Managing editor Leslie Colket believes that people are turning increasingly to such alternative approaches not simply because they want to cure their symptoms, but “because they want their quality of life to improve.”
Chiropractor and publisher Richard E. DeRoeck asserts that chiropractors have lagged behind proponents of other therapies in publishing books on their specialty. To remedy this shortcoming, Impulse Publishing is releasing DeRoeck’s The Confusion About Chiropractors: What They Are, What They Do, and What They Can Do for You. DeRoeck believes that while the lay public and other health-care professionals are moving gradually toward greater understanding and acceptance of chiropractic, “it remains a little-known and little-appreciated approach to health care.”
The Spread of Holistic Models
With the increasingly dominant view of health as a phenomenon profoundly influenced by a variety of physical, psychological and environmental factors, the number of publishing categories that relate to health has expanded greatly. Nancy Fish at Addison-Wesley observes that now, “health books are getting cross-referenced a great deal. Books on psychology, on aging, on child care, all have components of health care in them or are in fact health books. And there are many health books that are no longer being shelved on the self-help or how-to shelf.”
Probably the fastest growing of these cross-referenced categories is recovery or addiction books. According to Tom Grady, editor-in-chief of Harper & Row San Francisco, “Recovery is a blossoming book publishing category. It is not too strong to say that the notion of recovery has become a model for all sorts of areas, not just addiction. It is quite properly a health category, but it is also appropriate in the mind and spirit, religion and spirituality, and New Age categories.”
Together with the Hazelden treatment center in Minnesota, Harper & Row published Melody Beattie’s bestselling Codependent No More. According to Hazelden publisher Karen Elliott, the center has been publishing recovery books since 1954, beginning with the publication of a daily meditation book for recovering alcoholics called Twenty-Four Hours a Day, which has since sold more than six million copies. According to Elliott, the primary focus of Hazelden’s publishing operation is to promote “the recovery process, in the broad sense of holistic health and changes in lifestyle, for anyone affected in some way by an addiction.” Elliott notes that their direct-mail operation has grown “enormously” in the last decade. “When I started here nine years ago, we sent out maybe 30 or 40 orders a day; now we are sending out 1200 to 1500 each day.” She attributes this spurt in growth to the publicity recently given to addictions of all kinds and to the “several thousand treatment centers around the country that rely on Hazelden materials as a primary part of their treatment process and as part of the follow-up care.” Elliot adds that “a word that we use around here that has a lot of meaning for us is ‘bibliotherapy,’ or the continuation of the therapeutic process through books. What we are doing in our publishing operation is providing bibliotherapy to hundreds of thousands of people.”
In order to augment their direct-mail operation and reach additional readers, Hazelden in 1985 signed a contract with Minneapolis-based Winston-Seabury, which was subsequently purchased by Harper & Row. To date, Harper/Hazelden has published over 40 titles. The spectacular success of Codependent No More has pleased but not surprised Elliott, who explains that “we knew codependency was a primary condition for a lot of people. We had a very good track record with it by mail, selling over 100,000 copies, before Harper & Row licensed it.”
Hazelden’s editor-in-chief Linda Peterson points to the meditation books as “our premier pieces, our showcases.” Based on the Alcoholics Anonymous 12-step philosophy, the meditation books are directed not only to recovering alcoholics, but to adult children of alcoholics, to people suffering from chronic illness (One More Day), for people living with AIDS (The Color of Light) and even for people who simply want to “fill some void in their lives” though the 12-step approach (The Promise of a New Day).
Noting that Harper has a “long history in recovery books,” editor Tom Grady cites Vern Johnson’s I’ll Quit Tomorrow, first published in 1973, as a pioneering book in the field. Among more recent titles, Grady calls attention to The Addictive Organization, which argues that society and other organizations behave like addictive structures. Cheryl Woodruff, an editor at Ballantine, discerns a similar broadening of the recovery category, “initially dominated by books about recovery from alcoholism.” She points to the Ballantine titles Beyond the Booze Battle and Goodbye Hangover, Hello Life. Woodruff adds, ‘With the growth of the adult children of alcoholics movement, which is certainly the fastest-growing self-help movement in the country, we’ve seen an expansion of the category to include a recognition of the greater societal issues that cluster around the broad category of addictive behavior. We’ve observed that the recovery market is really representative of a lot of core health values, because the recovery process is based on physical, emotional and spiritual health.”
In the field of recovery, another publisher that has seen substantial growth and broadening of the category in the last five years is Health Communications, in Deerfield Beach, Fla. The company first gained national attention in 1986 with the success of Janet Woititz’s bestselling Adult Children of Alcoholics. According to president Peter Vegso, the outlook of the company has expanded outward from strictly drug and alcohol dependency topics. ‘We have found that a lot of the characteristics described in Adult Children applied to many people who came not only from alcoholic homes, but from dysfunctional families of all types.” Recent Health Communications books that address this broadened concept of dysfunctional childhoods include Charles Whitfield’s Healing the Child Within, which is selling 20,000 copies a month, and John Bradshaw’s Bradshaw On: The Family and Healing the Shame that Binds You.
Alternative Marketing Strategies
Health Communications sells the bulk of its books through trade bookstores but, like Hazelden, it markets them most effectively through a network of therapists. The company publishes two journals for therapists, as well as a magazine for adult children, and sponsors 15 conferences for professionals each year. Vegso says that the cross-marketing “is a key ingredient to our success.” He observes that the sales histories of the company’s books “follow the pattern of word-of-mouth. One of our strengths is that we have been courting a professional audience for a long time while we’ve also been courting the general consumer who relates to these problems. We have a mailing list of about 180,000 professionals who are interested in our work. They recommend our titles to our patients, and their patients are part of support groups and they mention them there.” Three titles that have done well at recent Health Communications conferences are Healing Your Sexual Self by Janet Woititz, Children of Trauma by Jane Middleton-Moz and The Miracle of Recovery by Sharon Wegscheider-Cruse.
Publishers of health titles are increasingly following the model of Hazelden and Health Communications in marketing them. Fish notes that Addison-Wesley is “looking for people who have the right credentials and the right endorsements and also for immediately receptive markets for those books. For instance, we did a book called Somatics and the author, Thomas Hanna, was the director of the Novato Institute for Somatic Research and Training, so there was an instant market for that book—he could sell it through his institution.” Oxford University Press editor Jeffrey House adds that for presses that publish primarily for professionals, it can be relatively easy to add one or two trade books to the list you’re selling to them,” such as Oxford’s The Hyperactive Child and Adult, “and have it do quite well” by means of their recommendations alone.
Villard Books entered a publishing agreement with Fair Oaks Hospital, a noted rehabilitation center based in New Jersey, to produce a series of eight books on biopsychiatric topics. According to Janis Donnaud, the arrangement was partly inspired “by what we saw happening with the Hazelden books.” Fair Oaks Hospital, Donnaud explains, offered “the ability to reach the marketplace in a direct way through its chain of 80 affiliated hospitals. We wanted to take advantage of that situation by taking on an entire project of books with them.”
Rodale’s Bill Gottlieb jokes that to him, placing titles in bookstores is “sort of like putting out the bait and hoping the fish bite,” while direct mail “is more like dropping a bomb.” Prevention Magazine Health Books are marketed through direct mail, book clubs and trade bookstores, as well as continuity series and annual programs. Because the books, particularly those in larger, encyclopedic formats, are relatively high-priced, Gottlieb observes, “they are a much harder sell” in bookstores. Thus, of the 275,000 copies in the first printing of Everyday Health Tips, only 3000 went to bookstores. Direct mail is an easier sell, Gottlieb says, because “we have a loyal readership of eight million Prevention readers who we know are interested in health.”
The Health-Care Consumer
Whether marketing or acquiring titles in health care, a clearly targeted and documented audience is necessary for success. The demographic profile of the readership for general health books, described independently to PW by Nathan Keats, Joel Gurin and BillGottlieb, is consistent: 70%–75%women, age 40–50, affluent and well-educated. Adds Gurin, “Diet books will be overwhelmingly bought by women; heart-disease prevention books by men.”
Given these demographic facts, a number of publishers are targeting women and their health concerns explicitly. Joelle Delbourgo describes Ballantine’s just-released Every Woman’s Medical Handbook by Miriam Stoppard, a British physician and wife of playwright Tom Stoppard, as a comprehensive overview of women’s health concerns. ‘What sets it apart is that it takes a strong patient’s advocacy position, recognizing that women are often treated in a paternalistic way by their physicians.”
Another book for women designed to reveal “what doctors never tell you,” says Clarkson Potter’s editor-in-chief Carol Southern, is The Truth About Women’s Surgery by Women. The book presents case histories of individual women who have had both good and bad experiences with common surgical procedures for women. The aim of the book, says Southern, is “to make women better prepared for dealing with their doctors” when facing the possibility of surgery.
Delbourgo, noting that “if you can do a really first-rate book on a specific topic in women’s health that has been overlooked, it can do very well,” cites an upcoming book on endometriosis by Neils Lauerson and Constance de Swann. Endometriosis, Delbourgo adds, “is an illness that in the past many doctors have treated as being in women’s heads.”
Promoting such books can be challenging when the disease is unfamiliar. At Triad Publishing in Gainesville, Fla., editor-in-chief Lorna Rubin recalls that the company’s first successful consumer book, on osteoporosis, was initially difficult to sell. Published in 1982, Stand Tall:The Informed Woman’s Guide to Osteoporosis was, according to Rubin, “the first book to deal with that topic. We took a chance on it, because our whole marketing approach was education. We would call bookstores and tell them the topic of the book, and they would say, ‘What?’ So selling the book was then a process of educating everyone as to what that big word was.” Thanks in part to a complementary marketing effort by Ayerst, a manufacturer of estrogen supplements, the education effort succeeded, and “when we stopped counting,” Rubin adds, “the book had sold about 150,000 copies.”
John Wiley began publishing consumer health books on specific diseases a year ago, in part, according to editor David Sobel, to tap into the support networks for those diseases. Books such as Alzheimer’s: A Care-givers Guide and Sourcebook are marketed to organizations and care-givers for those diseases as well as through bookstores. “We intend to be doing a whole lot more of this kind of publishing,” Sobel says, adding, “The nicest thing about these books is that even when the advance orders aren’t huge, they reorder on a very regular basis. These books have long, steady lives.”
The Aging Factor
Demographics also suggest that aging should be a primary concern of health-book readers. Aging appears to be less of an issue for the elderly or late middle-aged than it is for people in their late 30s and early 40s. At that point in their lives, Joel Gurin suggests, “People start to realize their mortality and think more about health and aging.” Joelle Delbourgo cites two titles developed out of an association with Esquire magazine: How a Man Ages and How a Woman Ages. The titles have jointly sold over 110,000 copies, and have been particularly popular with people in their 30s.
Nonetheless, more and more readers over 50 apparently are turning to health books. Harmony’s Guzzardi states that the company’s New Ways to Health series is explicitly directed to readers “in their 50s and 60s who have had it with traditional medicine and are willing to take chances now with alternative therapies.” According to managing director Roger H. Lourie, Devin-Adair Publishers, in Greenwich, Conn., is not only aiming some of its books at an older market, but is printing those books in larger type sizes.
As Bill Gottlieb points out, the aging of the American population in itself provides more than adequate reason to believe that the market for health books will continue to grow. Jeremy Tarcher predicts that bookstores, which have “in some cases legitimate concerns” about the quality of health books published currently, will find in coming years that as public attention is focused on these types of books, their quality will improve. And Nancy Fish perceives “a continuing national fascination with health. Health books continue to be supported by every kind of bookseller. All the indications we have,” she concludes appropriately, “are that the market will continue to be healthy.”
Bethune is a freelance writer and editor based in Los Angeles. Background research for this article was contributed by Ellen Komp and Molly Mcguire.
Getting Information to the Masses
From his vantage point as CEO of the newly formed Knightsbridge Medical Publishing in Beverly Hills, Calif., G. Anthony Edens sees his greatest challenge not to be finding high-quality information but rather finding effective means of distributing it to the people who need it most. Using the analogy of an hourglass, Edens explains that “there is a huge amount of state-of-the-art information on the top, and at the bottom are the millions of people with chronic disease who need it. And the information is caught in the center, coming through a grain at a time.”
In collaboration with Jerry Sindell, formerly of Tudor Press, and Ronald Pion, a teaching physician at UCLA, Edens hopes “to find a way to package that information and get it around the bottleneck to the people who need it.”
Knightsbridge plans to take a multimedia approach to reach its goal, in keeping with the experience of its founders. Edens was previously an attorney with MGM television, where he met Pion when the physician, together with former CBS executive Van Gordon Sauter, proposed the television series Group One Medical, a “sort of People’s Court of medicine,” according to Edens. Pion himself had founded the Hospital Satellite Network, which broadcasts 24-hour programming to hospitals across the nation, and he has been a medical correspondent for a Los Angeles television station. He is a firm believer in “empowering patients and their families to take more responsibility for their health and well-being.”
In keeping with that goal, Knightsbridge will publish “authoritative medical information for patients in all forms that are appropriate,” Edens says. Book formats will include both hardback and paperback. Where the content is subject to rapid change, Knightsbridge will publish in three-ring binders. “In cases where they are more suitable,” Edens notes, “we will use video or audio. In some cases the three will be combined in a patient information package.”
The company will focus on chronic diseases that have high prevalences, a million and a half cases and more. ‘We’re going to work with the relevant associations involved and tap the resources of the best physicians in each area to put together easily understandable and helpful information for patients with that disease.” For widespread diseases and conditions, Knightsbridge will rely primarily on the mass market for distribution. For less common diseases, such as Parkinson’s, says Eden, ‘We will work with the Parkinson’s association and distribute the books by direct response.” Of 14 projects currently underway, Edens expects the first to appear next fall or early spring, most likely in the form of what the company calls a “OnePage” book. Part of a series, the first title will cover cholesterol. The book will store, ship and display in a package the same size as a mass market book, but will unfold into a small poster-sized page that can be displayed on a wall or refolded into its cover. Edens believes that the one-page format “is an excellent device for presenting everything one would need to know about controlling cholesterol.”
The object of this unusual format, Edens suggests, is to reach people for whom a traditional 300-page book is not an effective medium. It is a strategy that reflects the determination of the company’s founders to find innovative ways to bypass the information bottleneck. —J. B.
An AIDS Health Book for Teenagers
One aspect of the AIDS crisis now receiving increased attention is the importance of starting public education about the syndrome at a young age. The latest entry in this field—and one published by a not-for-profitgroup—is a book for teenagers from Consumer Reports Books called AIDS: Trading Fears for Facts—A Guide for Teens ($3.50) by Karen Hem, M.D.
Consumer Reports executive editor Sarah Uman explains that when it came to the editors’ attention that there were few books on AIDS aimed at teenagers, “a high-risk group,” they decided to produce one. “Once a year we try to do an issue book,” Uman says, “which quite candidly means that there will not be a return on the book. But because we are a not-for-profit organization, if we can provide them with accurate and easy-to-understand information, we will have more or less served our purpose.”
After developing a table of contents for the proposed book, Uman sought out a specialist in adolescent medicine, Karen Hem, who, according to Uman, runs the first adolescent AIDS program in the country, at Montefiore Medical Center in The Bronx. Teamed with Theresa Foy DiGeronimo, an author of young adult books, Hem developed the text with the goal of writing it at “a reading level accessible to any 13-year- old who can read at an eighth-grade level.” Difficult but important words are also spelled phonetically and each book will be packaged with a poster of the Da-Glo jacket art by Keith Haring.
Uman then had the book assessed by a dozen science and health instructors teaching AIDS curricula in private and public schools across the United States. “With the exception of two teachers,” Uman recalls, “they all felt that while the material was wonderful, the school boards would never allow the book to be adopted, due to its factual treatment of sex.”
Despite this setback, Uman plans “to try and get out as many copies as possible to as many teenagers as possible.” The first printing of 100,000 will be distributed to the trade and through wholesale (Curtis Circulation Co. will distribute the book into the newsstand market). ‘We will also probably go to various foundations,” Uman adds, “to see if they will take quantities of the book for distribution at youth centers and similar locations. We will pull out all the stops to get that book in teenagers’ hands.” —J. B.