Consumer Health Goes Proactive

Fifty years ago there was the mentality that when you got to a certain age, you were going to get sick and there wasn't anything you could do about it," says Susan Bernstein, director of book development and acquisition for the Arthritis Foundation. "But people, especially baby boomers, are now taking a more proactive attitude." Today's consumers do everything they can to feel and look good and to avoid the degenerative diseases their parents and grandparents suffered. Adds Bernstein, "Health self-management—through diet, exercise, stress management, and adaptive living—is a big trend now."

Among the health publishers tapping into this phenomenon is Rebus Inc., whose University of California–Berkeley Wellness imprint is aimed at the 85 percent of consumers who don't have a specific disease but who would like to maintain control over their health. (Rebus also copublishes the acclaimed UC Berkeley Wellness Letter). Coming this September is The Wellness Kitchen, by John Swartzberg, M.D. and Sheldon Margen, M.D., a companion book of recipes to the authors' Wellness Foods A to Z.

"We actually have a separate division within the company, which is known as the Wellness or Healing Kitchen," remarks Joan Mullally, head of business development. "We want to help people to see that good nutrition is beneficial and a healthy diet does not have to taste disgusting or require hours in the kitchen. It can even have a positive benefit for certain medical conditions."

Rebus is also launching in September "The Johns Hopkins Cookbook Library," a series that draws on the latest research from Johns Hopkins medical and nutrition specialists to provide nutritional strategies for fighting particular diseases. The first three volumes will be Recipes for Arthritis Health, Recipes for a Healthy Heart, and Recipes for Weight Loss.

Publishers also see a strong consumer interest in particular illnesses and medical conditions. "Health titles with a specific focus, such as a single disease, are the ones consumers really respond to," says Harry Burton, the publicist for Newmarket Press. Linda Lamb of O'Reilly's Patient-Centered Guides agrees. "As consumers become more educated, they want to move beyond the generalities to more specific nuts-and-bolts information. The market can bear only so many entry-level books."

When its "Dummies" line branched out into consumer health four years ago, John Wiley & Sons discovered that the titles on men's health, women's health, and other general topics did not fare as well in the marketplace as the books focused on individual diseases. Indeed, editors were surprised by the sales on last season's Fibromyalgia for Dummies, which was more than double the expected number.

"People need to recognize themselves in the title of a book," says VP Diane Steele. "Our upcoming summer and fall list is a mix of not-so-risky second editions and some stretches with Breast Cancer for Dummies (July), Depression for Dummies (September), and Alzheimer's for Dummies (October)."

Warner Books has also had great success with its "What Your Doctor May Not Tell You About..." trade paperbacks, which cover conditions like fibroids, autoimmune disorders, and osteoporosis.

"Specific is better," says Warner executive editor Diana Baroni. "When people have a particular condition, they look for a book on that topic. The premise of our series is that it is not just an overview of what your doctor will tell you. Many patients want to know what else is out there. Therefore, we look for physicians using protocols that may not be the norm but that are successfully helping people." Coming in March 2004 is a book on colorectal cancer by the doctor who is working with Katie Couric to set up a cancer center in her late husband's name. A big title for Warner, it will be published in hardcover.

For many health publishers, alternative and natural are no longer dirty words. In 1976 when Rudy Shur and his partners began producing books on alternative medicine, their company, Avery Publishing, was considered a fringe publisher. By the time it was sold to Penguin Putnam in 1999, the firm had become a "middle-of-the road" middle-size house, selling 100,000–1,000,000 copies of its books and dominating the alternative health market. "It was weird," says Shur, "because we had not changed anything in terms of the kind of information we were providing. We concentrated on what we thought was important. It was just that more people wanted to learn about alternative medicine."

Shur quickly established another company, Square One, and staffed it with ex-Avery personnel, but he could not publish any health titles until this year because of a noncompetition contract with Penguin Putnam. While consumer interest in alternative health remains strong, he has, in the meantime, observed some retrenchment in terms of fewer "vitamin-of-the-month" titles. "From what I read in the press, there were too many books on St. John's wort."

That hasn't stopped Shur from jumping back into consumer health publishing. Coming this September is Rethinking Cancer: Non-Traditional Approaches to the Theories, Treatments, and Prevention of Cancer by Ruth Sackman, cofounder and president of the Foundation for Advancement in Cancer Therapy (FACT), an organization that educates cancer patients about alternative noninvasive and nontoxic therapies. "While conventional surgery is effective with many widespread cancers, it is not a cure, and the survival rate is still very low," explains Shur. "But most patients do it because they are not given a lot of options. Sackman gives people an open door to learning more about other avenues."

Shur plans eventually to do five health titles a season, or about ten books a year, out of a total annual list of 40 titles. "Our books will be 20 percent conventional medicine, 80 percent alternative health."

Alternative health is also integral to health publishing in big houses as well as at major medical foundations. Bernstein, of the Arthritis Foundation, sees integrated medicine, which blends alternative and conventional approaches, growing.

"We publish four to five titles a year for a consumer market that is pretty broad—some 70 million people in the United States have some form of arthritis," says Bernstein. "Our titles range from living with arthritis to diseases that fall under the broad arthritis umbrella: back pain, chronic pain, hip and knee replacements. We try to offer a balanced approach, focusing on both conventional medical and natural treatments."

In July the foundation will publish Natural Therapies for Fibromyalgia. There is strong consumer interest in this topic, Bernstein explains, because the drugs currently prescribed are antidepressants that have a lot of side effects. "These drugs are not designed specifically to treat fibromyalgia," she notes. "They just treat some of the symptoms."

Many of the physicians whom Wiley publishes also take an integrated approach. "They're not afraid to talk about herbs," comments Tom Miller, executive editor of the house's general interest publishing program. When he started at Wiley over six years ago, the firm really didn't have a dedicated consumer health list. "I was hired to jumpstart the list. Since then I have established lists in alternative medicine, mind-body medicine, and spirituality."

Miller now issues about eight or nine health titles a year, including this December's The Super Mind-Body Cure by neurologist Jay Lombard and Christian Renna. "This is a fascinating book. The authors argue that many diseases are caused by imbalances in neurotransmitters (brain chemicals such as dopamine and serotonin)," says Miller. "They explain how to diagnose these imbalances and offer mind-body and lifestyle advice."

Avery is also "branching out into the mind-body arena," says associate publisher Eileen Bertelli. Among Avery's big fall titles is The Fasting Path: The Way to Spiritual, Physical, and Emotional Enlightenment by herbalist and psychotherapist Stephen Buhner. What intrigued Bertelli about the author's proposal was his spiritual approach to fasting traditions. "It was a step away from detox, which I think has been overpublished."

Although consumers are increasingly turning to the Internet for their health information, publishers find that print is still alive and well. "Consumers are looking for guidance, and that is what an author advocate provides: a definite point of view," comments Megan Newman, editorial director of HarperCollins's HarperResource imprint.

The books she believes have been hurt by the web are the big institutional omnibus titles, the family medical guides that are less driven by opinion and personality and are more generic and expensive. Square One publisher Shur also points out that many health sites lack an editorial process to weed out bad information.

Although it sometimes seems as if publishers are jumping lemming-like into the ocean to catch the next big wave, for most houses the decision to publish a certain title is driven not by the latest fad but by the author and the message. Acquiring editors ask: Does the author have the right medical credentials and expertise? What is the topic and who is the audience? Is the proposal saying something distinct?

For instance, Warner's January 2004 title The 30-Day Natural Hormone Plan by Erika Schwartz, M.D., ties in with the recent controversy over hormone replacement therapy, but what impressed Baroni was the author's background and experience. A conventional medicine doctor, Schwartz used to prescribe synthetic hormones until she went through menopause herself and experienced what her patients were telling her about their ineffectiveness.

Likewise, Da Capo senior editor Megan Cochran recently bought Don't Die Young, written by the associate director of cardiology at New York's St. Luke's–Roosevelt Hospital. "What is unique," explains Cochran, "is that the author proposes that people over the age of 50 be screened for heart disease and be treated with four medications, including aspirin and a beta blocker. His ideas are so simple and novel, almost counterintuitive, and yet not quackery."

In the end, concludes Square One publisher Shur, the key to any good consumer health book is providing real answers to the pressing questions people have about their health.