Subscribing to a Belief in Expertise

Today’s consumers have a seemingly insatiable appetite for health information. They find it via the Internet, television, radio, newspapers, magazines and, in one of the most convenient forms, newsletters.

Dozens of paid subscription newsletters, generally running eight to 12 pages, are mailed directly to homes from hospitals, universities and prominent doctors. Hundreds more are sent free by organizations such as health plans as a promotional tool.

Competition has been fierce. Over the past decade, as the newsletters have multiplied, the primary players--usually those published by major medical centers--have segued into more specialized information, bringing their reputation for reliability to the hot issues of aging, women’s health and men’s health.

Not only have these publications helped fill the growing demand for more specific information, they’ve managed to stay relevant as consumers have become more savvy at extracting news from various sources. The publications have benefited, editors and publishers say, but so have consumers.

“We realized you couldn’t spend enough time talking about breast cancer in a general health publication to meet the needs of some women,” said Ed Coburn, publishing director for Harvard Health Publications. “In an eight-page monthly newsletter, you couldn’t take three pages talking about breast cancer, because you’re not doing a service for the other readers.”

Dr. Anthony L. Komaroff, editor-in-chief of the Harvard Health Publications, a division of the Harvard Medical School, said that in launching the Harvard Women’s Health Watch and other special newsletters, the editors calculated that there were audiences for generalized publications and more focused newsletters.

They wagered, correctly, that while the more specialized publications “would to some extent cannibalize” the general one, the total number of subscribers would grow.

The top circulation of the Harvard Health Letter was 432,000 in the early 1990s. Today it’s down to 150,000, but combined circulation of all the publications stands at nearly 700,000, Komaroff said.

There are now 125,000 subscriptions to the Harvard Heart Letter, launched in 1990; 225,000 subscriptions to the Harvard Women’s Health Watch, launched in 1993; and the 125,000 subscriptions to the Harvard Men’s Health Watch, which premiered in 1996. The Harvard Mental Health Letter, founded in 1984, has just under 60,000 subscribers, mostly mental health professionals.

“Consumer interests have become more focused over time,” said Andrew Thorne, of Englander Publications in Greenwich, Conn. The for-profit publisher has teamed with noted hospitals in recent years, launching several health newsletters.

Informing Consumers

About 20 years ago, Americans had few places to turn for general health information besides their doctors. And doctors didn’t always want to share information with their patients, believing that they were ill-equipped to understand the complexities of medicine. In the 1980s, organizations like the People’s Medical Society began encouraging consumers to become active participants in their health-care decisions.

That’s when a flurry of newsletters made their debuts, bringing valuable information directly into the mailboxes of consumers who could read them at their leisure. The world-renowned Mayo Clinic in Rochester, Minn., began its Mayo Health Letter in 1983; Tufts University’s Health & Nutrition Letter debuted the same year. The Wellness Letter followed from UC Berkeley’s School of Public Health in 1984; the Johns Hopkins Medical Letter Health After 50 in 1989.

With the material vetted either by the institutions’ faculty or advisory boards, the newsletters gave subscribers paying about $30 a year confidence they were getting solid information. At the same time, the newsletters gave the institutions higher profiles. For example, the Cleveland Clinic, a major center for cardiac care, launched Heart Advisor in late 1997 and Men’s Heart Advisor in December 1998, boosting its name ID among consumers nationally and internationally.

Today, consumers might receive newsletters from their health plan, their doctors or dentists, and nearby hospitals. Because “99.9% of people get their medical care locally” and never get to a Mayo Clinic or Cleveland Clinic, the local newsletters build brand recognition, said Charles Inlander, president of the People’s Medical Society, a consumer health advocacy organization in Allentown, Pa. “When people read that their local hospital is offering a new procedure or treatment, they may think, ‘This must be a good hospital because they put out a newsletter.’ ”

The information is helpful, Inlander says, but doesn’t reflect that “these are the same hospitals that are making medication errors, giving you infections you shouldn’t be getting and doing the wrong diagnosis.”

Patients should be wary of newsletters created as a commercial marketing ploy, warned Dr. Edward Hill, a family physician in Tupelo, Miss., and chairman of the American Medical Assn. board. As an example, he cited those designed to drum up business for bone-density measuring technologies. “The science of bone density is all over the board right now,” Hill said. “The question is who needs to be checked and who doesn’t, and I don’t think a newsletter can answer that for a patient.”

However, newsletters can provide valuable general awareness about conditions such as osteoporosis, doctors agree. When a patient asks a doctor about something he or she has read in a newsletter and that leads to a diagnosis, “there’s a very positive health aspect,” said Dr. Martin Shapiro, chief of general internal medicine and health services research at UCLA.

Educated Readership

The newsletters in general serve an affluent, educated population, although many editors constantly re-evaluate the reading level of their publications and some are considering ways to reach non-English speaking consumers.

Many of the newsletters are provided by organizations that don’t provide direct patient care, but see themselves as having an educational mission. One of them is the Massachusetts Medical Society, which publishes the peer-reviewed New England Journal of Medicine, one of medicine’s most prestigious journals. For eight years, the society has been putting out Health News, published through Englander Publications with a circulation of about 85,000, said executive editor Lloyd D. Resnick.

Since the late 1990s, Englander has been publishing Cleveland Clinic’s Heart Advisor and the Cleveland Clinic’s Men’s Heart Advisor, each with a circulation of 75,000. With Weill-Cornell Medical College in New York, it launched Women’s Health Advisor, circulation 60,000, and the Food and Fitness Advisor, circulation 55,000. It also puts out Mount Sinai School of Medicine: Focus on Healthy Aging, which has 85,000 subscribers.

Device and Drug Recalls

Special interest groups also send newsletters, such as Public Citizen Health Research Group’s Health Letter, edited by Dr. Sidney M. Wolfe, which takes strong positions on federal agency policies and lists medical device and drug recalls in each issue, and Consumer Reports’ On Health, which provides a broad array of information and guidance on self-care, medical tests and doctor visits. Many of the newsletters initially feared competition when Internet sites began delivering more consumer health information, Lindner said. “What ended up happening was the Internet made it so easy, there were really lots of junky sources out there, and many of those persist on the Internet.”

According to Harvard’s Komaroff, in about 1996-97, the free information on the Internet cut into circulation not only of health newsletters, but of competing publications, such as health reference books. If free Internet information dries up, he said, it’s possible that newsletters and books will again be the vehicle by which more people get comprehensive health information.

In general, newsletter subscribers tend to be relatively affluent older folks whose Internet use lags behind that of other age groups and who are more comfortable with something they can hold in their hand. “When all is said and done, a paper newsletter is wonderfully portable and convenient to stick in your pocket and read wherever you are,” Coburn said.