It is perhaps a mark of its genius that this country's publishing industry seldom misses an opportunity to innovate, particularly in the vast and profitable genre known as self-help. Rarely, however, is the public let in on the birth of a whole new kind of book, as it was this month during the "Today" show.
The occasion was an interview by the show's host, Katie Couric, of Bob Arnot, NBC's chief medical correspondent and the author of the newly released book "The Breast Cancer Prevention Diet." Ms. Couric was gamely pursuing a line of questioning concerning a series of critiques of the book by several prestigious medical groups which had, variously, called the book "misleading," "dangerous," "premature," "irresponsible" and "a disservice to American women."
Dr. Arnot, a specialist in sports and emergency medicine, finally admitted that the title oversold the book, which he said should have been called "The Breast Cancer Risk-Reduction Diet." Still, he insisted, "it's a very responsible book . . . and I think that silly things like letting the word prevention get in the way of looking at this information doesn't make any sense."
Witness, then, the arrival of what may be called the speculative self-help book, or maybe semi-nonfiction--though somehow neither of these designations quite does justice to what may be the most irresponsible behavior by mainstream publishers in years. Consider the genre's principal hallmarks:
- Overstate the malady, then appear to be "responsible" by making a "correction" in an obscure forum. Dr. Arnot's book maintains that the U.S. is experiencing a breast cancer epidemic, saying that "one in eight women will be diagnosed with breast cancer." But according to studies by the American Council on Science and Health and researchers used by Dr. Arnot himself, this paints an incomplete picture. The figure refers to a woman's lifetime risk of breast cancer. But the annual age-adjusted rate was 111.3 new cases per 100,000 patients--or 1.1 cases per 1,000 women a year. That's still terrifying but perhaps not terrifying enough to propel a book to the top of the bestseller lists. (In a later posting, the MSNBC Web site, which had been promoting its correspondent's book, revised the figure to "one in eight by age 85.")
- Pick a topical disease and proclaim a recent "breakthrough," no matter how small or questionable, then lard the book with platitudes. Consider the regimen recommended in "The Prostate Cure" by Harry Preuss and Brenda Adderly: "1. Select and work with a physician for proper diagnosis. 2. Take Cerniten [bee pollen] to reduce your symptoms. 3. Exercise regularly for total health maintenance. 4. Maintain an ideal body weight. 5. Eat a diet healthful for proper functioning of the urinary tract. 6. Fight anxiety, depression and stress. 7. Take yourself lightly."
- Circumvent traditional peer review of crucial studies. Central to Dr. Arnot's argument is his citation of the work of the University of Toronto's Lilian Thompson, which Dr. Arnot says shows "that breast cancer size actually decreased with a daily course of flaxseed." But Dr. Thompson has only obtained these results in rats. As she recently explained: "I never spoke to Dr. Arnot--his assistant called me--and I was very clear that this work is ongoing and that we don't yet know if the findings in animals will apply to humans."
- Build your book around drugs that haven't been approved by the Food and Drug Administration. Though the FDA is fallible, physicians used to wait for the agency's approval before promoting new concoctions. No more. Steven Lamm, for example, was advertising the anti-impotence drug Vasomex in "The Virility Solution" before the drug's maker had even submitted it for regulatory approval. Dr. Lamm is also the author of "Thinner at Last," in which he advocates the use of the now-banned Fen-Phen antiobesity cocktail.
- Treat all "medical" citations with equal weight: As if no one would notice, Julian Whitaker and Brenda Adderly, the authors of "The Pain Relief Breakthrough: The Power of Magnets to Relieve Backaches, Arthritis, Menstrual Cramps, Carpal Tunnel Syndrome, Sports Injuries and More," mix legitimate scholarly references with ones such as: "Biomagnetic Handbook (Choctaw, Oklahoma: Enviro-Tech Products, 1990)," and "The Complete Guide to Electro-Acutherapy (Glendale, California: National Electro-Acutherapy Foundation, 1978)."
The list could go on. But however flimsy the science, these books are attractive to publishers because they have a ready-made audience--"victims" who search desperately for a cure to maladies real and imagined. Publishers pretend that such books merely provide information to "empower" patients. What about the reader who, encouraged by Dr. Lamm and Simon & Schuster, gobbled down all that Fen-Phen a few years ago and now wonders why he has pulmonary hypertension?
What happens when legitimate criticism arises? On "Today," Dr. Arnot managed to imply that Fran Visco, a breast-cancer survivor and head of the independent National Breast Cancer Coalition, was somehow in the pocket of pesticide and chemical companies. His publisher, Little, Brown, also went on the offensive, sending out copies of an old Consumer's Union report that took the American Council on Science and Health, one of Dr. Arnot's critics, to task for taking positions that "are nearly always more laissez-faire than those of Government regulatory agencies," as well as for taking money from industry--and never mind the merits of the group's criticism.
Such mendacity is as nothing next to Dr. Arnot's relations with the University of Toronto's Dr. Thompson. Earlier this month, when he first felt the sting of criticism, Dr. Arnot and his researcher began, in Dr. Thompson's words, to "pressure" her into "backing him up."
"I told him I didn't have any results" regarding human breast cancer response to flax seed, Dr. Thompson told me. "He keeps calling me and pressing to say I'm seeing the same result in humans. . . . I told him no, no, no--and then, the next day, he goes right back on TV and tells people that not only did I confirm what he says--but he says 'now that this book is sort of up for attack, she's backing up.' I never said anything to back up from."
If nothing else, these examples should underscore what happens when today's restructured publishing industry, with its reduced ranks of midlevel editors and increased attention to matters of pure marketing, tries to prescribe treatment on life-and-death matters.
As Gloria Rock, a nutritionist at the University of California at San Diego who was consulted on the Arnot book, says, "The [publishing] industry doesn't seem to understand the long-term damage it does by prematurely hyping a condition and a 'cure' when it really hasn't scientifically established either." Perhaps it also doesn't understand the long-term damage it is doing to itself.
Greg Critser writes frequently about health and medical issues.
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