14 October 1999 Rev 6 April 2000
4,300 words

Writing books and articles about nutrition:
Woman's Day educates cooks;
Make your query stand out with a chart.

Dr. Atkin's new writer: Sheila Buff

NEW YORK--What sets Woman's Day apart "is the connection that people feel to the magazine," said Madonna Behen , Health, Nutrition and Fitness Editor. Readers feel that "this is a magazine that they can trust."

Behen spoke at a panel on nutrition at the Editorial Freelancers Association medical writers and editors group, at the EFA office on W. 28th St., on 14 October 1999.

She was followed by EFA co-exec Sheila Buff, who has written "about 30" books on natural history, health and nutrition, and is now collaborating with Robert C. Atkins, MD, on his new Age-Defying Diet Revolution book. Buff explained how any idiot, especially a journalist, can write a book, if he or she is a reasonably good researcher who can meet unreasonable deadlines. (see below).

(For a cynical expose of nutrition writing, or a useful guide to success, whichever you're looking for, see Confessions of a Former Women's Magazine Writer, by Marilynn Larkin, at Stephen Barret's NutriWatch web site.)

Married, thrifty, with children

The WD target reader is a married woman with children, in her early 30s to mid-50s, working outside the home, said Behen. The mainstay of WD is recipes, child-raising and domestic advice, but readers are also interested in health, diet, and fitness. They tear out pages and file them away.

"Our cover celebrity is a chocolate cake," said Behen. "Diet and chocolate cake, people want both." Good nutrition is a negotiation between things you like and things that are good for you, and WD, with the help of nutritionists, helps women negotiate.

("I like chocolate cake," said Jeffrey P. Koplan, MD, MPH, director of the CDC. Koplan was author of an epidemiological study and editorial on obesity, published in JAMA . Chocolate cake can be part of a good diet, he said at a JAMA press conference in Los Angeles, "as long as you have a balance.")

Nutrition for 21 million cooks

To judge from the ads, WD seems a little downscale at their $1.49 cover price. Imagine someone who buys Hummel figurines and Fern Michaels novels. But they're not dummies. The health information in WD is more sophisticated than JAMA's (6th grade level) Patient Page , and more like the Merck Manual consumer edition. It's better organized and more readable than the New York Times. WD doesn't often have the hard edge of Consumer Reports, but they draw a careful line between defensible science and unsupported health fads. The back cover is a Benson & Hedges ad (page rate: $137,000) but the dangers of tobacco are regularly noted in the health coverage. These women have primary responsibility for feeding their families, and want to know more about nutrition and health. Men don't read, so WD readers inform the whole family. Circulation is 4 million, readership 21 million, so WD readers are a good, cooperative target for nutrition education.

The health editor has to follow everything important in medicine and nutrition, evaluate it responsibly, digest it, and give it to her readers in a form they can understand. Nutrition studies, often conflicting, are pouring out of universities and medical journals, and flooding the mass media. Busy corporate executives read newsletters with information critical to their business. Busy working mothers read newsletters with information critical to their job of raising a family. A lot of WD stories are 1-page newsletters on health and nutrition--preferably with a table.

$1-2 a word and up

The pay ranges "widely" from to $1-1.25 a word for a writer without clips from a major consumer magazine, who has never written for WD before, to $2 a word and up for regular writers, said Behen. She usually assigns stories, but "If a writer comes to us with a good idea that we haven't heard before, we reward them with an extra 20%."

Behen has lots of good writers, but they're not always available when she needs them. So she always needs more good writers with clips from consumer magazines.

Write tight with tables

WD has several sections and regular features devoted to nutrition and health. The sections are: "Health," "Diet & Exercise," "WD Report," and "Children." Behen gave a commentary on recent health and nutrition stories that she photocopied for a handout. (She left extra handouts on the table at the EFA office if you're dropping by.)

  1. "Health." This section has 2 regular 1-page features, "Your Health" and "WD Checkup," and longer pieces.

    Longer nutrition pieces in the Health section cover vitamins, food safety, food allergies, and food-drug interactions. They're very highly organized, with tables and graphics, and often strung together from short descriptions of vitamins or foods, sometimes with dramatic narratives of women who suffered horrible reactions, sometimes not.

    The "Food Safety" article deals mostly with E. coli 0157:H7, salmonella and campylobacter, sourced to the CDC, USDA and a university-based scientist, but no dramatic narratives. On pesticides, a paragraph at the end quotes a Consumers Union scientist that risks are "small but still intolerable." Buy organic, they conclude.

    "Foods and Drugs That Don't Mix" is "amazingly popular," said Behen, and has to be rewritten every few years to include the new drugs.

    There are a few important principles of health and nutrition that have to be repeated again and again, so WD is always figuring out how to tell the same stuff with a new spin.

    Like vitamins. A *very* tightly edited 3-page story on vitamins and minerals used a creative, eye-catching typography. Every claim quotes a source at a university or government agency. Do you need supplements at all? Yes, WD concludes, quoting *2* sources--the Center for Science in the Public Interest and the Western Journal of Medicine. (WD is occasionally willing to give advice based on a rat study, for inositol, for example.) But check with your doctor before taking megavitamins, they warn.

    "We rarely assign more than 2,000 words," said Behen. Most features are 1,500-1,800 words, max. "Women really don't have time to read more than 1,500 words about osteoporosis," she said. The trend is towards 1-page stories. As the word count goes down, the graphics goes up. The stories are more tightly organized, with standardized content and typography: bullets, bold-face, sidebars, and tables.

    "We try to standardize the way we do health articles," said Behen. "Readers love charts." Some short stories are done entirely as charts--"Top 10 Supplements," or "Alternatives to Sugar". Readers also like "Do's and Dont's" lists.

    Want to make your query letter stand out? Include a chart.

  2. "Diet & Exercise." This includes recipe-oriented stories, and psychology-oriented pieces.

    In "Eat & Be Merry" this Thanksgiving, a registered dietitian figured out 1,800-calorie-a-day menus that balanced good nutrition against a "daily treat" like fudge.

    "Break Your Obsession With Food!" is written by 2 psychotherapists who claim it's not easy but can be done.

    (The "Food" section is written entirely in-house, and not a freelance market.)

  3. "WD Report". These are features whose greater length is justified by its greater interest, complexity or importance.

    Explaining cholesterol is a challenge. But cholesterol is a major controllable factor in heart attack and stroke, the major causes of death and disability. "People are confused," said Behen. "We tried to simplify it." The "WD Report" on cholesterol (2/16/9, p. 57) pulls out all the stops. (In the hands of a less-skilled art director, it could have been a disaster.) HDL (good) is a smiling face, LDL (bad) is a frowning face with a dunce cap. The message is conveyed with dancing fish, smiling avocados, bulleted lists inside sidebars, and colored boxes off-centered for emphasis. A reverse box on the first page to give you a reason for reading it: "Heart disease claims the lives of five times more women than breast cancer." The 4-page text tightly summarizes a huge amount of current research, sourced to the WD advisory board or other major authorities. It includes a conservative selection of "alternative" supplements, such as vitamin E, niacin and cholestin, which have an arguable scientific basis (although the American Heart Association (AHA) and the American College of Cardiology (ACC) aren't convinced).

    Heart disease itself was 5 pages in "Taking it to Heart" (11/1/99). A lot of fairly complicated information is digested into risk factors, prevention, and when to go to the ER. It's wrapped around 4 case histories with gripping narratives that illustrate classic heart attacks and strokes. (Written with the AHA, this feature tactfully ignores vitamin E.)

    Some stories quote experts, but some quote real people in "True Story" format, and you have to make sure when you interview them that they're willing to be identified by name and photographed, said Behen. But it's OK to use PR people, and you can find others on Internet chat groups.

    WD frequently gives Internet sources in the "Want to Know More" box at the end of most feature articles, and has done features on "How the Internet Changed my Life" and "Dangers to Kids in Cyberspace."

    WD has a web site on America Online (Keyword: Woman's Day), which is available only to AOL members. There are message boards, recipes, health articles, decorating tips, and other content, most of which is taken from the magazine. Behen, other editors and a featured writer or expert have chats on-line. WD has registered a web site , but it's not up yet.

  4. "Children". The 1-page "Your Child's Health" column is written by Loraine Stern, MD, a Los Angeles pediatrician, so it isn't a freelance market.

    But it *is* one section that is written with the hard edge of Consumer Reports. Stern, who looks like a Jewish grandmother and actually does recommend chicken soup, points out in the 11/1/99 issue that children with colds should not get cold and cough medicines. Tobacco smoke causes problems, she says. She repeats some well-chosen public health messages that bear repeating: child safety seats, trampoline dangers, and a blast at insurance companies that pay for psychiatric drugs but not counseling.

4 keys to a WD assignment

There are 4 keys to getting an assignment in Woman's Day, said Behen, who has one of the principal requirements of a medical editor--a name that's easy to misspell.

  1. Don't be incompetent. Behen can always spot a proposal letter from a writer who hasn't read the magazine. Writers spell her name wrong, or address a query to the wrong editor, or to her predecessor who left 4 years ago. "If I can't trust them to get this right," she said, how can she trust them to get the story right?

  2. Note the calendar. The lead time for WD is 5-6 months, a huge burden. It's mid-October, so Christmas is way gone. "I'm interested in summer ideas," said Behen. (WD also has an unusual frequency--17 times a year.)

  3. Go beyond mainstream sources. WD gets letters proposing stories based on Jane Brody's last column. "We get JAMA, the New England Journal of Medicine, and the Wall Street Journal," said Behen. They don't get the more specialized journals. You might find something on the Internet, she suggested. "Most of the major hospitals have really good web sites."

  4. Write a detailed query. "The query we like is more of a proposal or outline," said Behen. Writers complain that they're being asked to do all this work with no guarantee of a story, but it does make it easier to write the story. It also helps to include proposals for sidebars in a longer story--and tables.

Evaluating the science

WD has a full-time research department, said Behen. "We require writers to send in backup material." That includes names and phone numbers of everyone they talked to. "We don't ask for interview notes, but we do check with the doctor," she said. "We don't read the quotes back," because otherwise doctors would change their quotes forever. Instead, they paraphrase to make sure the essential facts are right.

"We want primary sources," said Behen. "We want a copy of the study" from a medical journal. An article in another woman's magazine is not an acceptable source.

Licorice: friend or foe?

One of the great problems of nutrition writing, which readers always complain about, is the study-of-the-month syndrome, where new, sometimes contradictory, studies come out every month about the purported benefit of a nutrient, with dizzying confusion. Here's the "Eat Healthy" article in WD (3/10/98, p. 56) which tells you that, according to University of Illinois at Chicago researcher John Pezzuto, PhD, licorice contains glycyrrhetinic acid, which blocks tumor promotion. But wait! Here in last week's NEJM (341:15), Decio Armanini, MD, of the University of Padua, warns that licorice can block the production of testosterone and cause sexual dysfunction. What's a woman to do?

Evaluating controversies

Behen hates to say, "Some doctors say this, some doctors say that," because readers hate it. Readers what to know what to *do*. So if there is an answer, WD tries to get it. "We try to take a point of view, but we don't try to editorialize," she said. "We can quote a doctor." They can ask their advisory board.

They look at the studies. Behen likes big N's. "Are there 20 subjects or 200?" she asks. She likes it when a study was published in JAMA and reported in the New York Times. She likes researchers from major medical centers, and most of the major medical centers have good web sites, she noted. She likes human studies better than rat studies, and rat studies better than in vitro studies. She likes to be ahead on the news--but not too far ahead. (She didn't bother sending anyone to the American Academy of Orthopaedic Surgeons press update the day before, because there wasn't anything new. WD's Supermoms are already wearing square-toe, low-heel shoes.)

They look at the researchers. Behen wants "the best researchers out there." The writer should know how to identify leading researchers. "Some doctors are very good at promoting themselves, they're on TV all the time," but, she warns, people in the field tell her, "That person is a quack."

Sometimes, Behen just winds up saying, "Some doctors say this, and some doctors say that."

Cover lines

Behen thinks of a good story as a cover line. Cover lines are getting bigger on women's magazines, crowding out the chocolate cakes, and WD has a separate box on the table of contents repeating the cover lines.

A cover line is "something that you can be pretty damn sure our readers are going to be interested in," she said. She rattled off some of the best cover lines: Backache, headache, diet, vitamins, herbs, fatigue, the top 10 ailments doctors miss, what your doctor isn't telling you, drug mistakes, food and drug interactions, getting organized, money-saving tips, how to make money at home, how to save money on medicine.

Think of something that attracts a 45-year-old woman on line at the checkout counter, Behen said.

Sex in the Bible Belt

Cosmopolitan, Glamour and Redbook cover sex in a way that WD would not, said Behen. "Woman's Day has a core of Bible-belt readers who don't want their grandchildren to be shocked by the cover," she said. (WD selects a quote from the Bible for the table of contents.) Not that they ignore sex. In fact, Supermom Andre Birnbaum selects red underwear in the Superstyle section (not to suggest that she would be photographed wearing it). WD might have a story on talking to your child about sex, or painful sex, or sexually transmitted diseases, said Behen.

The writers' guidelines includes religion among WD's subjects, but the stories themselves lean more towards secular self-help and academic psychology.

But demographics and trends aside, the kind of stories that Behen likes best are the ones on diseases like chronic fatigue, or polycystic ovary disease, or interstitial cystitis, that are often misdiagnosed, where women who have gone from doctor to doctor can actually find out what's wrong with them. "We get letters from readers that say, 'Thank you, thank you, thank you! I didn't know what was wrong with me.'"

Queries, with clips, should be sent to:

Donna Behen, Senior Health, Nutrition and Fitness Editor
Woman's Day
1633 Broadway
New York, NY 10019

Sheila Buff: Nutrition Books

In contrast to a magazine article, "Writing a book takes a long time," said EFA co-exec Sheila Buff. Even on a short schedule, "you have to be able to commit a solid 6 months" to doing nothing else. A book is at least 50,000 words, and a Complete Idiot's Guide is 100,000 words.

"Anybody who is intelligent and fast and a reasonably good researcher could do it," said Buff, "especially if they have a background as a journalist, especially for consumers." But you have to like doing it, and not everybody does.

"These books are pretty easy to do," said Buff, "because the Net makes it easy."

What publishers and packagers really need is "somebody who can do it on schedule," said Buff, "often in response to trends."

"When they call you to write a book, they're usually behind schedule," said Buff. "If you can't work hard and meet your deadlines, don't even think of doing this." You should be able to turn out 2,000 finished words a day, she said. She usually spends 5 hours a day writing--not counting time doing research on the Internet.

One good way to get the work, said Buff, is to get in touch with a packager, who is usually listed on the title page. The other way is to contact the editors directly, which takes a little more research. Sometimes they thank their editors in the acknowledgements.

Caution required

Buff doesn't do instant books. "They're not based on hype. You have to back it up" with research.

"You have to be very cautious" writing about nutrition, said Buff. For example, she saw repeated references to an article in Newsweek, in 1995 or 1996, about melatonin, which cited a Dutch safety study of 17,000 women who took 75 mg/day (a relatively high dose), with no harmful effects. "I'm still trying to find the original Dutch article," she said. "I've seen it cited numerous times--and the number changes." She cited it in Dr. Atkins' new book, and tomorrow she's going to try to find the original article. "If I can't find it, it's coming out" of the book, she said. (She couldn't find it, and wound up rewriting the paragraph and cited a different article.)

There's also a risk in anticipating trends or emerging research. With a good book, you could get a $10-15,000 advance, "and if you're lucky, could sell 100,000 copies," said Buff. "But if on the day your book comes out there's an article on the front page of the New York Times saying it causes cancer," your book is going to dive.

If you're a journalist, and you're following a drug that turns out to cause cancer, that's no problem, said Buff. You just write a new article about how it causes cancer. But if you've written a book about it, you're remaindered.

Supporting evidence

(There's a difference between having an article in your file that seems to support your claim, and talking to the researcher to make sure he agrees it supports your claim. Writers are liable to leave their authors on the spot, like William Regelson, MD, professor of internal medicine at Virginia Commonwealth University, author of the best-selling book, The Superhormone Promise, whom I wrote about in Urology Times:

Collaborations with doctors

As she explained at a
previous EFA meeting , Buff has written about 30 books. The health books have been collaborations with doctors, who according to the convention were the "authors," and she was the "writer." Writers don't always get royalties, but she struck deals that made it worthwhile anyway. "It doesn't matter whether your name is on the book," she said, "as long as your name is on the check."

Buff has written books on natural history and the outdoors, like The Complete Idiot's Guide to Birdwatching (Macmillan), and more recently nutrition, fitness and health, like The Complete Idiot's Guide to Alternative Medicine, and The Complete Idiot's Guide to Vitamins and Minerals.

In 1996, Buff published the Doctor's Complete Guide to Healing Herbs, with David Kessler, MD (published by Berkeley Books, and packaged Philip Lief, Princeton, NJ) (not to be confused with the FDA commissioner of the same name). She made the contact through an EFA member who was working at Philip Lief. It has stayed in print for "an amazingly long time," through a second printing, she said. It's widely recommended in bibliographies on survivalist web sites, as a useful resource when society breaks down and you have to take care of yourself.

Pressman takes off

Recently Buff published Glutathione: The Ultimate Antioxidant with Alan Pressman, DC, PhD (St. Martin's), whom she calls the "ideal co-author." He has a call-in radio program on WEVD-AM 3 times a week, where he regularly touts it, and now is syndicated nationally on an NBC radio show every Saturday morning. Pressman is a great author, because he doesn't try to write, and leaves the writing to her.

Call-in radio is also a good place to find out the medical problems that people are concerned about, noted Buff. "It's a good way to find out the failings of the medical system."

Pressman's book sold 20,000 copies in hardcover, and 60,000 copies in paperback, "which surprised the publisher," said Buff. She made a deal with the publisher that she would get, not royalties, but a bonus payment, if the book passed a certain sales figure. The publisher agreed, mostly because he had never heard of such a deal before, and it took him by surprise.

Vitamin E alphabet soup

Based on her own research, Buff believes that the medical establishment is too conservative about nutritional approaches to health (discussed before at the EFA) . For example, there is "reams of documentation" supporting the beneficial effect of Vitamin E on the heart, "yet the AHA has a statement on their web site saying that there is no good evidence," she said.

Yes, says the AHA . There are epidemiological, animal, and in vitro studies suggesting that vitamin E can slow the development of atherosclerosis and coronary artery disease. But the AHA will not recommend vitamin E's widespread use until randomized, controlled studies confirm its benefits. The editorial comment, "Antioxidant Vitamins: Sorting Out the Good and the Not So Good," Cam Patterson, et al., J Am Coll Cardiol, October 1999;34(4)1216-8 , goes further. They note that patients on vitamin E in the CHAOS study had a reduction in risk of nonfatal myocardial infarction, but an increased trend towards all-cause mortality, and that the GISSI study showed no benefit to vitamin E (which has several isomers with different characteristics).

(More recently, an article in the 20 January 2000 New England Journal of Medicine found that vitamin E had no effect on cardiovascular outcomes in patients at high risk for cardiovascular events. "Vitamin E Supplementation and Cardiovascular Events in High-Risk Patients" (N Engl J Med 2000;342:154-60.) )

Dr. Atkins

Buff is now working with a "more controversial" co-author, Robert C. Atkins, MD, whose Diet Revolution has been on the best-seller list for 3 years, and who therefore got a $1 million advance for his new Dr. Atkin's Age-Defying Diet Revolution. "There was a surge in interest in Atkins in the last 3 weeks," said Buff. Al Gore was reportedly on his diet. But Atkins has his critics (like Ellen Coleman, RD, MPH , and Cathy Nonas, RD ).

Buff and Atkins agree that alternative and complementary medicine is a good market, first demographically because "there is this huge bulge in the population that is going to have an impact," she said. Second, "There is a lot of research at the university level. A lot of what the nutrition community has been saying is now being backed up."

It's difficult to prove some of the medical benefits of nutrition, acknowledged Buff. If you have an infection, and you take penicillin, it cures the infection. But the important benefit of nutrition is "what doesn't happen." Second, penicillin cures an acute disease immediately, but nutrition is long-term.

Still, $33 billion a year is spent on weight loss, said Buff.

--Norman Bauman