Nostalgic for the good old days of curling up to reading Proust by the fireplace, the “sky-is-falling” opposition to the meteoric rise of e-books is in retreat. As we saw with the quaint devotees of the typewriter, the print newspaper and the landline telephone, there is, it seems, a grudging acceptance among the Chicken Little crowd that the days of physical bookstores are numbered. There are innumerable arguments on all sides of the e-book issue, and I will not debate their full merits here; like all new technologies, some publishers and authors have embraced e-books, others have decried them. In this essay I want to make one observation only: the rise of e-books is good for personal health.

From first-hand experience, I know that writing books about health policy and health promotion is a tough slog. There are some polemical, sharply penned books on health policy (on the US health reform debate, for example) that hit home runs; and psychology books, especially those geared to parents, often fare well. But generally speaking, most publishers, now facing a brutal market to sell print books, will side-line health books and refuse to spend scarce marketing dollars to promote them.

Prior to the e-book there was the Internet, a game-changer for all public policy authors. Thanks to the Internet, health researchers and patient advocates who wanted to reach a global audience with health-promotion books have had an easier time making their books visible. Nonetheless, before the e-book, the price point for most such books was far too high for most consumers. Sure, self-published health policy writers could upload their books on to Amazon, but books about better eating habits and exercise and participatory medicine – often based on peer-reviewed research made accessible for a lay readership – were simply too expensive. Authors need to cover at least some of their costs for the time it took to craft the book, often much longer than one year. Just as important, the marketing costs for health-related books remained high for the author; the author would need to promote the book heavily using social media, and, even if the book were published by a third-party publisher, the author would seldom receive marketing dollars. Mainstream publishers increasingly pick out just a few potential winners every year and market them intensively. In a recession and given fast-declining consumer interest in purchasing print books, this strategy looks like a darts game, even for popular fiction books with well-known writers; it is a much bigger financial risk for publishers to take on for non-fiction books.
Suddenly, the e-book soars onto the horizon. Apple’s iPad sold over three million units in less than three months and Apple aims to open an online bookstore, iBooks. Barnes & Noble and Amazon quickly reduced the price of their e-readers. Newer e-readers at lower price points are coming online soon.

What is fascinating to me is that some of the most vociferous arguments made against the e-book are the strongest arguments in support of the power of e-books to improve human health. In a recent article in the Wall Street Journal, Ron Adner (of the Tuck School of Business at Dartmouth) and William Vincent (a former book publisher at Houghton Mifflin) express concern about the rapid rise of e-books, in particular the prospect that advertising – in order to help monetize the value of the e-book – will creep into e-books (similar to product promotion in movies) in a manner that carries pernicious effects. They write: “Imagine the value – and controversy – of placing pharmaceutical ads in healthy-living guides, or partisan attacks in political memoirs. Writers, agents and publishers will have to negotiate a fundamentally new arrangement when ad-driven e-books become a reality.”
(The writers are mistaken when implying ads in books are new: older print books did have some advertising, notably, promoting other books by the author or by the publisher. Some had order forms in the back. Most famously, Charles Dickens serialized many of his novels in magazines that carried ads. Even today, some books have donation forms at the back for a particular cause).

Messrs. Adner and Vincent are probably right on one point – ads will rise in prominence in books, just as they have always run inside the pages of elite magazines, like the New Yorker. However, the power of the health policy author and the publisher to negotiate terms for which ads to place in the e-book will help sales, not hurt them. And I believe that healthy-living guides will, in fact, contain accurate healthy-living messages. That’s because placing healthy-living ads in health books, whether from Pharma or anyone, helps sell books. After all, the most popular health blogs and most accessed health Websites on the Internet for consumers are those that contain clinically accurate and relevant content. And Pharma, to the extent that they place any ads on any Websites, have a vested interest in ensuring that the ads placed there do not promote drugs but, rather, promote health messages aligned with the content of the Website. Consumers can sniff out inappropriate corporate promotions, especially from Pharma. What’s more, authors and publishers will, I suspect, have the right to ensure all ads are clinically accurate and do not unduly promote industry interests. We know authors and publishers want people to read the e-books. And people will read the e-books more, not less, if the ads are meaningful to readers.

Using Big Pharma as an example to condemn e-books is a loaded weapon. Most ads will, I strongly suspect, be personally relevant to the person reading the e-book. If someone reading an e-book has expressed interest – either via prior purchases on the Internet or by dint of what they are reading (e.g., an e-book on obesity), isn’t it in the reader’s interest for them to see ads about other obesity-related content? Most such ads, if Amazon is any example, will be ads for other health-promotion books. People who read e-books have shown that they purchase e-books. Accordingly, smart advertisers will advertise to them about other e-books on the same topic, not about drugs or automobiles or soda pop.

Putting aside the thorny issue of ads – and I admit that I may be wrong about ad trends; these sorts of rules have yet to be concluded and are subject to contract law among authors and publishers and e-book manufacturers – there are far more significant ways in which e-books help people who want to purchase health books. Of primary importance, as alluded to above, is the price point. A $9.99 e-book is more accessible than one priced at $29.95. Given the choice between a book on obesity policy and one of similar price by Dan Brown, the health e-book now has a fighting chance to compete. (Disclosure: my forthcoming book is on obesity policy). Second, as we say good-bye to physical bookstores and to those who handpick which books should sit on bookstore shelves, the free market of the Internet will play a vastly bigger role in which books rise to the top. “Best-sellers” lists will be more meaningful. Again, health books – for which we know there is consumer appetite given that health and lifestyle content on the Internet and in print newspapers is among the most widely accessed content – will benefit.

Finally, the concept of the ‘book’ is changing. Let’s consider for a moment the benefit to the reader of a policy book – whether about healthcare or transparency in government or environmentalism. The benefit to the reader, unlike with fiction, is to promote a new idea to prod new thinking. If nothing else, cheaper e-books provide a platform for more policy books that enable more thinking. Those who argue against this are obstructing what policy readers want: choice and opportunity and a lower price. Oxford reveals that one of the earliest definitions of the word ‘book’ was: “A written or printed treatise or series of treatises, occupying several sheets of paper or other substance fastened together so as to compose a material whole.” [Emphasis added]. Marshall McLuhan was wrong. For the consumer, a non-fiction book has always been, and always will be, about the ideas – not the medium.

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