Health Letter celebrates 20 years - Harvard Health Letter, changes in people's attitudes toward medical care

Harvard Health Letter, Nov, 1995 by Patricia Thomas

Years ago people didn't think twice about bending over for a shot, even if they hadn't been told what was in the syringe or how it might help. Today, no self-respecting doctor or patient would be satisfied with such an encounter.

In 1975, when the first issue of the Harvard Health Letter was published, people were just beginning to question the absolute authority of doctors and to demand a more active role in their own care. The new publication was the brainchild of Timothy Johnson, a Harvard physician who went on to become medical editor for ABC News, and Stephen E. Goldfinger, faculty dean for continuing education at Harvard Medical School and now editor in chief of the Health Letter.

Dr. Johnson envisioned a newsletter that would use Harvard's tremendous resources to bring state-of-the-art medical information to the general public, much as continuing education courses do for physicians. This proposal struck a chord with Dr. Goldfinger, who already felt that old-fashioned paternalistic medicine, in which the doctor's word was law, was not the best approach for patients.

A skeptical era

The consumer activism that took hold in the 1960s set the stage for the Health Letter. Just as Ralph Nader's shocking revelations about automobile safety made people more demanding of car makers, scandalous news had undermined public trust in the medical establishment. In 1973, for example, people read about government doctors who had left African-American participants in a syphilis experiment untreated for years and about physicians who sterilized mentally retarded girls against their will.

It was a tumultuous time. New diagnostic tools and treatments were proliferating, hospitals were getting larger and more intimidating, and doctors had been taught that educating patients was less important than ordering the right test and deciding which drug to use. On television people saw doctors and patients disagreeing about which operation for breast cancer was best, but had no way of evaluating what they heard.

And who could they trust? In 1973 the American Hospital Association (AHA) released a document called a Patient's Bill of Rights which appeared to promise the kind of humanistic care people really wanted. Then the AHA disappointed many people when it told hospitals that implementing the edict was voluntary.

No wonder consumers were beginning to feel that hospitals and clinics, like car dealerships, were places where they were truly on their own. The founders of the Health Letter felt that they could address these concerns, at least in some modest way. "We wanted to empower people to make better lifestyle and preventive medicine choices," Dr. Johnson recalled, "and we wanted them to understand better what was happening to them when they entered the health care system."

A growth process

Dr. Johnson expected that large corporations would purchase multiple copies of this new publication, then distribute it as part of a corporate health and fitness program. For the first couple of years, this marketing approach reached about 20,000 readers. Once magazines and newspapers began writing about the newsletter, originally a four-page monthly called the Harvard Medical School Health Letter, individual subscriptions caught on. By the time the Health Letter celebrated its eighth birthday, it was reaching about 300,000 people.

William Ira Bennett, another Harvard physician who now divides his time between magazine editing and the practice of psychiatry, steered the newsletter through most of the 1980s. An unprecedented explosion in biomedical knowledge made it harder than ever for doctors and patients to stay current, and the Health Letter used its insider's view to stay ahead of the curve. It grew from six to eight pages, added staff to meet the demands of an increasingly sophisticated readership, changed its appearance, and shortened its name. It was also during this era that dozens of similar publications, started by medical schools and universities across the nation, began following in its footsteps.

A closer look

In recent years, the Health Letter has added quarterly special supplements that tackle major medical topics or take an in-depth look at the quality, cost, or availability of health care. For each of the past four years, the Harvard Medical School faculty members who serve on the advisory board have worked with us to rank the 10 most important advances in medical research reported during the previous 12 months. This exercise helps readers (and editors, too) step back and take the long view.

The Health Letter continues to evolve in both form and content, and future subscribers may have the option of reading it on their computer screens. Still, Dr. Bennett is struck by how true the Health Letter has remained to its original mission. Every month it brings timely and accurate information to readers in an understandable and useful form, and it still relies on the resources of Harvard Medical School to do this.

Articles reflect the contributions of writers, Health Letter editors, and Harvard faculty. They are reviewed before publication by the advisory board and other expert consultants who generously donate their time and knowledge.