The Henrietta Lacks effect, or, The recipe for popular science success

The Immortal Life of Henrietta Lacks (TILoHL) by Rebecca Skloot was far and away the top science book of the year in my Best Science Books 2010: The top books of the year post from last month. In that post I took all the Best Science Books 2010 posts and tallied up the books with the most mentions. TILoHL was mentioned in 41 out of the 60 lists I found. The next highest was 17 mentions for The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee.

So, a pretty decisive victory. TILoHL was by far the best reviewed science book of the year.

What was interesting to me was that it seemed to cross-over quite a bit into an audience that wouldn't normally find and read science-themed books. It was really a very unique case of a breakout book that was able to find a much larger potential audience than a science book would normally have access to.

Was that just a feeling I had or was it backed up in some way. As I was compiling and posting the Year's Best lists, I did take note of the number of times TILoHL was the only science book mentioned or perhaps with just one other.

So, this analysis. Using the "data" I collected in the form of all those year's best lists, I decided to extract all the lists where TILoHL was the only book mentioned or where there was just one other. I've got all those lists below. From them I extracted the descriptive text that accompanied the book's selection. I looked at some key passages in that text.

What are the lessons?

Well, there is no "one answer," no secret ingredient that makes a science book cross over into a mass audience. And I also can't emphasize enough that this isn't real evidence, that what I'm looking at here is a very selective reading of the reviews and mentions of Skloot's book. Even of all the singleton listings I found, there's really only a handful that really jump out. But jump out they did.

And this is what I see as significant to the success of the book. People that were predisposed to like science books loved it and that shows through. More tellingly, however, are the cases where the reviewer didn't seem predisposed towards science books at all but still loved the story of Henrietta Lacks. Those were the key to the crossover/breakout success, the word of mouth that pushed the book over the top and into the stratosphere.

And what was it that drew those normally non-science friendly reviewers -- and the readers that flocked in their wake?

If there's any common theme it's that these normally picky reviewers loved TILoHL because it's more than "just" a science book. They saw it as a book that's also about people and society and ethics. Of course, from the point of view of someone inside the science world, we tend to see most science books as also about those things as well -- we don't see the practice of science as separate from human society. But somehow Skloot's book performed that most rare crossover and convinced everyone else that a book about science could also be about people.

So, if you're writing a popular science book and hope to break out to a broader audience, heed the lessons of these reviews well.

  • A spoonful of sugar of sugar can make the medicine go down. It goes without saying that any book that hopes to reach a mass audience should be entertaining and engaging at the most basic level but it probably bears repeating.
  • A strong narrative really sucks people into a book and carries them to the end.
  • A lesson to be learned by all science writers -- you might have an interesting scientific story to tell, but why should "normal" people care? Your story has to connect with people's everyday lives and concerns. This can be a challenge for lots of areas of science, like theoretical physics, but it's key to be able to tell a story that ties directly to people's lives.
  • Related to the previous point, the book needs to be primarily about people, not machines or bacteria or whatever.
  • People also care about larger social issues, like medical ethics and the challenges of racism and poverty. Setting the scientific story against the background of these types of compelling social issues is a great way to cross over to the huge audience because it connects to what they see around them not some abstract theory or intimidating lab setting.

A caveat: I don't mean to imply by these points that there is only one way to write a science book. Every book, every author, every story will require different strategies. Similarly, success can be judged in different ways, not just by the degree of "crossover." But I do think these factors apply in this particular case and that there are some broader lessons that can be learned.

The analysis I've done here is somewhat superficial and hardly unique or original in the kinds of points I make. But at the same time, it's starkly apparent when you look at the reviews below what the key to Rebecca Skloot's success were: she had a great story, she told it exceptionally well and that story was one that held strong interest for people beyond the normal science audience. The reason for that strong interest was that the narrative of the book touched a lot of people on an intensely personal level as well as exploring important social issues.

Who wouldn't love a book like that.

Sounds easy.

And now for the admission of guilt. Yeah, I haven't read it myself. I don't even own a copy yet. And that's partially what got me writing this post because I'm certainly going to be among the first in line when the book comes out in paperback next week.

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Here are the ones where TILoHL is the only science book mentioned. I've bolded some bits that seem particularly relevant. I think each review could be a lesson for a budding science writer on how to approach source material and turn it into stories people care about.

Salon.com

In 1951, a sample of cancer cells was taken from an African-American woman in Baltimore's Johns Hopkins Hospital. Henrietta Lacks died not long afterward, but her cells live on, proving to be so exceptionally easy to culture that if you were to gather together all the tissue grown from them, the result would weigh 50 million metric tons. Lacks' famous cell line (christened HeLa) is now used in virtually every medical lab in the world, a remarkable scientific success story. Yet, as Skloot thoroughly and sensitively documents, Lacks' own descendants muddle through without health insurance or the education required to understand what their forebear contributed to the world. In fact, the Lackses have had a long, fraught and confused relationship with Johns Hopkins Hospital itself, characterized by mistrust on one side and condescending utilitarianism on the other. Skloot's skillful account of Henrietta's dual legacy is not, however, an indictment of particular researchers or labs. Instead, it masterfully reflects the tricky intersection of science and society and an American medical establishment responsible for both astonishing triumphs and lamentable failures.

New York Magazine

Skloot uncovered, then spent ten years researching, one of the world's great untold stories: the human origin of biology's most famous cells--an undying strain, used in labs to help solve problems from polio to AIDS to cloning, known only as "HeLa." Skloot returns these syllables to their owner: The cells were harvested from Henrietta Lacks, a poor black woman dying of cancer in 1951 Baltimore.


Largehearted Boy

The "best of 2010" book lists are popping up everywhere, and Rebecca Skloot's The Immortal Life of Henrietta Lacks seems to be on them all (and deservedly so).

Skloot tells the story of Henrietta Lacks, whose cancer cells live on long after her death. These HeLa cells have become key facets in modern health research, and Skloot's research uncovers not only Henrietta Lacks' life, but also that of her her family and the medical advances her cells have helped bring. The book doesn't shy away from questioning medical ethics, but Skloot doesn't preach, she clearly provides the facts and lets the reader make up his own mind.

Simply put, The Immortal Life of Henrietta Lacks is the most arresting work of nonfiction I have read since Dave Cullen's Columbine, and is an always engaging and important book, an arresting combination of biography, science, and ethics.

Slate

Rebecca Skloot's The Immortal Life of Henrietta Lacks is a detective story about a poor black woman and her magical cells. Born on a Southern tobacco farm, Henrietta Lacks died in 1951 after being treated for cancer at Johns Hopkins. Without her knowledge or consent, scientists cut cells from her cervix and cultured them. In the lab, they grew into a cell line, called HeLa, that proved more robust than any before it. Lacks' cells were the ingredients for research into everything from the polio vaccine to chemotherapy and gene mapping. Skloot follows the cells on their scientific journey, using them to teach us about major medical advances. Even better, she takes us deep into the Lacks family, which learns about HeLa almost by accident and then grapples with feeling excluded from its powers. "Them doctors say her cells is so important and did all this and that to help people," Lacks' daughter tells Skloot. "But it didn't do no good for her, and it don't do no good for us." This is a voice not often heard in discussions of science. Skloot gets credit for bringing it to the fore and carefully thinking through the hard questions surrounding informed consent. Best of all, her book sings. She spent 10 years reporting and writing, and the effort pays off--she has turned unlikely material into a pleasure read.

Wichita Eagle

Sixty years ago, a woman named Henrietta Lacks was treated for cervical cancer at Johns Hopkins Hospital. Her cells were taken, without her knowledge or consent, for research and grew into a thriving cell line called HeLa, shipped all over the world for research. This book, a gripping combination of biography, science and history, tells the story of Henrietta's life and her family's realization of her contribution to science, plus the changes in medical ethics over the past few decades.

USA Today

Oprah Winfrey (who has bought the rights) is among the fans of this moving true story about a black woman whose cells were used extensively in research after her death -- without her family's knowledge.

Chicago Sun-Times

My choice this year was not the kind of book I typically read, but it was without question my favorite of 2010. Rebecca Skloot's "The Immortal Life of Henrietta Lacks" is chock-full of science writing but don't let that scare you. Skloot weaves the tale of one of the most important developments in the history of science -- the reproduction of HeLa cells -- with the human story behind it. She breaks down the science so it's easy to understand, and the story of Henrietta Lacks, whose cells are still used 60 years after her death for scientific research, will break your heart.

Chamber Four

The Immortal Life of Henrietta Lacks is the bizarre story of a tobacco farmer whose cancer cells have been used in scientific research for decades after her death. The book features a rare combination of great writing, fantastic storytelling, and deep social significance. Skloot admirably weaves several storylines--Lacks's life and death, the growth of HeLa cells, the many scientific advances those cells have made possible, the lives of Lacks's decedents--into a cohesive and gripping book. But Immortal Life sits on top of my list because of its social importance. The story of Henrietta Lacks was a generation or two from being completely forgotten. It would have been a shame to lose this piece of our history, not just because of the scientific significance of HeLa, but also because of the perspective Lacks's life and death adds to the Civil Rights struggle. Thankfully, with this book, Rebecca Skloot has made Henrietta Lacks truly immortal.

Here are a couple where only one other book is mentioned.

The Daily Beast

A surprisingly gripping account of the life of one Henrietta Lacks, unknown to most but touched by all because her line of cells were used in some of the biggest scientific breakthroughs of the 20th century. Skloot's biography finally and masterfully recognizes her unheralded contribution.

O Magazine

An uneducated black woman dies young and poor, but her cells live on, leading to countless medical breakthroughs--and to this multilayered narrative of race, class, and family.

Barnes & Noble (review here)

In contrast, science writer Rebecca Skloot also had a Helen Lane footnote moment in high school, but saw in that footnote the nucleus of a story about science and society. After ten years of HeLa sleuthing, Skloot's hunch has paid off handsomely: The Immortal Life of Henrietta Lacks is a modern classic of science writing.

Let me qualify that. This isn't science writing in the sense of Stephen Jay Gould or Richard Dawkins: Skloot doesn't spend a lot of time describing or extolling scientific discoveries. For her, the science is a bit player -- though an important one -- in a complex and fascinating drama about how medical research intersected the lives of a poor black family in America. Her mixture of science and biography is sui generis, and its themes profound: racism, ethics, and scientific illiteracy. (excerpt of review)

US News & World Report

The Immortal Life of Henrietta Lacks, by Rebecca Skloot. A true account of Henrietta Lacks, who died eight months after she was diagnosed with cervical cancer in 1951. Lacks's tissue cells, taken without her permission, are alive today and have been a cornerstone of the multibillion-dollar biomedical research industry--used to develop the polio vaccine and in research for cancer, cloning, in vitro fertilization, gene mapping, and Parkinson's. Skloot explores the human consequences of the intersection of science and business, rescuing one of modern medicine's inadvertent pioneers from an unmarked grave.

Seattle Times

In the 1950s, the doctors who took cancer cells from Henrietta Lacks, a poor African American farmer, never imagined creating HeLa -- the "immortal" cells grown in culture that live on and save lives around the world. Skloot's tireless reporting is sensitively done and written with unusual clarity; she erases the line between lab and humanity with inspiring deftness.

And a bonus review from Brian Switek because it's so telling.

The Immortal Life of Henrietta Lacks is a triumph of science writing (it is truly one of the best nonfiction books I have ever read), and I was deeply affected by it on a personal level. The story reaffirmed that small events can have major repercussions, and as sad and angry as the tale of the Lacks family made me by the end of the book, I was glad that [Rebecca] Skloot had worked so hard to reach them. Through something as simple as wanting to learn more about Henrietta's life, Skloot and the Lacks family were able to create a fitting tribute to Henrietta and her legacy. For the first time, the most important woman in modern medicine is having her story told, and I truly hope that it gets the attention it deserves.

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Yeah. I can see your point. But I think it may have also been excellent timing that contributed.

My unscientific sense of the zeitgeist is that people are eager to find evidence that the big bad biomedical/science/industry complex is teh evil, stealing our humours and such.

YMMV.

I have to admit I didn't take that into consideration. In a sense, it's all part of the same stew, though. The evilness of teh BSIC is a social issue, not a scientific one and the extent that TIMoHL focuses on that is the extent that it focuses on social issues rather than scientific ones.

It's all related.

I think the story of Henrietta intrigues people on many levels, for me the sense of injustice in her story is what drew me to the book. I was so pleasantly surprised to find myself reading a story that was a great mix of science and humanity. I usually don't read science books but Skloot's book has helped me rediscover the genre. I think TILoHL is going to do the same for many more people and Rebecca Skloot, with Henrietta Lacks, may instigate a new attitude to reading science books of this nature.