Fair warning, fear-mongering — and the real risk of STIs
By Julia Belluz - Thursday, April 11, 2013 - 0 Comments
(USACE Europe District/Flickr)
WMD-Rs, or “weapons of mass destruction of relationships.” That’s what Dr. Des Spence, a Glasgow-based general practitioner, calls the public-health messages about sexually-transmitted infections. Over the phone from the UK, he told Science-ish that the health community has overblown the risks of contracting STIs, and that he wished they would “start conveying the facts and not fear.”
Dr. Spence would know something about the facts. In a column he wrote for British Medical Journal this year, he described the evidence behind the “tyranny of terror messages” regarding diseases such as HIV, herpes, and Chlamydia. The chance of contracting HIV from unprotected sex between low-risk people is more than a million to one, and if the virus is contracted, it’s now treatable. So, too, with herpes (“an inconvenience but no life sentence”) and Chlamydia (which does not necessarily cause infertility). “It’s up to public health to provide the facts, not to engender fear and anxiety.”
Many health-care observers would agree with the Glaswegian GP: perhaps because of a hangover from then-untreatable HIV in the 1980s, perhaps in reaction to the pseudoscience-based fears that fuel the anti-vaccination and anti-wifi movements, or perhaps because of a gap between the worlds of health research and journalism, there remains a tendency by public health toward paternalistic, fear-mongering communications of health risks about everything from STIs to pandemic threats. No doubt, these guardians of well-being at the population level, from regional to international, have a difficult task: to strike a balance between over-hyping and underselling, over-reacting and doing too little. But with the recent passage of the 10-year anniversary of SARS, and new pandemic possibilities such as H7N9 and the Coronavirus, it seems like the right time to ask: could they be doing a better job at communicating?
Dr. Rebecca Haines-Saah, a research associate at the University of British Columbia (who also happens to be a star from Degrassi High) thinks so. “We [in public health] tend to appeal to moral and ethical duties and obligations to change but that doesn’t resonate with folks,” she told Science-ish. Like Dr. Spence, she noted that a lot of public-health communications are too stigmatizing—HIV/AIDS messaging, the recent Ontario anti-smoking campaign that compares social smoking to social farting—and urged her peers to reflect on the unnecessary distress they can wreak. “We go over the top, oversell the risks, market the goriest, scariest message to be effective—but is that even ethical?”
And is it actually effective? Dr. Bruce Baskerville, a senior scientist at the University of Waterloo who studies tobacco control, pointed out there are public-health maneuvers that work without the guilt and stigma. On the anti-smoking front, one area in which evidence from around the world is unequivocal relates to the effectiveness of tobacco taxation and pricing. “If you raise the price, there’s less uptake, and more inclination for people to quit smoking.” It’s a systemic change with little overt judgement. Rethinking cigarette packaging and opening quit lines for smokers helped, too. But, he said, “The best thing is giving the public valid information, to help people make decisions.”
Part of getting better information out to the people means working more closely with journalists, explained Anne Simard, chief public affairs officer at Public Health Ontario, and having conversations, not monologues. When asked about fear-mongering from public health, she pointed out that advocacy groups—such anti-vaxxers—and the media can also be sources of anxiety, and said her agency is working on beefing up its lines of communications on social media and with journalists. “People don’t tolerate uncertainty,” she said. The key is “being transparent, being clear about what we’re doing to get towards greater certainty, and how we do that in such a way so that people come along with us.”
Indeed, being open and honest, letting the facts speak for themselves, seems to be the way forward amid public-health anxiety, such as during pandemics. There’s literature to suggest when communications lack transparency and veer too far toward advocacy—stirring a hornet’s nest of worry and alarm—they can have the opposite of the desired effect. That’s not to mention the backlash and suspicion that can arise from withholding information, as seen with China’s SARS and H7N9 communications, and Canada’s less-than-stellar record on science transparency and media engagement.
A new study in the journal EPJ Data Science looked at swine-flu vaccine messages on Twitter and found that people were more likely to share and retweet negative views. Meanwhile, those who were exposed to many positive messages often later expressed negative opinions. The lead author, Dr. Marcel Salathé of Center for Infectious Disease Dynamics at Penn State University, said this may suggest heavy-handed public-health messaging flops.
As well, he cautioned that while this was just one paper, and his peers need to test and re-test his hypothesis to see if it holds up, “What’s really fascinating about this study is the major point that we can now measure these things on such a huge scale with thousands or millions of people in real time.” Public health should examine how messages move through social networks, and recalibrate campaigns accordingly. “Ten years ago, we talked about Dr. Google and how people get health information from the Internet. Now, we have to talk about Dr. Twitter and Dr. Facebook.”
That’s a lesson for public-health communicators of every kind. In the age of Dr. Twitter, people turn to the Web and their social networks for intelligence about everything from STDs STIs to emerging pandemics. Public health ought to be there, too: this time, presenting true and timely messages, engaging in conversations, and nimbly tracking their impact in real time. No fear, just facts.
Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health Forum. Julia Belluz is the senior editor at the Medical Post. Got a tip? Message her at julia.belluz@medicalpost.rogers.com or@juliaoftoronto on Twitter.
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As millions gather for Kumbh Mela, doctors are watching
By Hannah Hoag - Monday, February 11, 2013 at 11:55 AM - 0 Comments
55 days, 100 million visitors, and a high risk of disease spreading among the masses
Daniel Berehulak/Getty
When a cholera outbreak gripped a London neighbourhood in 1854, physician John Snow carefully mapped its deaths. The thin bars he traced under each address clustered around a water pump on Broad Street, which turned out to be the source of the bacteria. Snow’s studies of disease patterns won him recognition as the father of modern epidemiology—and crushed the prevailing theory that cholera was spread by bad air.
Faced with the same challenge today, Snow might use a tablet computer. In mid-January, as the Indian city of Allahabad began ushering in millions of Hindu pilgrims for the religious festival Kumbh Mela, emergency physician and epidemiologist Gregg Greenough settled into a temporary field hospital with his tablet computer. He and his team from the Harvard School of Public Health were on the lookout for signs of influenza, tuberculosis, cholera and other diarrheal diseases. The plan is to record the temporary residence of each pilgrim admitted to hospital and plot it on a digital map that geolocates the festival’s toilets and drinking water. “We’re helping them digitize the data and analyze it in real time,” says Greenough. “It should help keep the pulse of the community and see if anything is emerging so they can act on it quickly.” Continue…
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Flu season surging just in time for the holidays
By Helen Branswell - Thursday, December 20, 2012 at 4:02 PM - 0 Comments
TORONTO – Flu activity seems to be surging just in time for the holidays…
TORONTO – Flu activity seems to be surging just in time for the holidays in several parts of the country, health officials said Thursday as they urged people to take precautions against catching and spreading the illness.
It’s not too late to get a flu shot, they suggested, and also said people can protect their friends and loved ones by not attending parties and gatherings if they are sick.
“We have long recognized that the holiday period is a chance for greater social mixing,” said Dr. Danuta Skowronski, an influenza expert at the B.C. Centre for Disease Control in Vancouver. Continue…
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Studies say . . . a memory boost and the shock of birth
By Scaachi Koul - Monday, October 22, 2012 at 11:06 AM - 0 Comments
Chocolate makes snails smarter and fish could start losing weight
British Columbia: Researchers at the University of British Columbia have found that changes in ocean and climate systems could result in smaller fish. The study, published in the journal Nature Climate Change, looked at more than 600 species of fish from oceans around the world. It determined the maximum body weight the fish can reach could decline by 14 to 20 per cent by the year 2050.
Alberta: University of Calgary researchers exposed snails to epicatechin, a component found in many foods, including chocolate and green tea. In the study, published in the Journal of Experimental Biology, they found it helped boost the molluscs’ memories. They couldn’t determine yet whether the findings apply to humans.
Manitoba: Findings from the University of Manitoba’s faculty of medicine show that children from lower-income areas have a tougher time than kids from higher-income areas in health and school. Most worrisome, the study, which tracked Manitoba children aged 19 and under from 2000 to 2010, found that the rate of child deaths in lower-income areas was more than three times greater than in higher income areas.
Ontario: With flu season creeping up, a new study by Public Health Ontario suggests that ethnic communities are more likely to get a flu shot than Canadians who identify themselves as white or black. A dozen ethnic groups, including Filipino, Japanese, southeast Asian and Chinese, were all found to be more likely to get the shot.
Quebec: For a minority of mothers, giving birth leads to the same psychological shocks felt by soldiers in war. Researchers at McGill University found one in 13 mothers suffers post-traumatic stress disorder following delivery. The women suffer flashbacks, nightmares, sleeplessness and try to avoid anyone who reminds them of the trauma of birth, including their babies.
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Sir Michael Marmot on why all matters are health matters
By Julia Belluz - Tuesday, August 14, 2012 at 5:39 PM - 0 Comments
Photo: Colin Leslie/The Medical Post
By the age of 25, Sir Michael Marmot, the first in his family to go to university, was already a practicing doctor with a secure future ahead of him. He should have been a contented man. But he wasn’t. As he tells it, he felt there were limits to how he could help his patients in his work as an MD. He saw people every day who were dealing with what he calls “problems in living” that seemed to lead to their poor health.
“At this inner-city hospital where I was working, we had a lot of immigrants at this time, and they would come in with pain in the tummy,” he told Science-ish in a gentle, grandfatherly whisper. “We’d give them some white mixture and send them home. And I’d think to myself, ‘they’ve come in with problems in living and we’ve given them a bottle of white mixture and told them to go back to the problems in living that they had before’.” For Marmot, it seemed like a futile approach: Patients’ problems needed to be addressed outside the walls of the clinic as well.
That’s why he left his secure job to move to California to study epidemiology, looking at disease trends in well-defined populations and how they correlated with people’s life circumstances. As Marmot recalls, his supervisor at the time— sociologist-turned-epidemiologist Leonard Syme—told him, “Just because you’re a doctor, doesn’t mean you understand the causes of ill health. You understand something about biology and medical conditions but you’ve got to learn something about society if you really want to understand the causes of ill health.”
Since then, Marmot, now 67, has led some of the world’s most compelling studies on the “social determinants of health.” In some 30 years of research on members of the British Civil Service, known as the Whitehall Studies, he established a link between their relative rank and risk of cardiovascular disease and death (the lower the status, the higher the risk). This, despite the fact that they were all relatively well off.
Marmot has looked at other health oddities, such as why residents of some areas of Glasgow, Scotland have a 28-year gap in life expectancy compared to those living in other neighbourhoods, and how the disease patterns of Japanese migrants in America transform to resemble those in their adopted fellow countrymen over time.
This research has shed light on the intuitions he had as a young doctor: There are real, tangible ways in which seemingly non-health related matters—where you live, your rank at work—impact human health. Now, the self-described “evidence-based optimist” is bringing his message to Canada’s doctors. Yesterday, Marmot, a research professor in epidemiology and public health at the University College London, was the special lecturer at the Canadian Medical Association general council meeting in Yellowknife.
During his address to what’s known as the Canadian parliament of medicine, Marmot won Science-ish’s heart when he said: “Let’s have a dream of a fairer world but let’s harness the evidence to have the pragmatism to achieve it.” Later on, he sat down with Science-ish to share insights about his life in science, the nature of evidence in policy, and the impact he hopes his research will have. Here’s an excerpt:
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Should Windsor close the tap on fluoridation?
By Julia Belluz - Friday, March 23, 2012 at 5:21 PM - 0 Comments
.scribe/Flickr
Nothing showcases the human potential for creativity better than conspiracy theories. A search of “fluoridation” on YouTube gives a pretty good sense of the fantastically diverse views of anti-fluoridation campaigners, some of whom believe that adding more of the mineral to the water supply is akin to Nazi-inspired mass medication–and that it can cause all kinds of afflictions, from cancer to hip fractures and a diminished IQ.
A few cities across Canada (most recently Windsor) and the U.S. have been moving to phase out fluoridation. This, in turn, has spurred some commentators to squawk in dismay and defer to authorities like the U.S. Centers for Disease Control and Prevention, which touted fluoridation as “one of the 10 great public health achievements of the 20th century.”
Now, as much Science-ish likes to bust a dubious conspiracy theory, it also doesn’t like to rely on authority alone to draw conclusions. So what does the science show?
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French breast implants: a Science-ish saga?
By Julia Belluz - Thursday, January 12, 2012 at 6:12 PM - 0 Comments
(Lionel Cironneau/AP Photo)
Since December, health authorities around the world have been scrambling about what to do with women who have French-made Poly Implant Prosthesis (PIP) breast implants lodged in their bodies. After being approved for market, it recently emerged that PIP implants were filled with non-medical grade silicone—unbeknownst to regulators—and that their manufacturer had got rid of an outer skin to keep the implants from leaking and breaking.
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How public health failed
By Larry Krotz - Monday, November 29, 2010 at 1:00 PM - 17 Comments
The strategies needed to prevent the spread of HIV/AIDS never came close to being effective
With an almost eight per cent infection rate, 60 per cent of government health spending in Kenya goes toward AIDS; John only recently began to practice safe sex | Marco Negri/Zuma/Keystone Press; Larry Krotz
John is something unusual in Kenya, a gay man who openly admits to both that and to being a sex worker. Homosexuality there has long been anathema, labelled by former president Moi as “foreign, not done by Kenyans.” Putting the lie to this, John every morning dabs on some Hugo Boss cologne, stops into an Internet café to check out a gay website for arriving tourists, then cruises the streets looking for business. But when we sat down and talked in Nairobi, John, who is 32 years old and asked not to be identified by his full name, admitted something astonishing: despite his high-risk occupation and the fact that AIDS has been around almost his entire life, he claimed not to know until last year that he could get HIV through sex with men. In Kenya, the HIV epidemic is overwhelmingly a heterosexual calamity. Eventually tested, he knows he is positive and, though he now uses condoms, for a long time he very likely spread the virus.
Astoundingly, a full generation after the arrival of AIDS, especially in that most hard-hit of regions, southern Africa, disinformation remains rife. As the 23rd World AIDS Day approaches on Dec. 1, what is similarly disturbing is that strategies needed to prevent the spread of this awful epidemic never came close to being effective. Statistics alone tell the tale. True, more and more people are on life-prolonging antiretroviral therapies (ART), something that mushroomed when costs dropped to $100 per year per patient with the arrival of generic drugs. Yet for every 100 people put on ART, southern Africa registers 250 new HIV infections.
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'A beautiful living lab'
By Sarah Elton - Thursday, July 29, 2010 at 1:40 PM - 0 Comments
What do the stories of a million Indian deaths say about global health? A Toronto researcher aims to find out.
William Daniels/PANOS
On a cool day a few years ago in a village in the northeastern Indian state of Meghalaya, a group of government workers approached a thatched-roof hut. They had learned that a young man in his late 30s had died there several months earlier, and they wanted to ask his family some questions. How did he die? Had he been sick? In India, a medical examination or certificate of death isn’t required before burying or cremating a corpse, and so the workers were conducting a kind of verbal autopsy.
As the young man’s father told them the story—his son had developed a cough, then become sicker until he had trouble breathing—a few children and then a couple of older neighbours gathered around. His son had started smoking at age 10, the man said, but they didn’t know exactly what had killed him, only that he was in the hospital for three days before he died.
