Talking About Health; Why Health Communication Matters

What might happen when a pharmacist uses a conscience clause?

January 16, 2012

A conscience clause — when might a pharmacist feel conflicted about filling a prescription? The most commonly discussed event is birth control. Birth control pills, the morning after pill… these medications cause feelings of conflict between values related to pro-life and anti-abortion, and dispensing the medications.

The store, Target, supports a pharmacist’s rights not to fill these prescriptions. However, a pharmacist must direct a consumer to another Target store where the prescription can be filled. I can find no research that has been done to see how such conversations might take place or what happens when — as in the town where I live — there is one Target store. I don’t know if there is more than one pharmacist there. I don’t know if any of them object to filling these prescriptions. But if they do, what happens? How would I know? Who would tell me?

Why I am annoyed by this Nexium commercial

January 11, 2012

OK. Running on the networks is this annoying commercial. The key message is, “You wouldn’t want your doctor doing your job.”

I suppose it is intended to somehow make us feel guilty because we are somehow offending our doctor in our personal efforts to read product labels and make informed decisions about over the counter drug purchases.

I don’t think my doctor would be offended. Instead, I think both my doctor and I are annoyed by an ad that suggests only a doctor knows best.

I guess it’s time to get a new dentist…

October 27, 2011

I don’t have good luck with dentists. I do my best to get recommendations. Things go along OK for awhile. Then I start getting advised to do things that don’t make sense to me. I ask questions. But I don’t get satisfactory answers.

My current dentist knows that I came to him several years ago. Not because I was just moving to the area. But I wasn’t feeling good about how talk with my former dentist was going. So, this dentist seemed great for awhile. But last year, he recommended that I get a crown in a tooth where it seemed to me that we should start with a filling. I should have gotten a second opinion because instead, I put off doing anything, built up resentment that the dentist couldn’t explain why a crown was needed. “It will just be better in the long run” doesn’t tell me anything. I guess we could just put crowns on all my teeth and it would be better in the long run if what that means is that my natural teeth wouldn’t be wearing anymore.

OK, I should’ve gotten a second opinion last year. I didn’t. I have all the same excuses everyone has. I didn’t have time. I didn’t want to offend my current dentist. I didn’t know how to go about finding another dentist and asking for a second opinion. Yikes.

Well, this week I had my first scheduled cleaning since the crown. The technician asked me how it was going and I told her that it hurt to chew a steak on that side where the crown is… “I don’t eat much red maet,” I said, “But when I do, it hurts.”

She said, “That’s nornal. It’s new.” I should’ve known right then that things were not gonna go my way. She took exactly 12 minutes to clean my teeth and then went for the dentist. He took 15 minutes to appear. When he appeared, the technician said, “He’s Mr. Funny man today.”

He took a look and a poke and announced, or mumbled I should say, something to the technician. She said, “So you want to do the four now?” Four what, I wondered.

“Let’s do all six.” Six what, I panicked.

“Six what?” I asked.

“Fillings.”

“What?!” Mind you, I had been to the dentist six months ago. I didn’t have any new x-rays done at the current appointment. What was different today from six months ago?

“Well, you have some wear in the enamel on the top of some of your teeth. The dentin is about to be exposed in some places. I just want to prevent that.” I guess I looked skeptical as he said, “I can show you.” He handed me a mirror. I opened my mouth. He pointed to one of my incisors. “See?” I looked and, yes, I could see a dip in the enamel. Nearly six decades of living might do that, don’t you think? That’s a lot of chewing and, well, grinding my teeth–a bad habit of mine. I must have looked skeptical still as he said, “I could show you the others, but you might have to stand on your head to see them.”

“I see what you mean,” I said to the technician. “He really he is a ‘funny man’ today. What are you going to do? Why?”

“I will just put a bit of filling in there to protect the tooth. It won’t take much drilling at all. But I’ll still numb you up real good.”

I checked out. Literally and figuratively. I didn’t ask any more questions. But I didn’t make the appointment for the fillings. I have been looking and can find no research or recommendations relating to taking this action. I do find some discussions that lead me to believe that the dentist will have to etch my tooth to make the filling stick–my lay term. And that it is the first step toward the filling not sticking and then needing–a crown.

I would love to be wrong about this. I want to trust the health care professionals I pay for my care. But I need them to explain why their recommendations make sense and to respect my decisions about actions labeled ‘preventive’ care. I don’t feel either of these exists in this situation. And so, I guess it’s time to get a new dentist.

Would you like to have a copy of the book, ‘Moral problems in medicine’, edited by Samuel Gorovitz and colleagues?

October 7, 2011

It happens. My library at home and in the office spills over onto the floor in my office. The floors at home. In the library. And the bedroom. There is the chair beside the TV. Oh and the table in the library. There is the tactic of placing a few books here and a few books there. All in the name of ‘decorating’ with books. But it reaches a critical mass and is just…too much. So I have selected some to part with. Before just dumping them into the local book drive box, I thought I would give you a chance to say that you would like to have this book. I will tell you a bit about it and how to have it [book jacket in tact and all] for your own.

First, let me just say that Penn State has approved a dual title degree program in bioethics, with Communication Arts & Sciences being one of the departments within which a student might elect to pursue this degree http://live.psu.edu/story/54735. I have always been fascinated and engrossed in debates about health, health care, and ethics. Not the least of these is the continuous discussion about whether access to health care paid for by insurance ’causes’ individuals to use more care–the moral hazard linked to insurance. It is because of my interest in this area that I’ve read hundreds [yes, ’tis true] of books dealing with the topic on all kinds of levels in all kinds of nations. And I own a lot of books on this subject–broadly speaking. Which brings me to this book.

Regarding the book itself, it is listed in this bibliography: http://www.qcc.cuny.edu/SocialSciences/ppecorino/SS640/bibliography.html regarding “General works in medical and bioethics.”

The book was reviewed positively in the Journal of the American Medical Association shortly after publication. http://jama.ama-assn.org/content/236/25/2906.1.short Notably, the reviewer comments on the fact that the book does not limit the topic to any one field but provides varied views from contributors in a number of fields. At any rate, if the topic interests you and you want this book, tell me so in the comment section. I will select someone to receive the book and go out of the blog to get your mailing information via email. Then the book will soon be traveling your way…

Weighing in — what’s the debate about Dr. Oz and the apple juice story really tell us?

September 21, 2011

All has been quiet on the talking about health front. I am in the midst of teaching the undergraduate class about designing health messages at Penn State, so it is odd that I don’t find my way here more often. But in the fury of the debate over the Dr. Oz show about apple juice. [go here to read and listen to the debate if you want more information: http://www.doctoroz.com/videos/arsenic-apple-juice], I had to make time to add a few thoughts.

First, in favor of Dr. Oz — his show entertains us and informs us at the same time. We do have to remember that someone has to pay the bills for the show, so the entertainment quality has to be there. It is that simple.

The positive things about a show like Dr. Oz is that it can arouse public passions about scientific issues and lead to health advocacy. It may increase healthy behaviors and improve our vocabulary when it comes to talking about health and the science of health.

But on the negative side–it can be confusing and contribute to inaccurate understanding. It may arouse public passions but these can be misdirected.

The apple juice show and related debate illustrates both. The headline for the page above and the text beneath illustrates this reality. What is an “extensive national study”? According to the text, it means “dozens of samples” from “three different cities”. That is neither extensive nor a nationally representative sample.

How was the study conducted? Even with the several dozen samples, there is much room for the approach to vary. Did the tester shake the apple juice before drawing a sample? That might be important in terms of how the contents in the apple juice are distributed through the liquid. Did the tester take a sample from the bottom of the juice container or the top? Did the tester take more than a single sample of juice from each of the containers tested? Inquiring minds want to know…

But instead of focusing on specific and direct questions to guide our understanding, the backlash focused on name-calling. Skimming the contents of various letters from companies represented on the show and the Food & Drug Administration–FDA–“irresponsible” might be the most frequently leveled charge. Dr. Besser calls the Dr. Oz show “fear-mongering”. Watch this exchange:

I give credit to Dr. Oz for remaining calm and answering the charges.

But I wanted to know more about organic and inorganic arsenic levels, and other issues such as I raised above. I wanted to know less about Dr. Besser’s “upset”…

How should we talk about tanning?

April 12, 2011 GUEST BLOG POST by Danielle Torrisi

Take a look around any college campus, and you’ll notice at least a handful of tanning salons. Pick up their college’s newspaper and you’ll find ads for tanning salons with gorgeous, tanned women pictured with the slogan “Beautiful Tan Today. Young looking skin tomorrow” and promotional discounts that is sure to catch the eye of any student. The tanning industry portrays tanning as harmless and risk-free. However, research has shown that the incidence of melanoma has continued to rapidly increase since the 1970’s.

A recent study at a southern university surveyed 492 students and results showed that a majority of the participants knew sun exposure increases the risk for skin cancer, but only 29% correctly identified behaviors that reduce this risk.

Less than 46% of the participants were able to identify signs of melanoma, and less than 10% were able to identify the primary area of the body for melanoma. Approximately half of the participants strongly believed that a tan improves one’s appearance, and only half thought that sun safe behaviors are necessary. It is very troubling to learn that they think their appearance outweighs their health.

College students need to be informed about the dangers of using tanning beds in hopes of changing attitudes and behaviors. It all starts with the media and advertisements need to show a more natural appearing skin. “As long as marketers portray being tan as healthy, attractive and sexy, young women will continue to believe that a tan is desirable, regardless of the risks” (Spradlin et al).

It needs to be understood that there is no such thing as a healthy tan. “In fact, UVA rays which are used in tanning beds can go all the way through the skin’s protective epidermis to the dermis, where blood vessels and nerves are found. Because of this, UVA rays may damage a person’s immune system, making it harder to fight off diseases and leading to illnesses like melanoma, the most serious (and deadly) type of skin cancer” (Tanning). This needs to be reinforced in student’s minds in order to see a behavior and attitude change.

To view this article go to: Citation: Spradlin, Kimberly, Martha Bass, William Hyman, and Rosanne Keathley. (2010). Skin Cancer: Knowledge, Behaviors, and Attitudes of College Students. Southern Medical Journal. 103, 999-1003.

What do you think about tobacco settlement dollars?

March1, 2011

It is a fascinating history filling volumes of research journals and books and ledgers… The tobacco settlement… It came to my attention again today as I was reading about Pennsylvania’s adult basic health insurance program.

Mostly, in the past several days, I’ve heard sound bites about the program shutting down and leaving Pennsylvanians uninsured. The shutdown in the stories I’ve heard seemed to be linked to state budgets and all that is going on there. Today, I had a moment to explore more about these soundbites and learned that…the program began under Governor Tom Ridge who used the State’s tobacco settlement funds [http://onevoicetulsa.com/index.php?ht=display/ContentDetails/i/4424680].

The tobacco settlement was designed to provide states with funds to address increased health care costs related to tobacco use…smoking. This was to include cessation programs as well [http://www.tobaccofreekids.org/what_we_do/state_local/tobacco_settlement/].

One might ask how we get from the the latter to the former? We all share higher health care costs linked to smoking…whether or not we smoke or have smoked. So perhaps it was a creative and even equitable program that the former governor introduced…

Should those who educate our doctors include talk about cost consciousness?

February 24, 2011

In my piles of articles that I was sorting and filing today, I came across one written by Molly Cooke, a medical doctor. She published a piece in the New England Journal of Medicine [http://www.nejm.org/doi/full/10.1056/NEJMp0911502] that appeared in 2010, volume 362, pages 1253-1255. The article’s title is, ‘Cost consciousness in patient care — What is medical education’s responsibility?’

I was moved to print a copy of this article when it first came into my email on one of the many list serves to which I subscribe. I was reminded of why that was the case as I reread the contents. Dr. Cooke notes that while debate about costs of care has been a focus of society’s discourse relating to health for decades, medical education curricula seldom address how and when cost enters planning of diagnosis and treatment strategies.

Dr. Cooke addresses historical, philosophical, structural, and cultural explanations for this reality. One of the historical events relates to efforts for clinical pharmacists to guide doctors’ understanding about prescibing and testing. The ‘academic detailing’ veture, as it was labeled, made little difference in prescribing or other habits.

Dr. Cooke notes that doctors consider themselves to be patient advocates and, as such, want to focus on benefits for a patient, not the cost associated with accessing those benefits. Structurally, she describes an educational setting in which medical education students work in hospital settings where the primary goal is to get a patient out of the hospital. If discharge is the first aim, she believes that doctors learn to order any test they can to achieve that aim via evidence that a patient is ready to be let go. So, there is no time to learn about possible cost-effective approaches… Isn’t this a bit ironic? In the name of cost-saving, perform possibly unnecessary tests to discharge a patient sooner rather than later? If anyone has the data out there to show how that works out for the economic benefit of health care, pleasure share it…

Have you been following the news about liver damage and acetaminophen?

January 14, 2011

We don’t set out to overdose on our over the counter drugs, but some of them are ‘invisible’… they are included in so many products that it can add up before we know it and cause problems. Serious problems for acetaminophen… 42 thousand hospitalizations for overdosing… 400 deaths… just in the U.S. http://www.nytimes.com/2009/07/07/health/07well.html?_r=1

But the answer is not switching… aspirin is invivisible in lots of products as well. I write about this in the chapter about health profits in Talking about health… Elderly adults using creams with aspirin and young adult athletes seeking pain relief have had problems with overdosing by accident because the ingreident is included in so many products… A note of caution for us all…

Why does Vicks vaporub say for ‘external use only’ on the warning label?

November 22, 2010

I took my plastic bag and whipped through my medicine cabinet, laundry room, and kitchen over the counter medication shelf. We were discussing warning labels in my undergraduate health communication class, and I use products from my home to have students identify the parts of the warning as we discuss the content and what the research says about the likely effects.

Several products say, ‘for external use only.’ One says to avoid use on the lips. The latter is a product called ‘bite-aid’ and it comes in a chapstick kind of container. I told the story about sitting in the airport and reaching into my purse for my chapterstick, feeling the ‘bite-aid’, and applying it to my lips. It didn’t take long to feel like my lips were swelling. I told my class about how I asked my husband if my lips were swelling. I told him how odd they were feeling after putting on my chapstick, which I held out to show him. Still not realizing that I was not holding out my chapstick. He took one look and said, ‘That’s not your chapstick.’ With surprise, I looked down, read the label, visited the bathroom and scrubbed my lips–which soon returned to feeling normal.

“That,” I told my class, “is an example of a potential harm related to a product that could be solved with different packaging.” As I noted, “I didn’t intentionally put it on my lips, so even though the label says, ‘do not use on lips’, that content didn’t really help in my situation.”

One of the student’s then told about how the Vicks vaporub said, ‘for external use only.’ “My grandmother always made us eat a tablespoon of it when we were sick,” she said. I hardly knew what to say to that. “Why?” I asked. “Because it is for your chest cold and that is how to get it in your chest.” I was quiet as I thought about that. “It works,” she said.

Another product a student had was benadryl gel. The label also said, ‘for external use only’. The student observed, “That’s probably because you usually take benadryl as a pill… and this liquid looks like you could put it in a spoon like cough syrup. So I bet some people have done that.”

Warning labels have content that may help us avoid harm…if we read them. …and they make sense.