Talking About Health; Why Health Communication Matters

What does health policy have to do with communicating about health?

joy-in-boat-hoc-2009 November 16, 2010

Product recalls. Nutrition labels. Informed consent documents. Patient package inserts. Lots of people spend a lot of time designing these messages. Yet, research shows that far too often, no one reads them. Of course, one reason we don’t read them is because the print is so small, we need a magnifying glass to see what it says. Other times, we take for granted that the product wouldn’t be available if it was going to be harmful. Still other times, we need to add up the content of product labels to know how much we are really getting. Too much of an ingredient, such as aspirin, can cause serious health problems and may occur because aspirin is included in creams being used for joint pain or products being used to treat cold symptoms or any number of other combinations of things being used that individually do not pose a risk but combined can even be deadly.

parrottch5fig2 Warning labels provide another way that policmakers are trying to assure that we have information to protect our health. Warning labels are designed to get our attention with a signal work about a hazard: caution, danger, or often–warning. The label also includes a statement about what makes the product risky. For example, if it contains alcohol, then it may be flammable. If it contains an herb, it may interact with prescribed medication or the drug to be used for your medical procedure. The label may also include a way to avoid the harm, such as talking with your doctor about using the product. And it may include content about outcomes that could occur, although these may be worded abstractly, such as–“adverse reaction”–meaning what exactly?

In the end, it is still up to us. Policies give us the chance to gain some information. They can’t make us read the labels and use them to make decisions…

What is the message in ‘Jamie Oliver’s food revolution’?

141_0767 April 7, 2010

In the past couple of weeks, I have been watching the TV show that sparked some discussion on this blog a couple of weeks ago. After watching it so far [and with plans to continue to do so], I wanted to take note of a couple of points in his message that may be getting lost.

First, I heard Jamie say, “It is not about weight. …Thin people can be unhealthy, too.” This is a message about our health that gets lost in the clutter of messages about weight loss, dieting, obesity, and the fixation on what the scales say. Another time that I heard a similar message in a popular TV show was one year when the first dancer to be voted off ‘Dancing with the stars’ was a model. When she was rehearsing and then performing, she did not have the physical strength to pull herself up from some of the positions her partner placed her in. She was beautiful but as her expert dance partner said, “She is deceptively unfit.” So, yes, it is NOT about the weight. If we could follow more of the fitness model and less of the weight model, a healthy weight would likely be one of the outcomes. This is one of the great messages being communicated by Michelle Obama… to the kids of the U.S., get out and get up and get moving. To the rest of as adults who set role models for our youth and for our friends and family and coworkers, ditto… I talk about this in my book ‘Talking about health’ when I tell my own experience with sitting at the computer for too many hours over too many years and developing bone spurs in my neck–literally a stiff neck. I talk about how our generation of computer workers is not unlike the old factory and production line works in that we are in one position for too long and literally get stiff [and a little fat from it, too]. My physical therapist told me, ‘Never sit at the computer for more than 30 minutes without getting up and taking a stretching break for at least 2 minutes.’ He told me to set a timer and I do–at home and at the office. Get moving and make it fun!

A second message from Jamie Oliver’s show that we should hear and act on has to do with the how over processed our foods have become. We have given the food industry a profit motivation to come up with products for us to purchase that say on them such things as ‘fat free’ or ‘no sugar added.’ A long list of ingredients then includes a lot of long words that none of us recognize because they have mostly been created in food laboratories. I was shocked when Jamie showed a class of youngsters various vegetables and the kids could not name a ‘tomato’ or a ‘potato.’ They knew what french fries are but not what a potato looks like. Wow! A shout-out to those writing the ABC picture books. We need to put some vegetables in one. Perhaps an entire picture book devoted to vegetables. And then, of course, it would be great if we followed up by eating some of these vegetables. On this blog a couple of weeks ago when the Jamie Oliver show was brought up by a participant, it was noted that the cost of fresh vegetables is high. The cost of frozen vegetables may be a good substitute. One of the partipants in that discussion said that she could buy a bag of mixed frozen vegetables in the store brand for $1 and feed her family of four with it. I suspect that the store advertises that product with an emphasis on the cost rather than the nutrition. We need more communication about how to use frozen affordable vegetables when fresh ones are not an option.

Third, following on the heels of our food being over processed is a message about our foods containing too much salt. Most of us know that the ‘dead sea’ doesn’t support any life because the water is too salty. Well, when we get too much salt, our health doesn’t do well. That is one of the challenges of buying frozen vegetables. We still have to look at the product to see if anything has been added. Not all frozen vegetables are created ‘equal.’ Some of them have salt added. So it is not just the long scientific chemical names to watch out for when looking at nutrition labels and the ingredients of products, we need to watch out for ‘sodium’–salt that has been slipped into the ingredients. We can change the way products come to us. We change them with the votes of our dollars–our food purchasing dollars…

What is Dr. Besser telling us when he says, “There is no ‘evidence’ that herbs work for a cold”?

March 30, 2010

Spring is in the air and hopefully, you are not suffering from a spring cold. Or allergies. This morning on, “Good Morning America,” Dr. Besser talked about health information and social media–offering cautions about ‘advice’ that might appear on Facebook or other outlets, or health information sent via tweets.

After offering the general advice to be careful about what we believe, he focused on an example relating to the use of an herb to fight a cold. He made the statement I used in the title for this post: “There is no evidence that herbs work for a cold.” O.K. What’s wrong with that statement?

From a health communication perspective, this kind of comment is made often. If Dr. Besser or another source of the comment is someone we trust and believe to be an expert, we may accept the comment without further thought. We are usually not expert in health. Not surprisingly, we look to experts in health to guide our understanding.

But here is the problem I have with such statements. They do nothing to help us become more competent in making decisions for ourselves about health information. Dr. Besser could explain that there is no evidence and also explain what he means by evidence. For him, evidence = scientific data. Those numbers are usually the result of carefully conducted clinical trials. Those carefully conducted clinical trials cost — well a lot of money. And relatively few dollars are spent on research to study complementary and alternative medical practices–such as the use of herbs to fight colds.

The traditional approaches to health in the U.S. are prescription and over-the-counter drugs, and surgery, and the use of medical devices–many device relate to surgery and others that boost some of our ability to manage our own health. There are many expensive funded studies to evaluate the effects of these approaches. Based on the results, evidence is published and then disseminated to guide our doctors’ knowledge and our care.

We should realize that the research by pharmaceutical companies sometimes looks at herbs and works to understand how they might work to help or harm human health. Finding that an herb works may lead the drug company to produce synthetic versions of the herb and conduct research to see how they work. After all, we and our doctors do not live in the era of Dr. Quinn, Medicine Woman and cannot go into nearby woods to pick herbs to make teas or other potions to heal us. Medicine generally needs products that can be sold in mass quantities.

So, what does a lack of evidence mean when it comes to Dr. Besser’s statement? It means that no scientific clinical trials have shown the use of the ‘natural’ herb to be effective in reducing the effects of a cold.

Dr. Besser’s statment is not considering that your friend, your neighbor, or a thousand friends and neighbors on a social media site have used the herb and tell their stories about how it worked for them. It is not addressing the fact that we often trust the stories of others as ‘evidence.’ But it is not the same kind of evidence as science would provide. That is something he did not say. From a health communication perspective, we want to know this to help us better understand health information.

He also did not say whether the herb being promoted for a cold is one that drug companies may have or may be studying in some form. From a health communication perspective, we also want to know this to help us better understand health information…

Should we ask our doctors about antibiotics?

138_07301 February 27, 2010

On the ABC evening news this past week, Dr. Besser advised the audience, “Do not ask your doctor for antibiotics.” He provided the evidence to support the claim that asking for antibiotics greatly increases the chances that a doctor will prescribe antibiotics to a patient. He went on to explain that antibiotics are designed to treat bacteria. They do not treat a virus.

I would reframe this conversation. From the doctor’s side, if a patient asks for antibiotics to treat a virus, this seems like a great opportunity for the doctor to explain, “Antibiotics do not work to treat a virus, and your cold is caused by a virus.”

The advantages of this approach include the chance to improve a patient’s health literacy. We can increase our own understanding about health if our doctors take the opportunity to use these teachable moments to ‘teach’ us.

Another advantage is that we feel able to ask a question about our treatment without concern that our doctor might prescribe something unncessary. One likely unintended of Dr. Besser’s advice to not ask for an antibiotic is that it may lead us to wonder, ‘how often would a doctor prescribe something to me just because I asked for it?’

The medical research supports the conclusion that in the U.S., direct-to-consumer advertising leads patients to ask for tests and prescriptions that increases the likelihood that a doctor will order the tests and/or prescribe the medication. So, like in the case of antibiotics, when a patient asks — a doctor is more likely to prescribe.

But is this always a bad thing? We have decades of research to support the conclusion that the time demands on a doctor and the ever growing body of research about available therapies for various conditions = less chance to consider all options in each situation. To participate in our care, we should ask about treatments we may know about. Just asking may prompt the doctor to consider a path that wasn’t the one being considered. Just because it is considered doesn’t mean it should be selected. Sometimes, however, the doctor might judge it to be a ‘good idea.’

If each time a patient asks a doctor for treatment that is not a good match to the health condition, a doctor feels compelled to prescribe the treatment, it will lead to further waste in the health care system. We know that a doctor is not likely to follow the path a patient suggests if the doctor believes it will be harmful…at least, in the short term. But with antiobiotics as a case to illustrate, we want our doctors to think about our well-being in the long term. And if our request doesn’t make sense, take a minute to tell us why it doesn’t.

This approach means that doctors and patients can keep talking, and that their communication might benefit health in the short term and the long term, and the cost of health care as well.

Why should we keep track of our use of vitamins and other supplements and who should we tell?

February 11, 2010

119_1917a Taking vitamins is the number one way that U.S. citizens ‘complement’ the formal health care they receive. This is a finding that has been consistent for some years and the 2005 Institute of Medicine Report about use of complementary and alternative medicine [ http://www.iom.edu/Reports/2005/Complementary-and-Alternative-Medicine-in-the-United-States.aspx] considers this reality as well.

Many debates about using vitamins, minerals, and other supplements — including garlic or herbs or cinnamon or ginger — focus on getting us to eat ‘healthy’ rather than depending on vitamins to make up for a diet that may be lacking. Other debates focus on the cost of ‘unproven’ therapies.

Whatever the debate, keeping track of use increases our ability to report use to our doctors. Talking to our doctors about use may make the difference between a therapy working or not. Many prescribed medications have been found to interact with different vitamins and other supplements, spices, and/or herbs. Sometimes, we need more or less of a medication based on use. So keep track and talk about use to avoid harmful effects.

How fear appeals affect our motivation to practice healthy habits?

A winter walk

February 7, 2010

Fear is something most of us would rather not experience. Especially when it comes to our health. Yet, so much communication about health aims to make us fearful. Why is that?

Over time, research has shown that fear can be motivating. Because we don’t want to be fearful when it comes to our health, we may take action. That is, if we know how and believe the action will actually benefit our health.

The problem with too many fear appeals aimed at our health is that they do not fulfill the task of telling us what action to take, why the action will be effective, and how we can develop the skills or gain the resources to take the action.

Take the example of skin cancer. Most of us know that too much exposure to the sun can cause this deadly disease. We also know that some sun or UV exposure helps our body make vitamin D. So how much sun is too much sun? What if we like to stay healthy by being outdoors in the sun? What if our job requires us to be in the sun? An effective fear appeal communicates about these issues and doesn’t just make us fearful about being in the sun.

So if communication about health makes you feel fearful, look for the response recommended to reduce the threat. If the message doesn’t contain that information, it’s not a very good message. But at least you will know that what to look for to control the danger posed in the message and your fear as well. A response to the threat and ways you can carry it out.

Until next time, talk about health with the ones you love. It really might be a matter of…life and death.

Who is the source of that information about health on the internet?

119_1916 January 19, 2010

Surveys show that most of us go to the internet to search for health information and we do it fairly often. I was reminded of that as I had one of my infrequent flair-ups of pseudogout. It has been years since I’ve had the pain and swelling in my knees and this time it affected my fingers, my wrists, and even my back. And it didn’t go away after a few days. So I went online. And I found lots of information.

How we search for health information on the internet and what we do with the information once we have it is likely to predict whether the information is going to help or harm us. We can conclude that we are not at risk based on the information and be wrong. We can conclude that we are at risk based on the information and also be wrong. So a good place to start thinking about health information found on the internet is to consider the source of the information.

First, consider the motivation of the source. In the broadest sense, .com sites are commercial, while .org sites identify organizations, and .gov sites come from the government. We usually start with a search engine such as Google to seek answers to our questions. When I did, Google health came up as the first link to information. With so many people searching for health information, I guess it isn’t too surprising that the owners of a search engine like Google might want to get in on the act…

Second, consider the expertise associated with a site. Just ‘who’ is the author of the content you are reading and applying to your health? Is it a doctor or a nurse or a physical therapist? Is the doctor speaking on behalf of research or based on experience as a doctor? Is the information just presented, so the source is just the internet with no way of knowing if there is medical research to support the claims, particular researchers presenting the claims, or doctors supporting the research conclusions. I followed the Google health link and I searched for information about the expertise. I found some information at the bottom of a loooooooong page of information. But I couldn’t trace it back to any research. So I couldn’t find out much about where all the conclusions were coming from. Health communication researchers find this to be the case time and again. Not just on the internet. In newspapers, magazines, and broadcast news reports, the expert source on which information is being based is too seldom mentioned.

Third, what part of the information is the author of the content emphasizing, and what part is not being discussed? Is the author providing information for an organization that wants them to present a particular point of view? So, they might be describing the benefits of getting care at the organization whose site they represent but not tell you that it cost more than your insurance is likely to pay. Or, they might be telling the benefits related to one type of treatment for the drug company who has paid for the site you are reading, and they likely believe in those benefits, but there may be no discussion of the risks for the treatment. So, consider not only what content is included in the information but what content might be missing as well.

Doing so should help to make the information we find useful and help us to frame additional searches for more information to fill in the missing content…

HPV, HIV, HBV…and more

January 8, 2010

I am working on a project designed to understand how college students think about HPV. I have learned that the human papillomavirus — HPV — is confused with HIV by some male college students in this project and that some females confuse it with HBV — the hepatitis B virus…

The media has covered the HPV vaccine and, of course, we have all those direct-to-consumer ads appealing to the ‘I want to be one less’ angle. What isn’t clear in many of these stories and ads is that HPV is transmitted by skin-to-skin contact. That is why genital HPV cannot be guaranteed to be protected by use of a condom during sexual intercourse.

The HPV vaccine is, of course, not designed to prevent HIV. A female who has completed the series of HPV shots likely has about five years of protection from HPV. She is not protected from the human immunodeficiency virus — HIV. Males who mistake the two conditions, HPV and HIV, may wrongly believe that the HPV vaccine protects her and him from HIV and thus feel less inclined to use a condom to prevent HIV. That is a serious mistake.

The incidence of head and neck cancers over the past decade has been found to be related to oral HPV. College males who report engaging in open-mouthed kissing have been found to be more likely to test positive for oral HPV. But this is not the only path for transmitting oral HPV. As with genital HPV, the skin-to-skin contact provides a transmission route.

There is a vaccine for HBV. HBV affects the liver and is transmitted in ways that are similar to HIV, including blood and bodily fluids. It really can be a matter of life and death if we fail to keep straight the differences between these three and our actions to prevent them.

Direct-to-consumer advertising..

January 7, 2010

Only the U.S. and New Zealand have policies that allow advertisers to sell prescription drugs, durable medical goods, and even medical tests by appealing to consumers to be informed and ask their doctors to ‘prescribe’ specific drugs and therapies. On the one hand, these ads provide an opportunity for consumers to learn about different treatments. They also may reduce the sense that particular symptoms or conditions are unusual or embarrassing. For example, depression has long been a stigmatized condition. DTCA have undoubtedly played a large part in making us feel like the prevalence of depression is much greater than we might otherwise think. That might make us more willing to tell our doctor about our symptoms and seek help with them. On the other hand, DTCA have been faulted for providing a lot of content about the benefits of particular prescription drugs or treatments and providing very little information about possible harms.

If we find ourselves learning something new about health from DTCA, we should look for the content to give us a balanced review. Companies want to make profits. They won’t make profit by harming us, but they may make profit by persuading us that our life will be better if only we take a pill…

What’s new for HPV in 2010?

imgp0009 January 2, 2010

Near the end of 2009, the U.S. FDA approved the use of an HPV prevention vaccine for boys. It will be interesting to see how this will be sold in the marketplace. After taking such care to sell a vaccine as a strategy to reduce the incidence of cervical cancer with the slogan, “I want to be one less,” and assuming that even among a public with moderate to low levels of health and science literacy — most know that males do not have a cervix, what will the pitch be to convince parents to vaccinate their sons? It seems unlikely that any ad will focus on selling a vaccine to parents that implies that their sons could be the vectors of disease for girls, as that would turn attention toward sex which the advertisers so carefully avoided in focusing on cervical cancer.

Whatever the pitch, part of our conversation should focus on the vaccine’s efficacy. Clinical studies vary in estimating how many years of protection a vaccine affords, but it seems to be around three years. Some say it may be five years. In either case, there is no revaccination policy at present. As consumers, parents, patients…we need to advocate for a policy.

We need to ask ourselves if and when it is the right time to be vaccinated. We need to understand what HPV is and how it is transmitted. Since the virus is spread in skin to skin contact, a condom may not be enough protection from getting the virus if we come in contact with it during sex. We should talk about that fact with our daughters who may be trying to decide if the use of a condom is the best way to protect themselves from sexually transmitted infections and diseases. And we need to talk with our sons about the fact as well, and remind them that the HPV prevention vaccine does not protect from HIV.

We need to realize that for women, being vaccinated does not mean we do not need to have cervical cancer screenings. Will the advertisers include that in their future messages?