Talking About Health; Why Health Communication Matters

HPV and throat cancer message from Michael Douglas

June 5, 2013

Michael Douglas has been in the headlines because he talked about the connection between throat cancer and the human papillomavirus–HPV. There is a rather complete discussion of the issue here: http://www.cbsnews.com/8301-204_162-57587350/oral-sex-and-throat-cancer-michael-douglas-hpv-report-spotlights-epidemic/.

As with Angelina Jolie and BRCA mutations and breast cancer, Michael Douglas’ celebrity gives him a platform to increase public awareness about cancer causes. I appreciate his willingness to discuss it and to get a conversation going about an increase in throat cancers, particularly for men, related to the HPV.

What did Dr. Oz say about genes and health, and what did his guest doctor say about viruses causing cancer that left me talking to the TV–and not in a happy voice?

February 4, 2011

Aieeeeeeeee. Dr. Oz had some visiting doctors on his show again today. As they were wrapping up some of the discussion, Dr. Oz said, “Genes load the gun… The environment pulls the trigger… I want you to remember that.” What?! We have discussed the importance of family health history in this forum before. So the role of genetics is one that is an important topic when talking about health.

But I wonder how many viewers really got the idea that it was family health history they should be thinking about with his expression–“Genes load the gun.” This is an old metaphor for the role of genes for health and has not been very effective. Add to that, the conversation that Dr. Oz was having about genetic mutations on the show. It all got mushed together…

“The environment pulls the trigger.. I want you to remember that.” Really? What does it mean? Again, the meaning of environment in this metaphor has many interpretations. Environment for most people is about where they live, the climate, the neighborhood, pollution… those things all matter when it comes to our health and interact with our family health history. But environment includes our personal behavior and our social environment–friends, family, and culture. What we eat, for example, is part of the ‘environment’ that our genes live in… But I am not confident that this meaning is clear when talking about genes and health with this metaphor…

Then there was the conversation about viruses–that cause cancer. HPV was one of the two examples discussed. I think that this also was not a good way to discuss the issue. If I have cervical cancer, you cannot ‘catch’ it from me. Cervical cancer is not a virus that can be passed from one woman to another. Cervical cancer is often caused by the lesions that form from genital warts caused by HPV–the humanpapilloma virus. So there is a virus that causes a condition that may be the cause of cancer…and not just cervical cancer but also penile cancer and throat cancer and head and neck cancers… So we may pass a virus between us that leads to genital warts that sometimes do not heal and may cause some changes in our cells and become cancer…

So let’s focus on understanding that increases our health literacy and not shorthand expressions that don’t… And let’s look toward spring and the daffodils that will replace the frozen icy tundra in my woods today…

What did Dr. Besser say about the HPV vaccine?

February 1, 2011

Today, on ‘Good Morning America,’ Dr. Besser–the show’s medical expert and reporter–talked about recommendations for vaccines that older teens should get. http://abcnews.go.com/GMA/OnCall/video/new-vaccine-guidelines-for-older-children-teens-12810738 He recommended three vaccines, including one to prevent whooping cough,meningococcal booster to prevent meningitis, and a hepatitis B vaccine.

Dr. Besser was talking about the American Academy of Pediatrics new recommendations for older teens. The Academy recommended other vaccines as well, including the HPV vaccine. http://abcnews.go.com/Health/w_ParentingResource/vaccinate-child-time/story?id=12806514&page=1

Interestingly, Dr. Besser did NOT recommend this vaccine…for teen boys specifically, saying that he wouldn’t, “get it for my sons.” When asked why, he said for boys, it is a preventive for genital warts which are he noted “easily treatable.” When pushed for more information, he added, “It’s very expensive.”

Interesting. We have discussed HPV in this forum before and in the past week, had quite a discussion relating to HPV. http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=376&action=edit That discussion built on an earlier one. http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=33&action=edit

It is important to remember the limitations of the vaccine for females and cervical cancer prevention noted on the National Cancer Institute’s site, “The vaccine tested in this study has several limitations, noted NCI’s Hildesheim. For one thing, the vaccine offers no protection against other types of HPV that can also cause cervical cancer. In addition, it’s unknown whether the vaccine’s protection against HPV-16 is long-lasting. Finally, it does not prevent HPV-16 infections already present at the time of vaccination from progressing to cancer.” http://www.cancer.gov/clinicaltrials/results/summary/2002/cervical-cancer-vaccine1102

Let’s not forget an important message then… still get a pap test as an early detection strategy for cervical cancer…

What happens when mothers talk to daughters about HPV vaccines?

January 6, 2011

This will not be the first time I have focused on HPV… In fact, about a year ago, I posted on this topic. Today, I want to mention that Janice Krieger and some of her colleagues at Ohio State published an article in Human Communication Research about the importance of mothers talking to daughters about HPV [http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2958.2010.01395.x/abstract]. Another article published in the Spring of 2010 has similar conclusions [http://pediatrics.aappublications.org/cgi/content/abstract/125/5/982].

Mothers’ confidence about talking to their daughters about HPV — believing that they had knowledge and could answer their daughter’s questions — had an important effect on the likelihood of talking. Also, mothers’ belief that the HPV vaccine is an effective response in preventing cervical cancer motivated them to have these conversations. Both findings emphasize the need to communicate about HPV and the HPV vaccine to form knowledge. The findings, as the authors note, also bring to light a need to observe these actual conversations and their effects. For example, mothers may talk about HPV as being a common and easily transmissible virus. Or, mothers might say that HPV causes cervical cancer. The latter might lead daughters to assume that brothers and male friends are not at risk for HPV. That would be an inaccurate conclusion.

puzzlepic3 I have a granddaughter who is seven years old. She happens to live in Texas. This is one of the states that considered making the HPV vaccine mandatory in order to be in public school [http://politifact.com/texas/statements/2010/feb/06/rick-perry/perry-says-hpv-vaccine-he-mandated-would-have-been/]. It didn’t happen … for various reasons. For one, the vaccine is really a series of three shots — not one. The cost for the three shots is about three hundred dollars [http://cancer.about.com/od/hp1/f/hpvvaccinecost.htm]. Time and money… and debate about sexuality.. and religion… then there is the belief that government should not mandate anything… How do we communicate strategically to build mothers’ confidence to talk about those things? And what do we say to boys as well?

http://www.nytimes.com/2010/10/29/us/29vaccine.html

What is “public health” anyway?

copy-of-p3061598 March 1, 2010

As children begin to know about roles and jobs, some will say, “I want to be a doctor.” Their parents buy them a ‘doctor’ kit to play with, and they practice being a doctor. I never hear a child say, “I want to work in public health.” Why is that? What’s wrong with this picture?

Public health isn’t part of the usual high school curriculum, so we don’t get an introduction to what a career in public health might look like. When health education is taught in high school, the course doesn’t introduce students to the public health system. And so, not surprisingly, few of us know what public health is or what the public health system does.

Public health often treats health as a public good. A public good is something for which the benefits for one of us cannot be separated from the benfits for ‘all’ of us. When I get a flu shot, I am supposed to benefit by not getting the flu. But others benefit because they do not get exposed to the flu from me.

So monies spent to inspect restaurants or public pools benefit every member of the public who eats at the restaurants or uses the pools, not just one of them. Monies spent for newborn screening programs benefit all of us because we identify conditions at early stages when prevention or care may limit the harm, and all of us benefit by having a friend or neighbor who can be a healthier and more productive citizen.

School vaccines. Programs for reproductive health. Collection of data about births and deaths–vital statistics that can show patterns and be used to suggest how to improve birth outcomes and decrease deaths. Cancer registries. Programs to prevent disease and accidents. All of these and more are prt of public health’s efforts to promote the public good.

Is the public good “good” for me? Often it is. Sometimes, it may not be.

There are limits to what vaccines I want to be used as gatekeepers to my employment. But there are even more limits to what genetic tests I want to be used as gatekeepers to my free choice to pursue life paths. So the first step is to become aware of what public health means what public does. Then we can advance agendas relating to support for public health and guidelines about where to draw the line in the name of promoting the public’s health.

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.

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?