Talking About Health; Why Health Communication Matters

How do different metaphors to define genes relate to understanding?

November 14, 2013

Many of the important messages about health include information about the role of genes for health. Genes matter. Behavior matters. Environments matter. The problem is how to communicate that genes do not absolutely determine health. This will be an important part of health communication for many decades to come.

Professor Celeste Condit wrote about how genes have been defined in her book, “The meanings of the gene” [http://www.amazon.com/The-Meanings-Gene-Heredity-Rhetoric/dp/0299163644].

Efforts to define genes often depend on the use of metaphor, explaining what a gene is in terms of something else that an audience is assumed to already understand. Many of these metaphors use “instruction” as a key component. Professor Rachel Smith and I decided to evaluate two of these instruction metaphors, one that defined genes as “a blueprint of our possibilities” and the other that defined genes in terms of “instructions” more generally. The abstract of the article to be published in February in the journal, Health Communication, appears at: http://www.tandfonline.com/doi/abs/10.1080/10410236.2012.729181#.UtLxv1OFeSo. The online article is at: DOI: 10.1080/10410236.2012.729181

Participants received a message about the role of genes for health for which the introduction varied the definition of a gene, and all other content was the same. Participants who read a message with the blueprint metaphor were more likely to believe that genes absolutely determine health and that genetic therapies are the effective means to address the role of genes for health. The instruction metaphor related to participants having stronger beliefs that genes make one more susceptible to disease but do not absolutely determine the onset of disease, and beliefs that we have some personal control over the role that genes have for our health.

These results support the importance of the metaphors used to define health and scientific terms. Just one exposure to a message that defines genes in different ways can have powerful effects on our attitudes about genes and health.

Creativity and health

June 2, 2013

My husband and I recently had the pure joy of a week long visit from our five-year-old grandson here in Pennsylvania. We were a bit worried since he had never stayed overnight away from home. We have stayed at his house while his parents had an overnight trip. But he had not stayed with us at our home alone.

The adventure began with a plane flight. And the plane flight should have been easy peasy leaving about 8 am and arriving in State College about 4 pm. Recall the two hour time change and that makes for six hours. We had a nice layover in Detroit with plans for lunch and riding the train.

We began to get phone calls at 4 am that our flight was delayed. And delayed and delayed. We went to the airport expecting the flight to leave finally about 10:30. It did not. Mechanical problems. Most other passengers were being placed on other flights but we needed 3 seats with 2 together. Our grandson was a great sport about it all as we got to the airport and watched the flight board inch later and later. The attendants at our gate were also helpful. they provided him with first class passenger goodies. And we all got 25 dollar vouchers for food and drink.

We finally took off about 1:30. Yep. And we did not have a connecting flight now until 9:30 pm…about an hour past our grandson’s usual bedtime. Still, he remained completely enthused. Exploring everything with us in the stops along the way. Enjoying dinner. He did fall asleep on the last flight home and wasn’t too happy about being awakened to get off the plane. Still, the adventure spirit prevailed.

We went to beaches that weren’t open for swimming and parks to feed ducks. We had picnics everyday. But mostly we played in the sand, threw rocks into a frog pond, and built forts. We piled honeysuckle bushes being cut back and climbed to the top of the growing pile.

And we talked. Endlessly. If you haven’t talked with a five-year-old lately, I highly recommend it. They are so boundlessly creative. During one conversation, my grandson announced that he had powers to change me into anything I wanted to be. I said I was fine as I am, thank-you very much. He said, “No, Grammie. You have to pick something and I will change you into it.” I said, “OK, a butterfly.” “Why?” he asked. “Because I could fly and spend so much time among beautiful flowers.” “OK, Grammie” he said. “Then I am making you into a monarch butterfly. You will be beautiful and birds won’t eat you.” That’s mostly true. That monarch butterflies have an ingredient in their bodies that is mostly poisonous to most birds. How thoughtful and creative that my grandson would think of that in our conversation. I hope he can always be so thoughtful and creative. I am sure it will serve him well. A discussion of some of the research findings to support creativity’s boost to well-being can be found at this site: http://www.cnn.com/2012/05/25/health/enayati-innovation-passion-stress

Health communication about eating sugar and wrinkles

August 29, 2012

Another one of those incomplete messages came my way. I was reading again while waiting for a meeting. And the headline was ‘Face facts about sugar.’ There it was. A statement, with no link to the published medical research and no mention of a journal it was published in. The magazine is a 2012 one. But when I went to search for research related to the idea that “Consuming sweets can damage skin’s collagen”–the article’s claim–I found research that was published in 1998 and conducted on male rats [see http://jn.nutrition.org/content/128/9/1442.short]. OK, interesting. But it seems worthy of at least a descriptive study in humans. And worthy of including female humans. While we might not want to volunteer for a randomized clinical trial in which we get assigned to a group that eats, let’s say, the amount of sugar that is ‘average’ or eats no sugar at all, it seems like there may be some ‘natural’ study groups out there to observe and survey. Folks who simply don’t eat sugar or eat very little sugar. Let them provide photos of their faces, or some lab work relating to collagen levels. Compare the results to a group that eats more ‘normal’ levels of sugar. Factor in whether they are male or female, how old they are, and a few of the other correlates related to collagen–such as lifetime sun exposure [see, for example, http://www.ncbi.nlm.nih.gov/pubmed/8642084]. It would be interesting to ‘see’ if there are differences in the appearance and would give us some actual ‘human’ face facts.

Health communication about medical test sensitivity: The TSH and CA 125 blood tests example

July 23, 2012

Doctors often recommend blood tests to help them diagnose our condition or to check our health status. For example, I have an underactive thyroid condition. As discussed in my book ‘Talking about health’ — my ‘normal’ numbers fall outside the range of a healthy ‘normal’ [see for a discussion http://www.denvernaturopathic.com/news/TSH.html]. I was diagnosed with this condition in my 20s and have taken daily medication to address it since that time. My mother was diagnosed with the condition in her 20s as well. I go to see my internist annually, and he puts in an order for a TSH [thyroid stimulating hormone] test [http://www.endocrinology-online.com/Content/For%20Patients/TSH.htm] that I go to the lab for several weeks before my scheduled appointment. This test is considered to be very sensitive–but what does that mean? It is the probability that a person having a disease will be correctly identified by a clinical test. However, a careful reading of the article at the link shows that the results may depend on the time off day you were tested–a reason why the test is given in the morning after fasting.

But aren’t all medical tests highly sensitive? Otherwise, why do them?

The answer to the latter is ‘because that is the best that can be done’. The answer to former is ‘no’.

Take the CA 125 test, for example. The test was hoped to be a valid indicator of ovarian cancer. However, the test indicates the presence of other disease as well. So a positive CA 125 test validly indicates the presence of ovarian cancer sometimes but often does not:

“The result of a Ca-125 test is interpretable only by considering the context in which it was ordered. When you order a Ca-125 test you will have to estimate your patient’s risk for having ovarian cancer. If your patient can be put in a group in which the likelihood of cancer is high then a positive test is probably correct and a negative test wrong. If your patient can be placed in a low risk group then the positive test is probably wrong and the negative test meaningless. Furthermore, there is no way to evaluate a positive test. You can repeat the test and pick the best 2 out of 3; 3 out of 5; 4 out of 7, etc. Otherwise, she will be heading for surgery” [http://www.gynoncology.com/ca-125/].

So if your doctor orders a CA 125 test, remember that the results should be discussed. This is true of all medical tests.But when a test that has been ordered is not highly sensitive, it is really important to discuss the meaing of the test result. If the test comes back positive and is not highly sensitive, have a conversation and ask: ‘What’s next to rule in or rule out the condition you were testing for?’ AND ‘What other conditions could the positive test result suggest I may have? How will we rule out whether I do or do not have them?’

Another possible positive reason to drink coffee

April 14, 2012

A beautiful new granddaughter came into my life one week ago. And I am reminded of the meaning of sleep deprivation. And I am happy that I enjoy a good cup of dark roast coffee. Sitting in the piles of research I have been reviewing was an article about the incidence of gout in women and drinking coffee [see http://www.ajcn.org/content/92/4/922.short]. Following the behaviors of 89,433 women across time, 896 cases of gout were confirmed in the women, or about 1% of the women being followed. These women were found to consume less coffee than women who did not experience gout… I thought coffee drinkers among us would want to know this and talk about the possible health benefit with other coffee drinkers as well…

The power of poetry in talking about health

February 15, 2012

I discovered a new site and a beautiful poem there. I will share it at the end of this post. But to begin, it is worth considering what we know about poetry as ‘talk’ and its effects for our health. Doctors benefit. Reading poetry has been found to increase empathy for patients. [http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2929.2005.02178.x/full]
[http://www.stfm.org/fmhub/Fullpdf/July01/lame.pdf]

Patients can benefit from reading poetry aloud, contributing to healthier and less stressed breathing and heart rates. [http://ajpheart.physiology.org/content/287/2/H579.short]

Perhaps a poem a day… keeps the doctor at bay…

{ naked } from Maria Korporal on Vimeo.

What is the missing content in this ad and why is it worth talking about it for the sake of health?

January 18, 2012

I have been meaning to look up the research linked to ads about high fructose corn syrup for awhile. You know the ones. They says that the two are the same and that your body doesn’t know the difference. What they don’t every explicitly say in any of the ads I have seen is: they are both high calorie carbohydrates that should be eaten in moderation, err on the side of less rather than more.

Turns out that the Corn Refiners Association started the ad campaign to clear up misconceptions about corn syrup versus cane sugar. You can see the original ad here:

http://www.youtube.com/watch?v=scHpZ10ok0c&feature=related

I cannot embed it because the Corn Refiners have disabled embedding. After a bit of surfing, I did find one of the ads from the campaign because someone else is using it along with their personal conclusions about why corn syrup is bad. I thought it would be worth checking to see if I could find any research.

A review of the science [found here: http://ajl.sagepub.com/content/4/6/515.full.pdf+html] supports several conclusions. Of course, the broadest conclusion is that more research is needed. But that being said, here goes. On p. 519, the authors conclude,

“From a compositional standpoint, high-fructose corn syrup, sucrose, invert sugar, honey, and concentrated fruit juices are all virtually interchangeable. All of these nutritive sweeteners are composed of approximately 50% glucose and 50% fructose. All are absorbed similarly, have similar sweetness, and have the same number of calories per gram.”

Consumer Reports and Apple Juice: Why Did Dr. Besser Apologize to Dr. Oz?

December 11, 2011

Not long ago, near the end of September, I reflected on the debate that took place between Dr. Besser and Dr. Oz about apple juice. It was a chance to consider the meaning of evidence when reports appear about the safety of food or other substances. I noted that I would have appreciated it if Dr. Besser had spent more time talking about why the evidence was of poor quality and less time attacking Dr. Oz.

Well, new data is in. Dr. Besser apologized to Dr. Oz and aimed his criticism at the FDA where data about arsenic in applie juice had been piling up for a number of years. A new study released by Consumer Reports added to that data. Dr. Oz gives tips about the amount of apple juice that should be safe for children at different ages to drink. It is clear that all of us need to keep asking for answers to the question: how did the science reach that conclusion? When we ask, someone just might listen and try to give a more valid answer…

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.

Inquiring minds want to know–floss before or after brushing?

October 10,2011

Well, conversation at conferences can turn from the serious to the mundane but arguably serious. “Do you floss before or after you brush?” was the question at a recent conference. My answer: brush, floss, and brush again. Why? Who wants to brush before — yuck! But alas the American Dental Association provides a reason for flossing before brushing http://www.ada.org/1318.aspx.

In short, flossing gets the ‘yuck’ out so the fluoride in your toothpaste can reach your gums and promote health by reducing gingivitis. OK. Now you know.

Why didn’t my dentist ever tell me that? I suspect that dentists are happy if we floss at all…any time.