Talking About Health; Why Health Communication Matters

What did Michelle Obama have to say about WalMart today?

January 20, 2011

Michelle Obama spoke today standing in front of fresh produce at a WalMart. She talked about the initiative that WalMart will undertake to make healthy food more accessible.

http://www.youtube.com/watch?v=TwMsh8vaYvE

WalMart will reduce the sodium in their products and get rid of products with trans fats. They will lower the prices for fresh fruits and vegetables. In short, they will work to make it possible for more of us to afford to eat healthy… Let’s hope it is a model that others follow…

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.

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 does the “food pyramid” tell us about health communication and ‘old science’, ‘new science’, ‘conflicting science’, and no science’?

143_07811 May 3, 2010

I cannot recall the first time I heard about the ‘food pyramid’ but it was decades ago. The United States Department of Agriculture [USDA] online site at http://www.mypyramid.gov/ provides an overview of the research in this area. Right under the image of the pyramid on the homepage, the follow sentence is bolded: “One size doesn’t fit all.” Over to the left of the pyramid, the heading, ‘Specific Audiences,’ includes ‘Preschoolers’, ‘Kids’, ‘Pregnant & Breastfeeding’, and ‘General Population’–giving us a sense of groups whose needs vary. Skimming through some of the information, it doesn’t take long to affirm one of the points that I make in my book, Talking about health…

When communicating about health, sometimes there is no science to guide prevention guidelines, diagnosis, or treatment. A quick review of the history of the food pyramid shows that even before vitamins and minerals had been discovered, the USDA provided dietary guidelines–the first time appearing in 1894. The first food pyramid was published in the 1960s. The goal is to help us know how to talk about food and nutrition without having to be an expert. So food is divided into groups and we gain a sense of how much of each group adds up to a more versus less healthy diet.

Often, what we know in any area relating to health is based on ‘old science’ that we learned in school several years or even decades ago–forgetting the simple fact that times change. New knowledge is generated everyday. If asked, we know this truth. The trick is to apply it when we are communicating about health. ‘New science’ may support the ‘old science’ or build on its core idea. ‘New science’ may also conflict with ‘old science’ creating doubt and indecision. It is helpful when talking about health to consider the ‘age’ of the science we are using and also the characteristics of the people the science is based on. As suggested by the latest food pyramid, when science takes into account the ‘age’ of and audience, the food pyramid looks slightly different for different groups…

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…

What is math anxiety and what’s it got to do with my health?

117_1754 March 16, 2010

Math anxiety is the tendency to feel anxious at the thought of doing math. This feeling may happen when faced with making change, calculating a tip for the waiter or waitress, balancing a checking account, figuring out how much of an over the counter medicine to take, or adding up how many calories or other nutrients food contains. Not surprisingly, if we feel anxious about these everyday tasks, the prospect of trying to understand health statistics seems even more daunting and causes even greater anxiety.

Math anxiety causes people to avoid situations that might lead to the feeling. In other words, if math makes us feel anxious, we avoid numbers and statistics and any situation where we might have to face dealing with math. Of course, such avoidance means that we miss opportunities to practice math and succeed, which would reduce our anxiety and increase our confidence in our ability to do math.

This reality is particularly alarming when it comes to our health. To make informed decisions, we will probably have to consider some information that is presented as health statistics. It may be information about our risk for a disease, or it may be information about our benefit from a treatment. In either case, it is information that would help us make a more informed decision.

What is the solution? Don’t avoid math. Make the extra effort in whatever situation it might be to understand the statistics and practice the math. In the end, it will pay off. Make the extra effort to be sure your doctor knows you want to know the numbers and what they mean. Make the extra effort to be sure that your local school system is providing opportunities for students to practice math, reduce, their anxiety, increase their confidence in doing math, and improve their skills…

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.

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.