Talking About Health; Why Health Communication Matters

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…

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”…

Do we have a responsibility for health and the environment? …and the sheet ‘experiment’…my ‘story’…

July 27, 2011

Look closely. That is a baby robin peaking its beak up above the nest line. Where? On my front door…

This is the view when I got a stool and stood up to peer inside.

There were two babies. Can you tell?

http://www.learner.org/jnorth/search/RobinNotes2.html#number%20of%20eggs This site gives a good overview about robins. You can guess their age based on the pictures there. They were probably about a week to nine days old…

I discovered them on a Saturday when I went to clean the front porch. I wanted to wash the door, so I put my hand up to lift the wreathe off the door and felt something — well, not part of my wreathe.. something really soft… I jerked back and went for the stool. You cannot really tell from the first picture, but the nest was hidden in the wreathe.

I worried once I saw what was hidden there that my touching the baby would keep the parents away… luckily not. Both parents spent all day every day for the next 10 days flying back and forth feeding the babies… And I left the door and the porch alone… except when I couldn’t help myself and had to have another peak…

We always have birds nesting around the house, on the gutters, above our lights on the deck… but never robins before. …and never on my front door. We had been hearing these sounds around the front door. They made our golden retriever bark sometimes. We would open the door… and nothing. I guess the parents were building the next.

It was the most blessed thing to watch the parents and their newborns for a week or so… I was happy to think that we have a place where the environment could nurture them. We have a lot of dragon flies this year, too… supposed to be a sign of a healthy environment.

A few days ago, I reported on Dr. Besser’s advice to put your pillow case and sheets in the freezer for two hours before going to bed… I am happy to report that for me and my granddaughter–this was just what the doctor ordered and helped us get to sleep in the heat of the record-breaking temps. For my husband, he said it made no difference… And so, Grace and I recommend it… John does not… 😉

What makes a good public health message–put your sheets in your freezer two hours before going to bed?

July 21, 2011

Yes, it is hot… And the weather affects our health…physically and mentally.

So, what are we to do about it?

I loved the message Dr. Besser gave on ABC News with Diane Sawyer tonight… ‘put your sheets in the freezer a couple of hours before going to bed…’

This is an example of a ‘good’ message. It is specific. It is doable. It is affordable…we mostly have sheets on our beds. We mostly have refrigerators in our homes and these appliances have freezers.

So, I am doing it. I will let your know tomorrow…did it work? That, of course, is one of the most important parts of a good public health message…

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 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.