We're Paying $1 Billion to Fall Behind

Every country makes mistakes. What’s harder to accept is when a country makes them on purpose—or at least knowingly. The United States is currently doing both, making choices that point not sideways, not slower, but backward in ways that could take a generation to undo.

The federal government recently agreed to pay roughly $1 billion to TotalEnergies to abandon offshore wind projects in U.S. waters. Those projects were expected to power more than a million homes. Instead, that capital is being redirected into dirtier, less sustainable oil and gas development. This is not deregulation. It is a deliberate, taxpayer-funded intervention to halt one form of domestic energy production in favor of another.

That alone should give pause. But it's part of a pattern—across energy, science, public health, civil rights, and institutional governance—that suggests the country is pulling away from the very foundations that built its strength. And not by accident.

Science and Research

Energy decisions make headlines. Science policy rarely does. But the consequences of underfunding it outlast any news cycle.

For decades, American leadership has been built on sustained investment in research through institutions like the National Institutes of Health and the National Science Foundation, investments that produced the breakthroughs defining modern life, from cancer therapies to semiconductors. Recent funding constraints and disruptions are already affecting research pipelines. Universities are scaling back. Grants are stalled. Researchers are reconsidering where to build their careers.

This isn't theoretical. It's arithmetic: slow the investment, slow the innovation, lose the ground. China has spent years building out its research capacity. The EU keeps deepening collaborative funding. The U.S. doesn't need to outspend them. But walking away from the table is a different thing entirely.

Public Health

The costs in public health are the most immediate. The United States spent decades creating a system capable of responding to outbreaks, developing vaccines, and protecting population health. It took a long time to build. It’s taking a far shorter amount of time to break.

Recent shifts in vaccine policy and public health messaging are accelerating that erosion. Growing political interference in agencies like HHS, combined with amplified skepticism toward vaccines despite overwhelming scientific consensus, is undermining the institutional confidence that makes public health systems work. Vaccines are one of the most effective tools medicine has ever produced, and the trust behind them took generations to earn.

Eroding confidence in that system doesn't create freedom. It creates a specific kind of vulnerability—the kind that shows up as outbreaks, as misinformation taking hold, as people dying from diseases we know how to prevent. And once that trust is gone, it doesn't come back easily.

Environmental Policy

Not every regulation is worth keeping. Some rules are outdated, some are redundant, and a serious case can be made for trimming them. But that's a different argument from what's actually happening.

Efforts to weaken water protections, emissions standards, and pollutant tracking may reduce compliance costs in the short term. But many of these protections were established after costly failures: industrial contamination, unsafe air, widespread health consequences. Rolling them back doesn't eliminate risk. It shifts it onto communities and future taxpayers. When guardrails are removed, the consequences tend to arrive later and cost more.

Voting Rights and the Press

A country's strength depends on whether people trust the system that governs them. The proposed SAVE Act would require documentary proof of citizenship to register to vote. Noncitizen voting is already exceedingly rare, yet millions of eligible Americans lack ready access to such documentation—rural voters, lower-income individuals, many married women whose legal names differ from their birth certificates. When barriers rise, access falls. Policies that reverse the trajectory toward broader participation reshape who governs and who does not.

The same pressure is bearing down on the press. The First Amendment isn't an abstraction—it's the mechanism by which power gets scrutinized, challenged, and held to account. When the government threatens broadcast licenses, targets specific media organizations through regulatory pressure, and repeatedly labels journalists as enemies of the state, the effect is a press that pulls its punches. A country without independent journalism doesn't become more stable. It becomes less informed, and more easily misled.

The Pattern

Each of these areas can be debated individually. But taken together, they point in the same direction: away from investment in the future, away from scientific expertise, away from broad democratic participation, and away from the independent institutions that hold power accountable. That is not a neutral shift. It is a deliberate one.

And because these systems are connected, the damage doesn’t stay in one place. Weaker research means slower medical breakthroughs and fewer competitive industries. A less trusted public health system means a less healthy, less productive workforce. And when people stop trusting institutions, the effects are harder to trace but impossible to ignore.

It's tempting to view these developments as inevitable, as if they're simply the product of forces too large to name or change. They're not. They are the result of decisions made by elected officials, supported by voters, and enabled by disengagement.

Many Americans supporting these policies are doing so in good faith, responding to legitimate concerns about economic security and eroding trust in government. But good intentions don't guarantee good outcomes. In practice, these policies often work against the very interests they claim to serve—gutting research slows the medical breakthroughs that save lives, weakening public health infrastructure puts families at greater risk, and turning away from future industries shrinks the economy those families depend on.

This isn’t really about left or right. It’s about whether the choices being made actually serve the people they’re supposed to serve.

The United States is not in irreversible decline. It remains one of the most dynamic and capable countries in the world. But direction matters.

Spending $1 billion to shut down offshore wind development is not the defining policy of this era. But it’s a clear signal of what the priorities are—and those priorities reach well beyond energy. Countries don’t usually fall behind all at once. They do it gradually, through decisions that each seem defensible on their own but add up to something much harder to reverse.

That process can be reversed. But it won't reverse itself. It takes attention and engagement—and if left unaddressed, it can last for a generation.

Nuance Is Out – It Needs to Come Back

The Rise of Binary Thinking in Public Discourse

In today’s world, nuance is rapidly disappearing. Politics, media, and public debate have become dominated by black-or-white, yes-or-no thinking and communication. Leaders and decision-makers no longer have patience for complexity; instead, they opt for sweeping, sometimes incendiary language that may look decisive but often creates more harm than good.

The consequences of this shift can be seen in political rhetoric, media coverage, corporate decision-making, and public policy. From government leaders passing policies without considering long-term effects to social media reducing issues to simplistic slogans, the ability to grapple with complexity has all but vanished.

This lack of nuance is not just frustrating – it’s dangerous. It leads to policies, leadership decisions, and public conversations that fail to acknowledge the full scope of reality. It’s time to examine why nuance has fallen out of favor and how we can restore it before losing our ability to think and communicate critically altogether.

How Media and Politics Reward Oversimplification

One of the biggest drivers of binary thinking is the modern media landscape. The 24-hour news cycle and social media algorithms can prioritize engagement over accuracy, meaning the most extreme, emotionally charged language gets the most attention.

Consider the recent coverage of the White House’s decision to suspend all federal grants and loan disbursements. While some outlets reported the White House’s justification – that the move was necessary to prevent public funding of “wokeness” and programs it deemed wasteful – others highlighted concerns from critics who labeled it an unconstitutional overreach that would undermine essential programs. The framing of the issue quickly devolved into a polarized debate – either a bold crackdown or a reckless assault on public funding—rather than an analysis of the policy’s mechanics, trade-offs, or potential compromises. Few discussions examined the long-term implications or the specific programs affected, reducing the conversation to partisan conflict instead of policy substance.

Daniel Kahneman and Amos Tversky's research on cognitive biases helps explain another factor contributing to this mindset. People naturally prefer certainty over ambiguity. Instead, they want to avoid wrestling with complexity and seek quick, straightforward answers. Media outlets and politicians exploit this tendency by simplifying issues into a good versus evil narrative, where one side is entirely right, and the other is completely wrong.

Musk’s NIH Overhaul: A Case Study in Oversimplification

An example of the dangers of eliminating nuance in decision-making is Elon Musk’s attempt to restructure the National Institutes of Health (NIH). Musk, known for his aggressive and combative leadership style, took a “wood chipper” to the indirect research costs paid to grant recipients. 

Instead of carefully studying potential reform measures, he slashed funding, jeopardizing ongoing and future studies and the employment of scientists, medical researchers, and support staff across the country. His goal was to make the NIH more efficient. However, his approach ignored the social contract between the government and universities and the complexity of biomedical research, which often requires long-term investment rather than immediate results.

The result? Chaos. 

Many critical NIH programs were abruptly halted, scientists scrambled for new funding, and even private-sector partners expressed concern about the long-term impact on medical innovation. What Musk framed as a bold, decisive move was an oversimplified gutting of an institution whose work does not fit neatly into a profit-driven model. (See my article, Running Government Like a Business? Think Again.)

This is the kind of false clarity that dominates leadership today. Instead of making thoughtful, informed adjustments, leaders increasingly favor sweeping, disruptive action – a “move fast and break things” approach that disregards complexity.

The Death of Complexity in Public Policy

This problem is not unique to Musk. Across government and business, leaders are rejecting incremental progress in favor of dramatic, attention-grabbing moves.

Consider Donald Trump’s recent tariffs on Mexico, Canada, and China. These tariffs were presented as a decisive strategy to pressure foreign governments on immigration, illegal drugs, and trade issues. However, the reality was far more complex – retaliatory tariffs from Canada and Mexico, disruptions to supply chains, and an absence of clear benchmarks for success. Instead of tackling the root causes of economic and immigration challenges, the tariffs acted as a symbolic, high-impact maneuver with uncertain long-term effects. This type of performative, surface-level decision-making creates the illusion of action while failing to address the underlying issues.

How to Elevate the Conversation

If I weren’t such an optimist, I’d say we’re too far gone – too many people are invested in and profiting from the current state, where crude, simplistic messages persuade individuals to act against their self-interest and undermine democracy. We must find ways to elevate how we communicate and interact to restore civility and evidence-based decision-making. This will require a declaration of the need for change and a commitment from various stakeholders to a range of efforts over an extended period. Here are a few key steps communicators, policymakers, and business leaders can take:

1. Encourage Complexity in Public Discussions. Rather than presenting false binaries, leaders and the communicators who advise them should emphasize educating the public about trade-offs and long-term consequences.
2. Prioritize Incremental Change Over Blunt Action. Policy and decision-makers should recognize that big problems require thoughtful, long-term solutions.
3. Acknowledge That Emotional Appeals Can Oversimplify Issues. Emotions are a powerful tool in communication, but they can be even more effective when combined with rational analysis. Journalists and communicators must counter the clickbait, outrage-driven news model.
4. Teach Critical Thinking and Media Literacy. The public needs better tools to recognize when issues are being flattened into false binaries. This process should begin early by teaching students how to evaluate sources, recognize biases, and engage with complexity.

Nuance is fading because it’s tougher to sell, more challenging to explain, and harder to act upon. Additionally, it requires time. In a world where leaders seek quick results, the media wants engagement, and the public craves certainty, complexity has become an inconvenience. However, the cost of ignoring nuance is massive. If we want better leadership, policies, and public discourse, we must resist the urge for quick, flashy, or frenzied explanations and responses. We must embrace complexity, acknowledge trade-offs, and have the patience to address issues with the depth they deserve.

No Easy Fix: Opinion and Belief vs. Facts and Truth

We’ve all experienced the feeling. Our hopes get raised and then... splat. No payoff. No satisfaction. 

I got excited when I saw the title of Adam Grant’s recent article, “The Science of Reasoning With Unreasonable People,” published in The New York Times. Could “motivational interviewing” help win over people who choose beliefs, faith, and opinions over facts? What wonderful news! We need a breakthrough when it comes to persuading people to accept the facts around a host of science-based issues including climate change and vaccine safety. 

Alas, it was not to be. In one example detailed in the article, an intensive effort managed to get an anti-vaxxer from negative to, well, a tiny bit less negative. At the end of his piece, there was a tinge of resignation. Grant wrote, “All I can do is try to understand their thinking and ask if they’re open to some rethinking. The rest is up to them.”

All I can do? There has to be more, right? 

It turns out that motivational interviewing might have a limited role in addressing the vaccine hesitancy of some new mothers. A study cited in the article demonstrated a seven percent (statistically significant) increase in vaccination coverage in a subset of infants. While a good outcome, the authors recognized a number of study design limitations. And in actual practice, there’s a huge amount of ground to gain.

The chasm between hard data and belief exists because facts don’t matter to a big chunk of the population. We’ve known this for years. If facts were all it took, we’d be done: People wouldn’t smoke cigarettes, abuse drugs, be racist, or refuse to wear motorcycle or bicycle helmets. If the facts don’t fit the person’s worldview or “frame,” as the cognitive linguist George Lakoff terms it, the facts bounce off like bullets shot at Superman’s chest. Your challenger deflects all the information while you get blue in the face.

So, it’s clear that information and insight by themselves don’t produce change. It’s the desire to change and seeing the value in change that drives us forward. 

One desire killer is inertia. We’ve heard the excuse: “That’s the way we’ve always done things.” There may be no consequences: “Who’s going to notice, who’s going to care?” We may feel powerless: “I don’t have the resources, I don’t have the access.”

A second drag on change is simple ignorance and, on this issue, I’m having déjà vu. I wrote about “Swine Flu's Teachable Moment” nearly a dozen years ago: “It was disturbing to read about a growing public health threat in "Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases" in this week's New England Journal of Medicine (Omer et al.). The bottom line is that there is a critical need for new education and policy efforts to protect children (sometimes from their own parents) and the general public.”

Dr. Marijn Dekkers, former CEO of Bayer and former Chairman of Unilever, pointed out at financial conference several years back, “Even the most outstanding ideas and scientific breakthroughs have no chance if people do not accept, appreciate and support them. All too often, people are afraid of – or uneasy about – new ideas, inventions, processes or products.” Dropping information – even crucial or compelling data – onto the heads of an unprepared public, or expecting a response to another “call to action,” is unproductive and unrealistic.

We’re in this situation partly because our science literacy is abysmal. The United States ranks 18th out of 78 countries, according to the most recent analysis by the National Center for Education Statistics. China, Estonia, Japan, Korea, Canada, Poland, Slovenia, UK, Netherlands, and Germany are among those ahead of us.

And it’s an even bigger issue than the public health or economic competitiveness. Poor science literacy can eat at the core of our democracy. Professor Jon D. Miller (now at the University of Michigan) told The New York Times in 2005 that “…people’s inability to understand basic scientific concepts undermines their ability to take part in the democratic process.” He continued that for so many issues affecting society, "if you don't know a little science [it’s] hard to follow these debates. A lot of journalism [will] not make sense to you."

It’s not a problem that can be addressed by a one-year budget cycle or even a five or ten-year plan. It will take a generational blueprint that needs to be comprehensive, coordinated, and well capitalized in order to see a return on the investment. Let’s get started.

Between posts, I invite you to follow me @pauoestreicher.

Angelina Jolie's Fearless but Flawed Message

This article also appears in Medical Marketing & Media.

 A good chunk of humanity is talking about Angelina Jolie’s double mastectomy today. She penned a remarkable Op-Ed in The New York Times about her decision to have preventive surgery and breast reconstruction following the results of a genetic test. The variant of her BRCA1 gene gives her an 87% risk of breast cancer and 50% risk of ovarian cancer. (Clearly, she’ll need to confront the latter issue at some point and I wish her the very best.)

I join the millions who are happy to read that Ms. Jolie is making a fast recovery. Her story is another reminder of the need for education and outreach, and brave decisions. And, she points out the crucial issues of access, cost and preventive health care (though the discussion is one much broader than breast cancer). As sad and terrifying as her experience must be, however, she's fortunate to have deep emotional and financial support. It’s a stark reminder of health care haves and have-nots.

Unfortunately, her nod to "wonderful holistic doctors working on alternatives" is less helpful. Steve Jobs was famously regretful of his choice to pursue alternative therapies. He wished - too late - that "conventional" (science/evidence-based) therapies had started earlier. Instead, he tried dietary supplements, juices and acupuncture for nine months while his cancer spread. I’d hate to see Ms. Jolie provide a platform to physicians like Christiane Northrup, who has used Tarot cards to diagnose illness, or celebrities like Suzanne Somers, who apply, ingest and inject unapproved products in an attempt to stay young, and Jenny McCarthy, who uses the very unfortunate story of her son to create fear and confusion around vaccines.

Of course, people die even though they had the best of what science could offer. Cancer is a terrible, complicated array of diseases. And it's true that some people get better while on alternative therapies. Is there something to it? Quite possibly. We know that many modern medicines are derived from natural substances. But the cures you often hear about could be the result of other factors including poor initial diagnoses.

When it comes to managing one’s health or the health of one’s family, most people don’t have enough knowledge to evaluate a medical product claim or even formulate the right questions to ask a health care provider. This all makes the public an easy target for purveyors of alternative medicines and bogus devices.

So, while some push for greater access to health care, a parallel effort must be made to fund research and education. Dropping information – even crucial or compelling data – onto the heads of an unprepared public, or expecting a response to another “call to action,” is unproductive and unrealistic. We need a massive, sustained effort to enhance health and science literacy.

Between blog posts, I invite you to follow me on Twitter @pauloestreicher.

American Cancer Society vs. The New York Times

This article also appears in odwyerpr.com.

Feud Adds to Public Confusion Over Cancer Screening
As if there isn’t already enough conflicting information about cancer screening, a tiff between The New York Times and the American Cancer Society – two trusted sources of information – have the public scratching its collective head. It’s another example of how the current state-of-the-art in diagnostics, conflicting medical points of view, and the way in which healthcare news is communicated can cause people to either run to or away from their physician.

Veteran healthcare reporter Gina Kolata reported that the ACS “is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.” Dr. Len Lichtenfeld, Deputy Chief Medical Officer of the ACS, writing in his blog, counters that it’s not true. He wrote, “The American Cancer Society is not working on any stealth project to change commentary on our website to emphasize the shortcomings and risks of screening.”

With a tone of exasperation, Dr. Lichtenfeld went on to write, “And here is another news bulletin for the press and the rest of the media: developing and accurately promoting guidelines are complex processes that don’t lend themselves to sound bite messaging.” So true. Cancer is incredibly complex and the screening tools are far from perfect. Yet, it was Dr. Lichtenfeld’s boss, Dr. Otis Brawley, who was quoted in the Times article. He said, “We don’t want people to panic, but I’m admitting that American medicine has overpromised when it comes to screening. The advantages of screening have been exaggerated.”

What’s really going on here?

1. We have a gender gap. Much of the controversy boils down to the fact that prostate screening is less effective than breast cancer screening. It’s a message not very many men want to hear.

2. Cancer diagnostics are not created equally. In addition to some screening tests having greater predictive powers than others, they do not differentiate between tumor types that may be more or less aggressive. This has a big impact on which cancers to treat or just to observe.

3. The ACS needs to harmonize its message. A third ACS executive, CEO Dr. John Seffrin, has now weighed in on this story. He said, “we have long acknowledged that cancer screening isn’t perfect. Sometimes cancers get overlooked. Sometimes cancers get misdiagnosed. Sometimes aggressive cancers can appear even after a clear screening test. It is important to acknowledge these limitations, understand them, discuss them with your doctor, and decide what is right for you.”

4. Physicians need to find the right language. The pros and cons, the risks and benefits, if and when to treat – they all must be discussed. It takes time, and it takes some skill to understand their patient and their ability to understand and deal with the facts.

5. The public needs improved health literacy. A corollary to number 4 above is that the public simply does not have a good enough grasp of the scientific concepts or the ability to assess the risks or benefits. If The New York Times and the American Cancer Society can’t agree or somehow misunderstand each other, then what hope should the average citizen have of making heads or tails of all the possible screening and treatment options?

Let’s hope we can get back on the same page and deliver timely, accurate and understandable information on what is literally life and death information.
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A Healthcare Answer For Some But Not All

The Internet Is Another Health Disparity That Must Be Addressed If you ask your friends, relatives and colleagues if they’ve used the Internet to find healthcare information, I’d be willing to bet the answer would be yes. There’s no question that the Internet is an ever more important healthcare tool. The ability to capture and consolidate information into electronic medical records; search and share health and wellness resources, and enhance communications between professionals and patients are among the many benefits of the web. It’s OK to cheer but just not too loudly.

The problem is that our friends, relatives and colleagues aren’t everyone – not by a long shot. According to Neilsen Online, there’s a whopping 277,636,000 Internet users in the U.S. The flip side of this seemingly good news is that it leaves about 30 million Americans disconnected from the world wide web and, thus, unable to access important healthcare tools and information.

The web is no panacea, of course. You may have read some of my previous articles where I pointed out the problems of web-based healthcare information. Because there’s so much junk science reported and repeated in cyberspace, it can be a case of information doing more harm than good. Still, there’s a growing list of important applications that will not be available to all who could benefit from them.

Take Keas, for example, the new company that boasts Google Health and Microsoft HealthVault as partners. Keas seeks to marry personal data and health information to produce personalized health plans for individuals. Delivered right to your desktop or smart phone might be diet and exercise advice, an explanation of lab results, different treatment options or reminders to take a medication.

During the healthcare reform debates, we heard repeatedly that a key to lowering costs is to have a healthier nation and that this goal will only be possible if individuals take more responsibility for their health. While we could achieve a lot if plain old common sense was applied more often, tools like those being developed by Keas could play an important role in both learning about and managing one’s health.

If experts are telling us that things like electronic medical records, on-line health information and personalized health plans are important to healthcare reform efforts and our own personal well being then we need to be thinking about two kinds of health disparities: insurance coverage and Internet access. Creative, cost-effective ways to distribute computers and expand broadband access must take on new urgency. The benefits would be manifold.

And, access should include more than the ability to go on-line. Access is meaningless if one can’t interpret what one has found. Even for those with Internet connections, there’s an enormous deficit in health literacy that threatens the public health, such as sensationalized claims that lead people to take potentially dangerous alternative medicines or parents to refuse vaccinations for their children other than for legitimate medical reasons. If there’s any hope in increasing coverage and quality while containing (or even lowering) costs, more attention must be placed on expanding access to and understanding of healthcare information.
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A Chink in Oprah's Armor

Is She Putting Your Health At Risk?

The list of Oprah Winfrey's accomplishments is long. The value of what she brings to her viewers and readers, and to communities worldwide is enormous. Yet, as Newsweek tells it in their June 8 cover story, "Crazy Talk: Oprah, Wacky Cures & You," there is danger in her embrace of alternative therapies -- danger to the public health and danger to her reputation.

The article discusses several cases where both lay and professional health "experts" have dispensed potentially dangerous advice, including the use of Tarot cards to diagnose illnesses, refusal of vaccinations, and self-medicating with hormones, herbal supplements and mega-doses of vitamins. Moreover, Oprah herself has spoken positively about a number of these "treatments" and "cures," providing an endorsement of gigantic proportions.

In response to the article and the condemnation of mainstream medicine, Oprah released a statement saying, "For 23 years, my show has presented thousands of topics that reflect the human experience, including doctors' advice and personal health stories that have prompted conversations between our audience members and healthcare providers. I trust viewers, and know that they are smart and discerning enough to seek out medical opinions to determine what may be best for them."

Let's break this down:

1. Doctors' advice. Yes, Oprah has welcomed quite a few esteemed medical experts who have clearly and accurately described a wide variety of medical conditions and potential interventions. Some physicians and their advice are more equal than others, however. There is a cadre of highly credentialed individuals who have repudiated peer-reviewed data in favor of so-called natural remedies. Dr. R.W. Donnell, the physician blogger, calls them “quackademics.” The article highlighted Christaine Northrup, M.D. who said that, "in many women, thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of 'swallowing' words one is aching to say." She also said women should consider iodine supplements (which, in reality, will make hypothyroidism worse). Oprah calls Northrup's book, The Wisdom of Menopause, her "Bible."

2. Personal health stories. We all know that information conveyed in a personal, emotional way connects with audiences better than just some dry facts. The flip side of this is that many times the information is less fact than it is anecdote or wishful thinking. Suzanne Somers, for example, speaks to Oprah's audience of her own quest to look younger and double her lifespan with a regimen of non-FDA approved bioidentical hormones and 60 other supplements, which she ingests, applies and injects. Though a personal story, Somers wants to be viewed as an expert. "I have spent thousands of hours on this. I've written 18 books. I know my stuff," she told Newsweek. Oprah said "every woman should read" Somers' books.

3. Trusting viewers. In my view, the word "trust" is just not applicable here. The issue is whether or not her viewers are a) exposed to other sources of information and b) able to differentiate real science from junk science. This is not an issue of smarts, either. The point is that, while there are plenty of intelligent Americans, the vast majority have low health literacy. In a survey of more than 19,000 adults (age 16 and up) conducted a few years ago by the National Center for Education Statistics, only 11% where found to be "proficient" in their health literacy. The majority, 53%, where in the "intermediate range," while 22% had "basic" and 14% "below basic" health literacy. Without proficiency, it is exceedingly difficult to integrate, synthesize and analyze the sometimes complex information that one is expected to tackle.

Is this Oprah's "jump the shark" moment? Her ratings are down as is readership in her magazine, O. But I hope the answer is no. Rather than defend the past and continue on this course, Oprah should seize the opportunity to do better in the future. Please Oprah, ensure that all sides of the medical argument are heard. Leverage your reach and good intentions by being a champion of health and science literacy.

Swine Flu's Teachable Moment

An Opportunity for Public Health and Vaccine Manufacturers

It was disturbing to read about a growing public health threat in "Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases" in this week's New England Journal of Medicine (Omer et al.). The bottom line is that there is a critical need for new education and policy efforts to protect children (sometimes from their own parents) and the general public.

Here's an example of some of the bad news: In the case of measles, it's been estimated that more than two million cases occurred each year in the U.S. before a vaccine was available. In a triumph of science and medicine, the number of cases dropped to a mean of 62 per year between 2000 and 2007. In the first four months of 2008, however, 64 cases were reported with 63 of those occurring in children who were not vaccinated. Why?

• Past success. With a number of diseases nearly wiped out by vaccines, it seems as though our memories have been wiped out as well. As time marches on, many have forgotten the potential severity of vaccine-preventable diseases. Using the measles example, some cases can cause pneumonia, seizures, meningitis or even death.


• Alternative medicine and junk science. Of course, "western medicine" does not have all the answers. But it's been reported that parents of unvaccinated children "were more likely than parents of vaccinated children both to have providers who offered complementary or alternative health care and to obtain information from the Internet and groups opposed to aspects of immunization."


• Ease of opting out. Although the constitutionality of mandatory immunizations has been upheld, individual states have the ability to set the bar and allow exemptions based on personal or religious beliefs. In another unfortunate example, "the mean annual incidence of pertussis was almost twice as high in states with administrative procedures that made it easy to obtain exemptions as in states that made it more difficult." It was reported also that children with exemptions were 35 times more likely to contract measles.


• Denial. Compared to parents of vaccinated children, significantly more parents of unvaccinated children believed their kids had a low susceptibility to diseases (58% vs. 15%) and that the severity of disease was low (51% vs. 18%).


• Lack of trust. Again, compared to parents of vaccinated children, significantly more parents of unvaccinated children believed that vaccine efficacy and safety were low (58% vs. 17%, 60% vs. 15%).

Although the hearts of parents who withhold vaccinations from their children for non-medical reasons might be in the right place, their brains are not. In the "rugged individualism" that many Americans use to define themselves, there is a consequence of putting others in harm's way. Those who are unvaccinated put their communities at a higher risk of disease outbreak.

Now, there's a race to develop another vaccine -- this one against the swine (H1N1) flu. Although no one wants a new disease to contend with, there may be a silver lining -- a chance to reengage the public on the importance of immunizations. No doubt there will be an educational push when the vaccine is available. But at the same time, a campaign should be tied-in to reverse the dangerous growth of vaccination exemptions.

No vaccine is risk-free and not every mind can be changed. Still, the CDC (with their reach and clout), vaccine manufacturers (who can gain sales and reputation) and health care providers (who are a trusted source and carry influence on family health care decisions) should join forces to develop a new dialogue with the public. And let's sustain the discussion, let's put the science and evidence in perspective, and let's build some trust.

NEJM Makes It Official

The Role of Communications in Public Health
Communicating. It’s the first word on the first page in the first article of the first issue (of 2009) in what many would consider first among the medical journals, the New England Journal of Medicine. My first utterance upon reading this was, simply, “Wow.”

In “Communicating Medical News – Pitfalls of Health Care Journalism,” Susan Dentzer, editor-in-chief of Health Affairs, writes “Whether they realize it or not, journalists reporting on health care developments deliver public health messages that can influence the behavior of clinicians and patients.” This is the lead that the NEJM chose to use for its first issue of the year. Not healthcare reform, not science policy, not clinical strategy. Communicating.

The article is a terrific platform to tell (or remind) its learned readership that they have a critical role in helping journalists get their stories right. As Ms. Dentzer points out, the consequences can be dire. With inaccurate details or story angles developed for shock value, patients can be spooked out of taking their medication or not even seek medical attention.

And, it’s not good for business either. Innovators, entrepreneurs, investors and diagnostic, device and biopharmaceutical companies can all suffer from the herds prodded on by cowboy journalism. In the latest issue of Health Affairs (28, no. 1), it was reported that U.S. health spending in 2007 grew at the lowest rate in nine years, mainly because of slowing prescription drug sales. Why? The availability of generic alternatives was a major factor. But Federal health officials also said that the trend in drug spending was influenced by increased safety concerns.

The problem of health and science reporting is further exacerbated, Ms. Dentzer said, by the many journalists who “consider themselves poorly trained to understand medical studies and statistics.” She laments also the lack of time, comprehensiveness and context afforded healthcare stories.

OK, so this isn’t exactly news to us in the communications/public relations field. Some journalists are ill-prepared and misinterpret the facts. Some news outlets are chopping their staffs and, thus, preventing opportunities for deeper investigation. And, some scientists and clinicians can’t form a coherent sentence.

Beyond the call for better training of health journalists and asking the medical community to provide wider balance, however, we need a change of mind-set. Journalists, news outlets, content experts and communications professionals all share a goal – get important, compelling information into the hands – the minds – of the right people. Let’s learn from each other. Let’s communicate. The bottom line is that we need each other if we are to inform and motivate and create positive changes in behavior. Though there’s a long way to go, having the role of communications in public health elevated in the NEJM is a great way to start 2009.

Do the Facts Matter?

Of Course They Do, Of Course They Don't
We receive, provide and use facts all the time. Facts inform our choices. Facts support our points of view. Facts help us find new facts.

Yet we see that facts matter little when it comes to risk and behavior. People can recite the facts but they smoke cigarettes, overeat, abuse drugs, don’t exercise, don’t take their medicine, and don’t wear motorcycle or bicycle helmets.

There are other circumstances where people just refuse to acknowledge a fact as fact. Have you noticed that some arguments are never won despite having solid, unassailable facts? If the facts don’t fit the person’s worldview or “frame,” as the cognitive linguist George Lakoff terms it, the facts bounce off like bullets shot at Superman’s chest. Your opponent deflects all the data while you get blue in the face.

Certainly there are internal and external forces at play. There may be inertia: “That’s the way we’ve always done things.” There may be no consequences: “Who’s going to notice, who’s going to care?” We may feel powerless: “I don’t have the resources, I don’t have the access.”

Still, we pump out what we think are compelling facts in the hope of persuading people to take some sort of desired action. That’s what prompted me to write this entry.

Another public health alarm was sounded this week with the release of a survey that said very nearly everyone (83 percent) at risk for type 2 diabetes in the US is not getting a simple blood glucose test or taking the appropriate actions as a result of their test. This joint effort between The National Changing Diabetes(R) Program, sponsored by Novo Nordisk, and Fleishman-Hillard points to some special concerns in Hispanic and African American populations. “Fifty six percent of Hispanics should be tested and 59 percent of African Americans are at risk for diabetes and should talk to their doctor about being tested.”

Dana Haza, senior director, National Changing Diabetes Program (NCDP), said, “This study clearly demonstrates the need for greater education and awareness, especially among people who are at risk.” And Martha Boudreau, president Mid-Atlantic, Fleishman-Hillard, added, “In working with our National Diabetes Goal partners to release this information and help create awareness about type 2 diabetes, we hope it will serve as a call to action for at-risk Americans to get tested and respond accordingly."

The NCDP is a very worthwhile initiative, don’t get me wrong. But if facts were all that mattered, we’d be done. Insight alone does not produce change. Those who came after Freud quickly discovered this truism. Indeed, a whole new genre of psychotherapy (cognitive) came to life based on the knowledge that knowledge doesn't bring change.

It’s the desire to change that brings change. To the at-risk person we must ask: “Why don’t you care, what don’t you understand, who might help you, what resources do you need, can you imagine what your future would look like if you changed?” Gaining these insights will help us place more effective calls for those desired actions.