Scientific Snobbery and Other Acts of Institutional Malpractice

Arthur Caplan’s important new EMBO Reports essay, “How stupid has science been?” serves as a powerful reminder that for decades, much of the scientific community viewed public communication as a career liability – the Sagan Effect, because many regarded the famed astronomer with disdain for trying to explain science in simple, relatable terms.

That cultural snobbery mattered. It left many citizens unprepared to evaluate claims and ceded ground over to the ill-informed, propagandists, and those seeking to manipulate others. Snobbery created a vacuum, but if we only focus on scientists’ failures, we’ll miss the larger structural forces now fueling mistrust and politicization – forces that must be addressed directly if we want science (and our health and global competitiveness) to recover.

Start with the partisan divide in trust. Pew Research Center finds confidence in scientists remains higher among Democrats than Republicans, and the gap widened during and after the pandemic. The pattern shows that party identity influences whether evidence is trusted – regardless of facts or how skillfully scientists explain it.

It’s worth remembering that science wasn’t always a partisan issue. America’s main science agencies were created through mid-century consensus, not by culture-war reactions. The CDC began in 1946 as a malaria-control effort that evolved into the foundation of the nation’s public health system; the NSF was established in 1950 when President Truman created it for “research driven by curiosity and discovery”; the NIH’s history dates back to the 1887 Hygienic Laboratory.

But now, active political interventions have been layered onto the federal science apparatus. Recently, the White House fired CDC Director Susan Monarez weeks after she took office, prompting senior resignations and raising alarms about political control of public health decisions. The administration also proposed slashing NIH’s budget by roughly 40 percent (about $18 billion). Even if Congress moderates these proposals, they signal that federal science has become a partisan battleground.

Performance and integrity are vital for building trust. Americans remember serious ethical and governance failures—like the inhumanity of the Tuskegee syphilis study and the retracted, heavily debunked Wakefield paper linking vaccines to autism—because they shattered the expectation that science self-corrects quickly and transparently.

Finally, our news and information ecosystem supercharges falsehoods. A study of millions of tweets published in Science showed that false news spreads “farther, faster, deeper” than truth – mainly because people share novelty and outrage, and platforms amplify it. That’s a systemic issue; clearer language from scientists helps but can’t, on its own, beat virality.

The trust dividend is pragmatic, not poetic. When evidence prevails, patients receive faster diagnoses and fewer risky detours; businesses scale sooner because regulators trust transparent methods; schools update curricula without culture-war spectacles; and cities act on air and water data before crises metastasize. That’s why the antidote to politicized science isn’t just speeches but a system: clear standards, timely corrections, and public dashboards showing how evidence guides decisions. Consistently doing this doesn’t just reduce tension—it boosts the nation’s ability to solve problems. Communication matters, yes, but performance plus transparency are what turn skeptics into stakeholders.

Certainly, talented public communicators like Neil deGrasse Tyson, Brian Cox, Michio Kaku, Hank Green, and Jessica Knurick, along with training hubs like Stony Brook University’s Alan Alda Center, have entered the scene. Helpful, but far from enough. These efforts must multiply a thousand, even a million times, reaching every part of the country.

So, yes: some snobbery initially created a vacuum. But now, polarization, policy shocks, long-term under-investment, governance failures, and algorithmic virality cause most of the damage. It’s a monumental problem, and we cannot wait for Congress to take meaningful action.

1. Scientists: make communication a core, even mandatory, part of your role, not just a side activity. Back in 2006, I urged scientists and doctors in Nature Biotech to make science more understandable and accessible to the public. It’s not about dumbing things down; it's about making them simple and relevant. If your research is funded by the public, explaining and justifying it is a service. Include a clear, plain-language summary on every paper and preprint; hold regular public Q&A sessions with schools, libraries, and faith groups; and include communication achievements in promotion and tenure dossiers.

2. Media: stop presenting “both sides” equally; emphasize the strength of evidence. False equivalence turns well-established science into a debate show. Use proportional balance: give more coverage to claims supported by strong evidence and less to fringe assertions unless the story specifically addresses misinformation. As I’ve argued elsewhere in “False Equivalencies: The Danger of Treating All Information Equally,” giving equal time to unequal sides misleads intentionally.

3. Schools: focus on teaching how to think rather than just memorizing facts. We don’t need every student to become a scientist, but every citizen should be able to recognize evidence, uncertainty, and tradeoffs. Make the scientific method a regular part of education from middle school onward, pairing it with statistics, probabilistic reasoning, and media/digital literacy. Balance STEM with the humanities so students can grasp ethics, history, and policy contexts.

4. Politicians: be the local leaders science needs. Establish a standing science advisory group in your office composed of accomplished professionals from nearby universities and health systems. Hold regular evidence briefings on issues important to your constituents (e.g., climate change, mental health, vaccine guidance, opioids, air, water, and soil safety). When guidance shifts, announce it openly and explain why. Leadership isn’t about having all the answers; it’s about showing your process.

The current politicization is (hopefully) temporary, not unavoidable. We can reverse it, but only if we address and invest in all the root causes—not just the easiest or least controversial ones. We must be brave and determined before we become sicker, poorer, and even more vulnerable.

Science Denial Part 2: A Threat to Children, Education and Competitiveness

The New York Times published a special Education Issue last week, “Learning What Works” in STEM (science, technology, engineering and math) education. The articles, collectively, set out an array of recommendations from top experts. They include:

• Increase attention to ideation and creativity
• Make teaching more immersive
• Increase teacher training and teacher pay
• Develop and distribute better instructional materials
• Encourage mentoring by outside experts or college/graduate students
• Provide the history and the context for science
• Dedicate time to applying ideas and practical invention
• Raise curriculum and testing standards

These are all good and important. So, let's go! There are many priorities out there but STEM education must be in the highest classification. We know from the scores obtained by the 2009 Program for International Student Assessment that 15-year-old students in the U.S. perform about average in reading. Average isn’t great but, when it comes to the math and science scores, it’s practically outstanding. Out of 34 countries, the U.S. ranked 17th in science and 25th in math. (The 2012 results will be released at the end of this year.)

But there are barriers to success even within the science teaching community. Dr. Eugenie Scott, executive director of the National Center for Science Education, said that roughly 20 percent to 25 percent of the nation’s biology teachers don’t believe in evolution and subscribe to creationist views. Teaching evolution and/or climate change in schools has been hotly debated by legislatures and school boards in states including Arizona, Colorado, Kansas, Kentucky, Indiana, Louisiana, Missouri, Montana, Oklahoma, Pennsylvania and Texas. These boards should embrace and promote, not disparage and reject, the facts.

Students receive at least some science as part of a required curriculum. But what happens when they arrive at home? Are the lessons in science class reinforced or refuted? In a 2012 poll by Gallup only 15% of U.S. citizens believe humans evolved without any intervention from God. Thirty-two percent said God guided the evolutionary process and 46% said God created humans in their present form. (Seven percent had no opinion.)

And what do the students hear from those in power? Rather than lead the country through and away from false and flawed ideas, a number of our elected leaders are cheerfully, bombastically, pulling the country backward. In Congress, the House Science Committee hardly holds to its title. Rep. Paul Broun (GA) fumed, “All that stuff I was taught about evolution and embryology and the Big Bang Theory, all that is lies straight from the pit of Hell.” Former Science Committee member Todd Akin (MO) famously opposed abortion for rape victims, in part, because “if it’s a legitimate rape, the female body has ways to try to shut that whole thing down.” Rep. Dana Rohrabacker (CA) said recently, “Global warming is a total fraud” and dismissed global warming as a plot to institute a “global government.” His suggestion that “dinosaur flatulence” could explain historic climate change patterns was also notable. Rep. James Sensebrenner (WI) similarly amped up the conspiracy theorists when he said climate change theory was a “massive international scientific fraud.” Rep. Ralph Hall (TX) also charged that climate change is the product of a global conspiracy of scientists and told the National Journal in 2011 that he didn’t believe in a human influence on global warming because “I don’t think we can control what God controls.”

This competition between God and science is a false construct and distracts us from the issues. In his book, The Language of God: A Scientist Presents Evidence for Belief (2006), Dr. Francis Collins, director the National Institutes of Health, wrote, “the principles of faith are, in fact, complementary with the principles of science.” He went on, “there is no conflict in being a rigorous scientist and a person who believes in a God who takes personal interest in each one of us. Science’s domain is to explore nature. God’s domain is in the spiritual world, a realm not possible to explore with the tools and language of science.” Not believing in a “personal God,” Albert Einstein, nonetheless said, "Science without religion is lame. Religion without science is blind."

The task of increasing our STEM preparedness goes well beyond the confines of schools. It’s immensely complex, opposing interests are deeply entrenched, and will take much longer and cost much more than most people realize. It’s not a problem that can be addressed by a five or ten year plan. It will take a generational blueprint that needs to be comprehensive, cohesive and well capitalized in order to see a return on the investment.

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

Science Denial, the U.S. and Us

This article also appears in odwyerpr.com.

Before a Call to Action, We Need Insights and a Plan

Professor Adam Frank at the University of Rochester rang a warning bell about the dangers of science denial in an important op-ed (Welcome to the Age of Denial) in The New York Times last week. He stated the sad fact that, “it is politically effective, and socially acceptable, to deny scientific fact.” Science denial is becoming more entrenched and culturally correct.

This juggernaut of illogic is like a cancer that has metastasized. He noted that, “climate deniers, taking pages from the creationists’ PR playbook, have manufactured doubt about fundamental issues in climate science that were decided scientifically decades ago. And anti-vaccine campaigners brandish a few long-discredited studies to make unproven claims about links between autism and vaccination.”

How do we fight this? Dr. Frank called on the scientific community to channel Carl Sagan, the late astronomer, author and science personality, and do more communicating (and for the general public to be more active, too). The Equation blog from the Union of Concerned Scientists echoed this “call to action.”

Yes, scientists must learn how to engage and how to communicate. I know there are some efforts underway at institutions such as the National Academy of Sciences and Stony Brook University’s Alan Alda Center for Communicating Science but, no matter what, there are critical steps that must come first. We need to ask questions and use the resulting information to generate the insights necessary to develop and implement a plan.

So, a “call to action” directed where, with what information, in what form? Before anything is done, we must understand the causes, motivations and forces at work. What are the religious, political and corporate interests, and what are their strategies and tactics? And, we must know our target audiences, and their issues and concerns. What’s the right language, the most compelling examples, what will it take to be persuasive? We know it’s not just about the facts – otherwise, everyone would accept global warming and evolution, no one would smoke, kids would get vaccinated and all motorcyclists would wear helmets. Scientists (and marketing and communications professionals) need to marry specific, emotionally-based messages with the factual.

The news media, of course, have a huge role to play. In misguided attempts to achieve fair balance (or, cynically, sometimes achieve the outcomes they wish), the media feeds into false equivalency – providing equal coverage to opposing views when, in reality, one side dramatically outweighs the other. An example was brought into the sunshine on the pages of The Wall Street Journal. It published a letter last year, “No Need to Panic About Global Warming (January 27, 2012), that said, “There's no compelling scientific argument for drastic action to 'decarbonize' the world's economy.” The editor noted the letter “has been signed by the 16 scientists listed at the end of the article.” I checked those names. Of the 16, there was only one climate researcher and one atmospheric scientist. 

Indeed, a few days later, another letter was published entitled, “Check With Climate Scientists for Views on Climate.” The 38 climate, environmental and atmospherics experts who signed the letter admonished, “Do you consult your dentist about your heart condition?” They went on: “While accomplished in their own fields, most of these authors have no expertise in climate science. Research shows that more than 97% of scientists actively publishing in the field agree that climate change is real and human caused. It would be an act of recklessness for any political leader to disregard the weight of evidence and ignore the enormous risks that climate change clearly poses.”

This isn’t just about promoting the truth or science getting its fair share. 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.” The Union of Concerned Scientists’ Center for Science and Democracy points out that “Many of the nation’s founding fathers were citizen scientists,” including Benjamin Franklin, Thomas Jefferson, John Adams, James Madison and George Washington. “John Adams, for instance, spoke of the “science of government.” In a debate with Benjamin Franklin in 1776, Adams invoked the principle of mechanical equilibrium to argue on behalf of his conception for our government’s system of checks and balances—designed, at least in part, to ensure policies based on verified, trustworthy evidence."

We've had one ”wake-up call" after another on the issue of science denial. But it's complex -- there isn't just one thing we should do. To start, though, we must review and revere our history, and use those founding principles again. The nation began with questioning dogma, exploring options, celebrating invention and spreading information. That brought us a long way and it can bring us further still.

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

How Google, IBM and Others Can Help Hold Feet to the Fire

A Proposal to Harness Computing Power to Showcase the Truth During Political Debates

Like so many, I'm profoundly disturbed when facts are ignored or twisted. I bristle especially when it comes to junk science and false health claims. Politics aside, Michele Bachmann's repeated assertion that Merck's HPV vaccine may cause mental retardation goes beyond inaccurate; it directly undermines public health. She ignores the experience of millions (and the lives saved, the disease prevented), clinical evidence, and the findings of the Centers for Disease Control and Prevention and the American Academy of Pediatrics. It would be an absolute crime if Ms. Bachmann's fear-mongering statement leads to just one girl eventually getting cervical cancer because her mother decided against vaccination. As Senator Daniel Patrick Moynihan famously said, "Everyone is entitled to his own opinion but not to his own facts."

Of course, health advocates, and public health and medical professionals blitzed the news media with the actual facts, which were 100 percent contrary to the presidential hopeful's claim. Unfortunately, the damage was already done. For some, the corrections will stick in their brains; for others, however, it will be in one ear and out the other. In Camelot, Inc., I addressed the challenge of undoing false or misleading statements: "It’s difficult to defeat because once in place, misinformation is terribly difficult to retract and, harder still, to erase from one’s memory. In a study of nearly 900 participants, researchers showed that “the repetition of tentative news stories, even if they are subsequently disconfirmed, can assist in the creation of false memories in a substantial proportion of people.”* Once the information is published “its subsequent correction does not alter people’s beliefs unless they are suspicious about the motives underlying the events the news stories are about.” And, “when people ignore corrections, they do so irrespective of how certain they are that the corrections occurred.” The bottom line is that people may continue to rely on misinformation even when a subsequent retraction is made and remembered."

Following last night's Republican debate, Ms. Bachmann denied saying that the vaccine was "potentially dangerous." "I didn't make that claim nor did I make that statement," she countered. And, yet, anyone can read the transcripts or look at YouTube to see and hear for themselves that she said it again and again. Of course, there were plenty of other flagrant violations of the truth by the other candidates. In the debate follow up, PolitiFact.com and others comment on the veracity of some of their key statements. It's important and worthwhile and... maybe too late to matter. How many listen to the pundits after the main event is over or read the news articles the next day? Just some small fraction of the debate audience, I'll bet.

So, here's a proposal that will hold every candidates' feet to the fire. Let's have all the fact checking completed during the debate. Before everyone shakes hands and calls it a night, a final segment is added: the candidates are confronted with their false or misleading talking points (maybe even a report card on how accurate or truthful they've been) and are asked to address the issues right then and there. During the course of the debate, all of the statements could be crunched through the vast holdings of credible, objective knowledge. Google was a co-sponsor of last night's debate, for crying out loud. And, if IBM's Watson computer can win at Jeopardy!, there's no reason that near-real time fact checking couldn't be a reality. It could be PolitiFact's Truth-O-Meter(TM) on steroids. No opinion sites or blogs would be part of the fact checking database -- only transcripts, proceedings and testimony; almanacs and atlases; laws, regulations and policy statements; credible survey data, and peer-reviewed research reports.

Google/YouTube and Twitter have expanded interest and engagement in the political debates. Here's a way for them and others to ensure that the widening audience gets the facts and not the flimflam.

* Lewandowsky, S., et. al., “Memory for Fact, Fiction, and Misinformation” (2005), Psychological Science, 16(3):190-195.

Between blog posts, you can follow me @pauloestreicher.

Cats and Dogs - It's Raining Opinion

A Bad Survey Results in Bad Reporting

Today, The New York Times published "Among Weathercasters, Doubt on Warming," a story based on a new survey from George Mason University that concludes there are "tensions between two groups that might be expected to agree on the issue [climate change]: climate scientists and meteorologists, especially those who serve as television weather forecasters."

In brief, only about half of the 571 TV weathercasters surveyed believed global warming has occurred, fewer than a third thought it was "caused mostly by human activity" and more than a quarter agree with the statement that "global warming is a scam." Here are some important under-appreciated facts:

Climate scientists and meteorologists are like cats and dogs, apples and oranges. College degrees versus graduate training and research. Predicting the weather tomorrow versus studying decades of data.

Not all TV meteorologists are created equally. Half don't have degrees in meteorology -- they simply report the weather. Sadly they are often the de facto local science expert because 94 percent of TV stations don't have a full time science reporter. Thus, misinformation and junk science can be easily perpetuated.

Politics forms the backdrop, not the science. I hate this but, as I've said before, the facts sometimes don't matter (Do the Facts Matter? Of Course They Do, Of Course They Don't). There's 130 years worth of information to conclude that CO2, driven up by human activity, is linked to climate change. Unfortunately, those now famous emails from a British group that allegedly tried to suppress some climate data have given climate change deniers a new reason to cast suspicion and doubt on the collective work of the field. It is also notable (and not reported in the NYT story) that 37.9 percent of the survey respondents identified themselves as somewhat or very conservative, 35.1 as moderate, and 27.3 as somewhat or very liberal (1.6 didn't know).

I really don't care where one stands on the political question -- my friends stretch across the spectrum -- as long as there is an open mind and a respect for the facts. But it would interesting to see how the survey might have changed if 1) political leanings were neutralized and 2) sorted by true expertise in the field/years of education. The bottom line is that The New York Times may be making a mountain out of a mole hill by elevating the visibility of a flawed survey.

Between blog posts, you can follow me @pauloestreicher.

Gaining Higher Ground by First Finding the Low

Treating the Cause, Not the Symptoms, of Pharmaceutical Industry Reputation

When confronted with a problem or an issue, we look for the root cause, the scene of the crime, Patient Zero. In the case of healthcare industry reputation, however, it seems that executives and consultants have a hard time finding that lowest common denominator. Though the pharmaceutical industry has suffered from behavioral, communication and performance missteps that have lowered reputation, it is low health literacy among consumers and the decline of science journalism that are fundamental to this problem.

Many millions have been spent on advertising campaigns to communicate the value of medicines and the cost of product R&D. Attempts have been made to showcase the role of industry research in modern medical breakthroughs. Disease awareness campaigns have been launched to help people better respond to symptomatic cues and get help. A conciliatory face has been unmasked as concessions on discounts and rebates were recently made during negotiations on healthcare reform.

It does not appear, however, that the “kitchen sink” approach to corporate reputation management is working. According to the yearly Harris poll of public attitudes toward different industry sectors, pharmaceutical companies have roughly the same score as cable companies and automobile manufacturers. The “good job minus bad job” number was nine (with supermarkets leading at 86 and tobacco trailing at -32).¹ Last year the number was 15 (with supermarkets at 84 and tobacco companies at -43).²

In the annual Harris Interactive Reputation Quotient survey of the 60 most visible companies, however, the pharmaceutical sector posted its highest reputation scores in five years – up to 31 percent in 2008 from 26 percent in 2007.³ The optimist might say that the upswing in public sentiment is proof that the varied messages and good works of the industry are finally penetrating the gloom. Yet, the cynic might say that it’s all relative; the self-inflicted wounds of other industries make pharmaceuticals look good by comparison. For example, the financial services fell into the reputation cellar with the tobacco industry, both at 11 percent. The auto industry suffered the largest decline (22 percent) in the survey's history. And, remember, 31 percent good for pharma means 69 percent not good.

Wherever the numbers are, they need to be higher. Bolstering industry reputation means generating more trust among the stakeholders. We can go a long way in enhancing the relationship with key stakeholders by delivering on healthcare promises. That is, better outcomes for patients. Generating better outcomes is heavily dependent on appropriate utilization which, in turn, relies on better health judgment.

Better health judgment starts with consumers and the need for them to be more knowledgeable about healthcare. 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.

In response to these issues and obstacles, the healthcare industry should get behind a massive, sustained effort to enhance health and science literacy.

Of course, having a more knowledgeable public will not guarantee an enhanced corporate reputation. It must be earned. The self-inflicted wounds – the reputation-killing missteps and misdeeds – need to stop.

But, putting that critical issue aside, without an ability to evaluate the facts and evidence, the important health and science issues of the day – stem cells, healthcare reform, research funding, vaccine programs – will continue to be misconstrued and remain political footballs.

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 healthcare provider. This all makes the public an easy target for purveyors of alternative medicines and bogus devices.

This growing problem drew widespread attention when Newsweek put Oprah Winfrey on its cover with the title, “Crazy Talk: Oprah, Wacky Cures & You”.⁴ To be sure, Oprah has made tremendous contributions to her viewers and to noble causes across the world. But when she give 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, viewers see an endorsement of potentially dangerous treatments and interventions.

Jenny McCarthy, another guest of the show, has used the very unfortunate story of her son to create fear and confusion around vaccines. Indeed, compared to parents of vaccinated children in the U.S., significantly more parents of unvaccinated children believe that vaccine efficacy and safety are low (58% vs. 17%, 60% vs. 15%). Also, significantly more parents of unvaccinated children believe their kids have a low susceptibility to diseases (58% vs. 15%).⁵

Following the Newsweek article and sharp condemnation by the mainstream medical community, Oprah released a statement saying “I trust viewers, and know that they are smart and discerning enough to seek out medical opinions to determine what may be best…” Trust isn’t the issue, however. It’s whether or not viewers have the ability to differentiate real science from junk science, medical myths from medical facts.

This inability to filter information holds true for the fastest growing sector of media – new or social media. Some commentators have heralded the arrival of “citizen journalists” to fill the void left by the dwindling professional corps. Sorry. Although bloggers help to generate much needed discussion, citizen journalism does not equal journalism. And, with the “viral” nature of the web, every anecdote, half-truth or falsehood has the potential to be perceived as fact, as real news.

Indeed, we need more pros to sift a growing mass of information. Professional health and science journalists must help to communicate the progress and the failures, and to differentiate the facts and evidence from the frauds and junk science. Unfortunately, we’ve seen surveys confirm what we already know about the state of health and science journalism over the past few months. It’s a shrinking, wounded profession. We know the symptoms – they’ve been well documented. Like the global economy, journalism needs a recovery plan.

A recent editorial in the journal Nature recognized that “scientists can do little to stop this bloodletting” though they can at least “help ensure that reporting about science continues to be both informed and accurate.”⁶ In addition, it was suggested that “the scientific community should work with journalism schools and professional societies to ensure that journalism programmes include some grounding on what science is and how the process of experiment, review and publication actually works.”

In another piece in the same issue, Toby Murcott wrote that science journalists must be more engaged – more a part of the action. They can’t simply massage a press release for their particular readership. He compares science journalism to the clergy, “taking information from a source of authority” and translating it for the congregation.⁷ He contrasts this with political journalists who, with a knowledge base on par with those who they monitor and interview, engage in an active exchange.

Physicians have a role in this, too. With inaccurate details or story angles developed for shock value, patients can be spooked out of taking their medications or seeking medical attention. Indeed, “communicating” was the first word on the first page in the first article of the first issue (of 2009) of the New England Journal of Medicine.⁸ Susan Dentzer wrote that “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.” Unfortunately, many journalists “consider themselves poorly trained to understand medical studies and statistics.”

Yes, the quality of reporting and the training of journalists must be bolstered. A survey released this year by the Association of Health Care Journalists and the Kaiser Family Foundation reported that 43 percent of respondents said training opportunities had declined.⁹

But addressing this one facet is not enough. Journalism is a business and, thus, a business case needs to be made in order to save (and expand) health and science journalism. The bottom line is that demand is low. Certainly, there’s no dearth of interesting material. It’s just a simple truth that a dreadfully large portion of the audience lacks the background and understanding to feel engaged in the subject areas. In a survey of more than 19,000 U.S. adults, only 11 percent where found to be "proficient" in their health literacy.¹⁰ This is where the recovery must begin.

The stakes are high and not just for the employment of journalists. Remember the first trial involving the anti-inflammatory drug Vioxx® in 2005? The jury awarded $253 million to the plaintiff. Why? The science went right over the heads of the jury. In an interview with The Wall Street Journal a juror said, “We didn’t know what the heck they were talking about.”¹¹ Jon D. Miller, director, Center for Biomedical Communications, Northwestern University Medical School told The New York Times that “People’s inability to understand basic scientific concepts undermines their ability to take part in the democratic process.”¹²

Industry support for a long-term effort targeted at raising health and science literacy could lead to an increased public understanding and appetite for health and science information, news outlets being repopulated with professional journalists to help carry information forward, and a higher and wider industry reputation. Let’s spread intellectual curiosity, and use the marketing and partnering expertise of the industry to achieve these essential goals.

1. The Harris Poll^®, August 18, 2009.
2. The Harris Poll^®, August 7, 2008.
3. Harris Interactive Reputation Quotient^TM (RQ) survey, June 23, 2008.
4. Kosova, Weston and Wingert, Pat. Newsweek, June 8, 2009, pp. 54-62.
5. Omer, Saad B. et al. Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases, New England Journal of Medicine 2009, vol. 360, no.19, pp. 1981-1988.
6. Nature, vol. 459, no. 7250, p. 1033.
7. Murcott, Toby. Science Journalism: Toppling the Priesthood, Nature, vol. 459, no. 7250, pp. 1054, 1055.
8. Dentzer, Susan. Communicating Medical News – Pitfalls of Health Care Journalism, New England Journal of Medicine, 2009, vol. 360 no. 15, pp.1477-1479.
9. Kaiser Family Foundation, The State of Health Journalism in the U.S., publication #7869, March 2009.
10. National Center for Education Statistics, The Health Literacy of America’s Adults, publication #2006483, September 2006.
11. The Wall Street Journal, p. A1, August 22, 2005.
12. The New York Times, p. F3, August 30, 2005.

Between blog posts, you can follow me @pauloestreicher.

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.

The World's Shortest Diet Book

It's All There in Clear, Concise Messages

I went to my local bookstore the other day to look at the management and leadership books. It was a mission to do a little competitive intelligence, since I'm working on one myself. (Yes, I do think there's room for one more! And if you know of an agent or publisher willing to work with a first time book author let me know.) On the way to my target, though, some catchy titles in the aisle of diet and weight loss books caught my eye. I diverted over there and... yikes. What a mess. How could anyone make heads or tails out of all the claims and contradictions?

Could this be an opportunity to work on a second book? Could I retrieve some of my long ago training in nutritional biochemistry, and meld it with my career in communications and passion for health and science literacy?

There's a huge need to be sure. The National Institute of Diabetes and Digestive and Kidney Diseases reports that two-thirds of U.S. adults are overweight or obese and nearly one-third are obese. Attempting to meet this vast market are the hundreds of fat-burning, colon-cleansing miracle products seen in advertisements and infomercials, and the thousands of books that claim to be the solitary answer to such a vexing and pervasive problem. (Message to the FTC and FDA: please help protect a desperate public from these purveyors of junk science.)

So, I got serious for a moment but then realized that I couldn't put an entire book together. I couldn't even think of enough material to fill a page much less a chapter. Why? Because it would be the world's shortest book. In my view, it all boils down to four words:

Eat less. Exercise more.

As communicators, we're taught to make the messages few, simple and memorable. I think I aced that test with my book title and book in one.

OK. Maybe there's a little bit more. There are different body shapes, different rates of metabolism, different personality types as well as economic issues. Unfortunately, when trying to stretch a dollar, junk food can often fill the belly at a lower cost. There are some people who must have a thorough medical examination to search for underlying causes of weight gain, and others who need some intervention to help them get jump-started be it through counseling, pharmaceuticals or surgery.

But the formula is pretty simple, nevertheless. If you don't put enough gas in your car, it dies while you're driving. Put too much in when it doesn't need it, you have an overflowing, dangerous mess. The key, therefore, is balance.

Michael Phelps, the record-shattering swimmer, gives us balance in the extreme. Did you happen to see one of those "up close and personal" vignettes from the Beijing Olympics where he was eating one of his meals? It was like Nathan's hot dog eating contest came to Animal House. Anything and everything was going down his gut. Yet, he's won more medals than anyone in history and hangs in poster form in many a teenager's room. He balances the ingestion of 10,000 calories with 10,000 worth of exercise.

I know my message is simplistic and I know also that the execution is not always so easy. Our bodies and our lifestyles change with age. Keeping in balance gets harder. We all know that we should eat a nutritious, varied, well-balanced diet. So, if one key is balance the other is expectation. We need to take the long view and not hope for or plan on a rapid reduction in weight. The goals must be achievable and bite-sized. With this in mind, I should double the length of my diet book:

Eat a little less. Exercise a little more.