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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Let’s Not Get Burned and Drowned (By Information)

Right, Wrong; Too Much, Too Little; Too Early, Too Late
If Martha Stewart was in public relations she might say, “Information – it’s a good thing.” Information can educate. It can inspire. But, it can confuse. It can even harm.

We’re exposed – sometimes bombarded – by health information everyday. It comes from our healthcare providers, from the media, from consumer groups, from government institutions and advertisements. Shirley Wang wrote in The Wall Street Journal last week, “Too much information about drug safety – disseminated through media, online alerts from consumer watchdog groups and even by the Food and Drug Administration itself – might overwhelm patients and raise undue alarm, some medical professionals caution." Indeed, also reported in this story was a survey of 300 medical professionals released last March by Pfizer that found nearly all (89 percent) were at least “somewhat concerned that patients might stop their medications if potentially negative safety information was released to the public too early."

The clutter and confusion is an issue not only for patients and caregivers but for physicians, too. The database of clinical guidelines (those standards of care developed by a wide array of medical societies) maintained by the American Medical Association contains over 2,200 entries. Some were not subjected to peer review and some contradict others outright. Dr. Darshak Sanghavi, a pediatric cardiologist at the University of Massachusetts Medical School, wrote in The New York Times recently that in the past year “the American Academy of Pediatrics abruptly reversed its recommendation that healthy infants avoid peanuts and other potential food allergens, without citing any new data. Weeks after the American Heart Association widely publicized the need to perform cardiac testing in children treated with drugs for attention problems, the academy issued a contradictory guideline discouraging such testing.”

These guidelines carry weight in determining if a drug, device or procedure will be reimbursed by insurance, and are supposed to be developed using hard clinical data – so called evidence-based medicine. But here, too, lie a bevy of contradictions. For example, Stephanie Saul wrote in The New York Times last week about the CyberKnife, an FDA approved treatment for the treatment of a variety of tumors made by Accuray. In prostate cancer, the key advantage is that treatments take five days instead of eight weeks for conventional cancer radiation. “As it turns out, Medicare pays for the treatments in 33 states — but not in 17 others. “You can live on one side of the street and get a procedure, but on the other side of the street you can’t,” said Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review.”

Where does this leave us? Here are a few thoughts:

For consumers: Trust, but verify. We’re told to rely on sources of information that we trust. But be careful. Trust is easily misplaced – just ask those who invested with Bernard Madoff. Look for information that lists its authors. Look for references. Additional comfort can be gained if the information is attached to a major medical institution, or a government agency like the NIH or CDC.

For health information providers: Release information when it’s ready, not when it’s half-baked. Many studies and interim results are made public too early. Clearly, if there’s a serious potential adverse event or public health issue, it’s important to err on the side of safety. But, in other cases, try less for a change. Not everything is news, not everything needs an announcement.

For healthcare decision-makers: Set expectations in advance for what information is needed to render judgment, while leaving room for some flexibility in a dynamic field. We need a clearer understanding of the thresholds of acceptability, when enough information is enough and transparency in the review process.

Positive steps have been taken, to be sure, but we still need to work to ensure that information is of higher quality, delivered at the right time and conveyed in language appropriate to the audience.

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.

Let's Get a Little More Serious

Enhancing Corporate Reputation By Playing It Straight

I held a session on risk preparedness, issues management and crisis communications, last week in my Strategic Communication class at NYU. One of the truisms I talked about was how, so often, damage to reputation, morale, operations and financial performance is self-inflicted.

The pharmaceutical industry, unfortunately, serves as a prime example. In my view, some of the fights to differentiate products and gain market share have fanned the flames of antipathy toward the industry. DTC advertising has helped a number of brands become household names but these efforts have not always enhanced the public trust. We’re not making our best effort to properly set expectations or adequately communicate the balance between risk and benefit when animated characters or claymation body parts are used to sell medicines. I’m sure these ads test well in focus groups but this environment calls for a more serious approach to marketing and education.

This doesn’t mean that we can’t or shouldn’t be creative. We just need to redefine what creative means. The default definition of “creative” can’t be hosting big events or using celebrity spokespersons. It has to be more encompassing and it has to involve real analysis – a clear link to the needs of stakeholders.

Pfizer represents an interesting yin and yang on this subject. On the one side, they have Chantix(R), the smoking cessation product, with its ads using the tortoise and the hare to illustrate the importance of perseverance and compliance. But how seriously should we take the safety warnings when we see a petting zoo on TV? On the other side is the retooled Lipitor(R) campaign featuring an actual heart attack survivor who now takes the cholesterol reducer. If this guy is giving me the good and the bad, I’ll pay attention.

But what really interests me is the Company’s recently launched Medicine Safety Education web site. I don’t have any knowledge about how well this has been promoted, received or utilized, but this site looks like a good start in both communicating and collecting information on drug safety. And, beyond the attempt at putting safety in perspective, there’s another critical element – a step toward educating the public on risk perception. It’s a small but worthy – and creative – step toward rebuilding trust and reputation.