Friday, January 30, 2015

“Measles Elimination” – an important public health concept that gets lost in the FOG of Words

People should get vaccinated against contagious diseases for their own safety AND because vaccination is a critical way to eliminate that disease from a population. These two facts are central to public health messaging.
 The first message is sort of simple “Get Vaccinated." (Not saying that people’s responses to calls to vaccinate are not fraught.)

Today I’m focusing on the second function of the vaccination message- to foster the public’s understanding of disease elimination. Uncannily, health writers, especially when they're writing definitions, seem to fall into a haze of complex and circular Epi concepts and language, not shared by the general public. 

The Fog of Words   

(accessed 1/30/15)
Q: What does "measles elimination" mean?
A: Measles elimination is defined as the absence of continuous disease transmission for 12 months or more in a specific geographic area. In such areas, there may still be measles cases, but they are from infected people who bring the disease into the area.
A Health Literacy Load Analysis – (what the message assumes the reader knows)
·                                 “continuous disease transmission” – both read it and understand it.
                      above has a critical timeframe ( 12 months).

Q Public
So let’s just say I’m one of the millions in the US (actually at least 50 % of adults) who reads at 8th grade level or lower and who doesn’t have a solid foundation in health concepts.   I stumble across “the absence of continuous disease transmission”.
(To further fog things up, the link the reader sees takes you to
A JAMA Pediatrics  article with a reading level and science literacy level of post HS/college)

Here’s what I likely come up with trying to read and understand this definition.
  • ·      A person is “absent” from the area where the disease is.
  • ·      Or I skip over the one word I know, “absence” and start with “continue”.  So something about continuing the disease.  Maybe people can continue to get measles for 12 months.

This definition bypasses the easier to read active verb form.  Instead, it turns the verb into a noun-deactivates it (nominalizes it) รจ”the transmission of measles.”

We know that active forms of verbs and sentences are generally easier to read.
If we unpack the complex sentence above we get 3 active ones: 
The disease is transmitted.
The disease is transmitted continuously.
The disease transmission must stop for 12 months.

You could write the definition like this:
Q: What does "measles elimination" mean?

A: Measles elimination is when people living in the same geographic area stop spreading (transmitting) the disease from one person to another for at least 12 months. There is not more measles in the area. Measles may start again if an infected person brings the disease into    the area.   

Any other ideas?  

Monday, January 26, 2015

Anti-vacciners are so darn readable

I was reading a blog I always enjoy, Skeptical Raptor, a recent post, " Debunking the vaccine denier myths of the Argument by Package Insert."  While I stumbled over the title a few times before I did realize it was critiquing a standard anti-vaccine argument, the critique presents a good insight into a clever but flawed argument they use.
* The Raptor's 2009 blog is also a good read.
The thorough analysis shows how the anti-vaccine argument, like so many arguments do a lot of cherry picking of language from the drug inserts accompanying vaccine packaging.

Raptor rightly concludes the blog post with an appeal that consumers read the vaccine inserts very carefully.
"...However, package inserts must be read fully, without cherry picking data that supports your point of view. Taking information out of context, without spending the effort to understand it completely, just shows the level of denialism. The anti-vaccinationists are focused on finding any data, no matter the quality, that supports what they want to believe. But if you are truly on the fence about vaccinations, then the adverse events information in a package insert is not the place to start. There is so much information out there, but if you read that information with an open, critical mind, you will find that the scientific consensus strongly supports the safety and effectiveness of vaccines."

For millions,  a quote in "print" especially something like a medication label ( selective quoting used by anti-vacciners), or newspaper article still has verities.  It's taken as gospel.  The "dueling experts" that is stuck a staple of news coverage ( more newspaper then broadcast) has always presented serious problems to lay people.  You have x argument and y argument about the common Z.

A Dose of Consumer Reality 
And for all of you working in readability, health literacy, human factors/usability of health information, I don't have to restate how "high barrier" all of these inserts are and thus how hobbled are the millions who would try to read this packaging. The  "readability" of this content is routinely 12th - 17th grade and higher. 
For good measure here's 2 painfully tortured snippets of language acting badly. 

With over half the adults having difficulty reading info at 8th grade level or higher, and more Americans struggling to work with basic math, combined with our poor to null understanding of basic research, drug trials and how the FDA and pharma work.... the appeal to consume this insert information is so much more magical thinking. 

What really has always fascinated me about the anti-vaccine movement is how darn readable their arguments are!

Saturday, January 3, 2015

Flu Shots for Preschoolers in NYC - yet parent-friendly information hard to find

No need to look back to the introduction of the polio vaccine in the 1950s to know that, for many parents, the issue of vaccinating their child is fraught. What childhood vaccines to give? When? What's the evidence?   There's a robust anti-vaccine movement that uses straight talk, convincing stories and impassioned celebrities to argue against everything from MMRs to HPV and, yes, the polio vaccine too.  Paul Offit's Deadly Choices: How The Anti-Vaccine Movement Threatens Us All,
or Nadja Durbach's Bodily Matters, discussing the anti-vaccine movement in the US and Britain respectively are good reads.
Yesterday the NYT (1/2/14) reported that roughly 150,000 children in city-licensed day care centers and preschools must be vaccinated against the flu when they return to school next week. 
This morning I couldn't find any information, let alone a parent-friendly explanation, of the new requirement  on the NYC Dept. of Ed website.  There are things like “Family Activities for Winter Break”, “the Big Apple Awards”, and even “Ebola Virus Information.”

Can someone share the link  (or copy) of the letter parents received concerning this? Thanks.


Monday, November 10, 2014

Depends Underwear: a reason to drop my pants?

Depend, the adult diaper folks, brings us a new TV Ad campaign called “Drop Your Pants for Underwareness.” 

Here are the key sound bites.
Sound Bite #1
[Depend is launching]
“A cause to support the over 65 million people who may need Depend underwear.”
     In one of the Ads, Depend Brand Director, Liz Metz, tells us she’s dropping her pants in the name of her father, who has prostate related incontinence.   She invites us to “join the cause” and drop my pants for someone who is important to me.
The Facts     
Incontinence in its different forms is widespread among US adults. Much more common in women the incidence increase with age. Roughly 18 million people have daily urinary incontinence.  Added to the roughly 34 million people who need to urinate with increasing frequency or urgency, it is a big problem that can cause people to curtail activities, socially isolate and suffer depression.
Sound bite #2
“It’s time to bring it out in the open. It’s time to drop your pants for underawareness. “
The Facts    
Incontinence is not something we readily discuss with our doctors. Of all the men and women who experience incontinence unfortunately at least half don’t tell a doctor about it.  In fact, 1 in 4 women over 40 suffer from some type of urinaryincontinence, but most are too embarrassed to talk about it. 

Sound bite #3
“…because wearing a different kind of underwear is no big deal.”
But it’s not the garment we really should be talking about here, is it?

Important facts dropped along with the pants:
What the Depend campaign deftly fails to mention, or even allude to in a tiny print messages, is that Incontinence is a symptom of something.  And that critical message is artfully masked by the focus on outing incontinence, dropping your pants for someone (echoes of ALS bucket challenge here), and asserting yourself by wearing novel briefs.

It really wouldn’t have taken much video scripting time to include an accurate central message about incontinence.  This is - a thorough physical exam is the only way to identify the kind of incontinence a person has and to identify the possible remedies.

One of the reasons that a medical exam is so important is that urinary incontinence can be caused by many different medical problems:
            Overactive bladder muscles
            Damage to nerves that control the bladder from diseases such as mul­tiple sclerosis or Parkinson’s disease
Poor overall health
Diabetes, stroke, high blood pressure, arthritis
Back problems
            Blockage from an enlarged prostate in men
And common medications - diurectics, estrogen, benzodiazepines, tranquilizers, antidepressants, hypnotics, and laxatives.
And there are a fairly long list of possible treatments - controlling fluid intake, bladder training, pelvic floor exercises, biofeedback and medication, lifestyle changes, losing weight, reduced alcohol or caffeine consumption, etc. In severe and very bothersome cases there is surgery.

the adult diaper market (a few years ago I’d trip over those words) has caught up to the baby diaper market in the US.  Adults in the US spend close to $20 billion coping with urinary incontinence per year, and an additional $12.6 billion on urinary urgency and frequency.  Women are the largest consumers (86 percentof total sales in the incontinence market.) 1 in 3 women over the age of 18 suffer from some sort of sensitive bladder or incontinence, but only 1 in 9 actually use a specialty adult incontinence product today. 

With close to 80 million baby boomers currently 65+ it’s the perfect market for products we would never have thought we needed 30 years ago. 316 million adults over 70 years old in the world today (1 in every 3 requires protection) – China being the biggest potential market.

So, I’m ready to drop my pants with the best of them for a cause that advances the public’s understanding of health.

I propose we all drop Depend an email urging them to tweak their message ever so slightly - to do their part to advance the public's understanding of the serious, life disrupting problem. 
“Drop your pants to show support for all those who suffer for incontinence.  It’s time we started talking to our doctors about incontinence ..Oh, and BTW, Depends may be able to help.”