Google Continues to Use its Power for Public Health Good

Yesterday, Google announced its new surveillance system for Dengue Fever. Dengue Fever is a disease caused by four related viruses spread by a particular species of mosquito. It can cause high fever, rash, muscle and joint pain, and in severe cases- bleeding, a sudden drop in blood pressure (shock) and death. Millions of cases of Dengue infection occur worldwide each year. Most often, dengue fever occurs in urban areas of tropical and subtropical regions.

The system is similar to that which was previously released as their Google Flu Trends program. These systems use search queries within Google (for example those that enter the disease's name and/or symptoms) to identify trends. The Dengue system also takes advantage of a new feature called Google Correlate, which shows previously unknown correlations between search terms. These correlations allow researchers to model real world behaviors by examining internet search trends. For those who may be skeptical of this model, you should check out a publication (co-authored by Google and the Centers for Disease Control and Prevention-CDC) in the 2009 Nature Journal . The article reports that "because relative frequencies of certain queries were highly correlated with the percentage of physician visits in which a patient presents with influenza-like symptoms, we can accurately estimate the current level of weekly influenza activity in each region of the United States, with a reporting lag of about one day."

This is a pretty exciting addition to public health surveillance (where the goal is systematic, ongoing, data collection that is used to monitor trends, identify priorities, direct resources, identify emerging hazards, and evaluate interventions).

This is not the first time that Google has jumped into the public health field with an impressive contribution. In 2010, Google searches related to suicide started appearing with a message guiding users to the toll-free number for the National Suicide Prevention Lifeline. The number is 1-800-273-8255. Triggered by searches such as "I want to die" or "ways to commit suicide," the number is listed next to an icon of a red telephone, at the top of the search results.

The addition of the Lifeline number came shortly after (at the suggestion of a Google user), the company started displaying the hotline for the American Association of Poison Control Centers after searches for "poison emergency."

These cases of Google's work in public health are great examples of effective health communication and public health principles:

• Identifying the primary channels through which your audience searches for health information (more and more are utilizing the internet) and delivering accurate and effective information and/or interventions via those channels.

• Maximizing data driven surveillance systems- using existing data (e.g., internet searches) to identify public health trends.

• Building strong partnerships (as evidenced by the publication by Google and CDC) CDC has partnered with a company with specific expertise and resources in an area that can be invaluable to their work.
  

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Will New Ads in Georgia "Stop Childhood Obesity" or Increase Stigma and Bullying?

On Friday's Today show, there was an interesting analysis of a new campaign from the Georgia Child Health Alliance (GCHA) aimed at reducing childhood obesity. According to the GCHA website, the Warning: Stop Childhood Obesity media campaign "is part of a large-scale public awareness campaign designed to educate Georgians on the childhood obesity epidemic facing our state. Backed by market research, the campaign’s warning messages about obesity are developed to reach parents and children using communication vehicles such as billboards, television, radio and more".

From the Today show segment (which featured the campaign's Director, a child actor featured in the ads, and a child psychologist) we learned that this media campaign is part one of a three part campaign. The three parts were briefly outlined:

1- Raise awareness about childhood obesity; letting kids voice their struggle in their own words.
2- "Activate"- focus on healthy eating and activity
3- Focus on real solutions

While the GCHA outlines their strategic mission for this campaign, they are hearing some major objections to their approach and it continues to grab national headlines. The major concerns voiced by objectors such as Rebecca Puhl (a weight discrimination expert from Yale University), are that the ads will increase stigma for overweight kids (which could increase their experience of bullying) and that the ads will be ineffective due to their fear-based approach. In my review of the ads, I have mixed (mostly negative) feelings about their development and implementation:

• Strike One: The goal of this campaign is listed as "raising awareness". These may be my two least favorite terms in all of public health. "Raising awareness" is too vague and does not lend itself to being evaluated. In actuality, campaign developers usually want to "increase knowledge" or "change perceptions" or "change behavior" (e.g., calling the 800 number on the screen). These are all things which can actually be measured and should be stated more clearly.

• Strike Two: When the Today show asked the Campaign director about the audience for these ads, he replied "parents, kids, and educators". Again, this is way too vague. Your message and call to action (i.e., what you want the viewer to do after watching the ad) would be completely different for each of those audiences. For example, you may want educators to reach out to the parents of overweight kids in their classes or you may want kids to tell an adult if they are being bullied about their weight. These messages need to be tailored to each audience.
  

• Strike Three: These ads definitely fall into the "fear-based" category. As you watch them, the ads read "WARNING" in bold red letters and you hear a "boom" (kinda like on "Law & Order) as the statistics run across the screen. As I have mentioned in previous blog posts, fear-based approaches have been found to be ineffective in other areas of prevention (e.g., alcohol and other drugs).

• In terms of redeeming factors, it does seem that the campaign was developed using formative research which included focus groups with overweight kids. The results of these focus groups were used to develop the dialogue read by child actors in the ads so that it would be "in their words". If kids are the audience for these ads, then the age appropriate priorities and dialogue (with the inclusion of child actors) is positive. From health behavior theory (e.g., Social Learning Theory), we know that kids will respond better if they relate to those in the ads.
  

Of course, it is unclear if they also focus group tested the ads and billboards after initial development, before they were rolled out. It is also unclear how they are being evaluated and what the ultimate goals are (beyond "increased awareness"). I'll be interested to see parts two and three rolled out and hope to include follow up thoughts here on Pop Health.

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When It Comes to Acne, We've All Been Duped And Lied To Our Entire Lives

When it comes to acne, I've got some really bad news for you.

You've been lied to; we all have.

It's true, unfortunately. Take, for instance, diet and acne. Do you think there's any connection between the two? If you're like most people, you would say, "Of course not! They disproved that myth years ago!"

Did they?

Do you know the exact specifics on the research they did to establish this proof? Again, most people won't know but they'll know there was probably a pretty well documented study or studies determining the validity of their statements. I thought the same thing, but I inevitably came across something pretty shocking and disturbing when I came across the truth. That exhaustive research?

A week long study....40 years ago!!

I couldn't believe it either; the entire basis for the "there's no connection between diet and acne" is a 7 day long study carried out in 1971. During that study, participants were given several servings a day of coffee, chocolate and other items. At the end of the week, doctors saw no new pimples so they shrugged and said "No connection!"

Ever since then, it's been shouted from mountain top to mountain top that there's no connection.

Since then, however, there have been year long studies on several different groups of people. An Inuit tribe was studied as they changed from a traditional diet to a more modern, westernized one. A group of Ache people (natives living in Paraguay were also studied in a similar manner. Finally, a group of people from Brazil were studied as they moved to the US and then back to their country.

In every, single case, occurrences of acne were non-existent. That is, until, they began eating a diet much like our own. Afterwards, many began breaking out in pimples. Now this might not exactly be the nail in the coffin, but the group from Brazil lost their breakouts after moving back home.

But wait, it get's even better! Dermatologists that have began to question the traditional views have started to treat many of their patients through diet; they have put their patients on a low glycemic index (GI) diet. What this simply means is the patients don't eat foods that cause large insulin spikes in the blood stream; no white bread or white flour items, little to no processed foods in favor of whole grains, vegetables and healthy meats and fats. In many cases, their patients have shown vast improvements.

Now I don't think you have to eat perfectly all the time to achieve clear skin, far from it. However this begs a very interesting question:

Why has the mainstream been lying to us for so long?

At the very least, why do they refuse to even take a second look at their long established views when it's become quite clear that they should at least reevaluate their position. Well, that question leads me to the acne industry itself.

The acne treatment industry is a billion dollar a year business. It is quite lucrative because, as I'm sure you're well aware, people will do almost anything to get clear skin. Just looking back at my own experience, I would've done almost anything to finally get rid of my pimples. Now when it comes to the medical industry as a whole, most of it is very influenced by the drug corporations. Much of the literature, continuing education and perks of the job are paid for and written by the pharmaceutical companies.

So instead of writing and researching more into holistic treatments that focus on things like the diet and acne connection, it's more focused on creating a new gel or cream to put on your skin to stop your pimples. Just look back about a year ago; do you all remember epiduo?

Epiduo was this great new breakthrough treatment for acne. Its secret? A combination of a retinoid, a man-made version of vitamin A in layman's terms, and benzoyl peroxide. This incredible combination did nothing other than over dry most people's skin. Before then, it was a combination of salicylic acid and benzoyl peroxide and before then, it was either or and before then....etc.

It's always something else with them. You know why? Because for the products to actually work, you have to keep taking them. That's assuming the products actually work for you in the first place! So instead of researching real, lasting cures that attack the root problems within your body, the industry prefers to manufacture "treatments" that force you to keep buying over and over again. Cured patients stop buying; treated patients keep shelling out the dough!

I don't know about you, but I'd prefer not to play their games. Getting back to the diet connection, you don't need to eat like a rabbit and never go out with your friends; far from it. Going down that route, you'll only stress yourself out and keep trying to restrict your diet more and more. You'll ultimately fail and feel even worse than before. But what you can do as an acne prone person is cut back on some things to start:

Dairy products have insulin-like growth factor in them that causes similar problems as normal insulin in our bodies: oily skin that flakes off as well as an overgrowth of bacteria. Cutting back will help alleviate your symptoms.

Drinking more water is very important; it hydrates your skin and helps flush excess hormones and toxins from your body

Green, leafy vegetables are important too. They alkalize the blood and help heal your body and skin from the inside.

So stop playing the acne game and stop buying into their lies. Acne is a problem that begins inside our bodies; trying to treat your acne by putting stuff on your face will only lead to failure. The breakouts, oil, dead skin and bacteria are all symptoms of the actual problems inside.

Treat your real problems, cure your acne from the inside out, and your body, as well as your face, will thank and reward you.

Check out My Blog on acne to learn more about curing yourself once and for all through proper treatment

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From The West Wing to the National Health Care Debate

Anyone who knows me well knows that "The American President" is one of my favorite movies. If it is a favorite of yours as well, you may recognize that the actress who plays Press Secretary Robin McCall also plays National Security Advisor Dr. Nancy McNally in "The West Wing". The actress is Anna Deavere Smith.

This week in my "Qualitative Research Methods in Community Health" class, we discussed ethnography. Specifically we discussed Ms. Smith's work as an example of performance ethnography. For over a decade, she has interviewed people across the country and used the "data" to develop a one-woman show. Her newest play is called "Let Me Down Easy" and its goal is to show the human side of the national health care debate. I highly recommend viewing the 10-minute excerpt and interview here.

I'm so sorry that I missed her play when it came to Philadelphia earlier this year because I think it is an amazing example of the richness of data collected using qualitative methods. It is often argued that qualitative methods are too "soft" and limited in view. I've heard them described as "basically just journalism". However, I would argue that qualitative methods are essential to the success of public health.

Instead of surveys and databases, these methods collect data via interview, discussion, and observation. The research is meant to discover the complex relationship between personal and social meaning, individual and cultural practices, and the material environment or context. In contrast to what we have learned since grade school science about the scientific method and generalizability of findings- here the focus is on obtaining a deeper understanding of a population or phenomenon.

Ms. Smith conducted over 300 interviews for "Let Me Down Easy" and ultimately condensed her findings to show the experience of contemporary health care through the eyes of 20 individuals. These kinds of stories are incredibly powerful in public health. They open our eyes to challenges that we never would have found via survey...because we wouldn't have known to ask the right questions. They allow us to share stories with policymakers so they can see the impact of their decisions beyond the sterile statistics often cited. They can allow us to explore experiences or illnesses that occur in too small a population to survey.

Ideally, quantitative and qualitative methods should be used together to create the strongest public health research design possible. It should not be us vs. them...but instead a joint effort. I encourage us all to see the human side of health care reform when Ms. Smith's play airs on PBS "Great Performances" next season.

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