Monday, November 10, 2014

When We Tweet About Health

A few weeks ago, I discovered that not one, but two colleagues in my PhD program— people I previously held in high esteem, had no idea who Amal Alamuddin Clooney was.  I did not think it was possible to not know.  But, like many things in life, whether or not you know who Amal Alamuddin Clooney is and every outfit she wore over her wedding weekend in Venice depends greatly on where you get your information (for Dan and Ilene, that would be the smooth underside of a rock). 
Where we get our health information is not just a matter of self-improvement, but one of public health.  One only needs to look at the current Ebola outbreak to see the importance of accurate and trustworthy sources of information.  As more and more of our conversations and news-seeking occur online, it’s important to understand who is talking about health online and what they’re saying.  With that in mind, I teamed up with a few colleagues* to examine health conversations occurring on Twitter.  Our results were published last month (synergy!).  We especially wanted to know the types of things people tweeted about (like whether it was evidence-based, personal, or commercial), and whether different types of users (like doctors versus patients) tweeted about different things.
Word cloud of health-related tweets in our analysis (Lee 2014).
Yes, Readers, qualitative research is every bit as sexy as it sounds.  We systematically gathered a pile of tweets and categorized each one.  We found a diverse array of health-related user groups posting about a wide range of health topics.  For example, while organizations and businesses use Twitter to promote their services and products, patient advocates are using this tool to share their personal experiences with health.  Most health tweets were claims that users would expect to be supported by some level of medical evidence or shared news, though whether these claims were actually scientifically valid was not examined. 
While our study may not save lives "millions at a time", it is among the first to capture, in depth and breadth, what users are tweeting about health.  It points to the diverse activity on Twitter and the need for helping users, especially patients, make sense of the health tweets out there, by medical professionals, you, me, and even Amal Alamuddin Clooney**.  Knowing about our information sources enables us to know what to do with their information. 

*Colleague is too inadequate a term.  I worked with four wonderful mentors who generously welcomed me and patiently guided me through the whole process. 

**Not actually on Twitter (but I am!  Follow: @superlegitJoy)

Monday, August 11, 2014

Implications Done Right

Clean water source. Hygiene. Ebola containment.  These public health priorities and crises often seem like issues that only matter for developing countries.  Indeed, the CDC and other authorities have issued ample assurances that given the quality of our healthcare system and our very different cultural practices, the risk of an ebola outbreak in the US is very low.  That doesn't mean that we've learned our lessons.

As Aaron E. Carroll of the New York Times points out in an excellent article, Guinea worms (and ebola) aside, we are still battling issues of clean water, hygiene, and quarantine in the US.  And we pay for not learning such lessons with illnesses, deaths, and high costs.  As he writes:

The Centers for Disease Control and Prevention estimates that 48 million Americans become ill from food-borne illnesses each year. More than 125,000 hospitalizations are caused by food-borne illness, and about 3,000 deaths. Many, if not most, of these illnesses could be prevented if people properly stored, cleaned, cooked and refrigerated their food correctly. 
Between 1976 and 2007, deaths from influenza ranged from 3,000 to 49,000 a year. The vast majority of deaths from influenza occur in people who are 65 years of age or older. Proper hygiene and staying home during the infectious stage of the illness are still mainstays of flu care. But we also have a vaccine for this illness. Too few people get it. It’s estimated that two years ago, if we had just gotten the influenza vaccination rate up to 70 percent, up from the 45 percent we achieved, we could have prevented an additional 4.4 million illnesses and 30,000 hospitalizations.

Carroll connects global health crises with your health and deftly demonstrates the importance of persuasive communication as well as practicing what we preach.  We know what the answers are and we need to be compelled into putting them into practice.  Lives and dollars are at stake.

Thursday, July 3, 2014

That Movie Magic

In the late 1980s, the term “designated driver” began popping up all over pop culture.  The bar in Cheers had a poster and on L.A. Law, Harry Hamlin asked a bartender to call his designated driver.  This was the work of Dr. Jay Winsten of the Harvard Alcohol Project.  Using movie magic for good, he asked Hollywood studios and TV networks to spread the word on designated drivers.  The point wasn’t to change behavior over night but to bring the idea into public consciousness and shape social norms. 

As someone who grew up in the 1980s, I can attest to the success of the campaign.  What was new back then is now a given among my friends today.  As someone who has never owned a car (or a suit— despite my age, I’m barely a grown up), I have ridden shotgun countless times while generous friends drove.  Consequently, I’ve gotten to observe the driving patterns of many conscientious, risk-averse, public-health minded friends— who always buckle up, would never drive drunk, and would otherwise never put our lives at risk.  That is, except for one thing: futzing with the damn smartphone (aka “distracted driving). 

We’ve read the risks.  Signed Oprah’s pledge like Sandra Bullock.  And cried through super sad PSAs.  Yet we stubbornly assume that we are safer, smarter, and luckier drivers than others and whip out phones to send messages, find that one song, and check Facebook when we think traffic is slow. Many states are enacting distracted driving laws to deter phone use, though the policies haven’t stopped many of us.  We need Winsten's movie magic to change social norms.  He is working on replicating his campaign with distracted driving.  Until it becomes widespread though, I offer 3 personal tips to reduce distracted driving:
  •  “Look, Ma, No Hands!”  Bossing someone around is more fun anyway.  Take advantage of bluetooth technology (or even Siri) to make calls and navigate via verbal cues rather than fumble with the phone.
  •  Cede/Commandeer Control.  As a driver, let whoever rides shotty co-pilot.  As a rider, I offer my phone and navigation skillz so the driver can focus on well, driving. 
  •  I Don’t Want To Die Today. As a rider, when I feel particularly uncomfortable with how much a driver is looking down on the phone, I shout “Eyes on the prize!” or other variants.  It’s usually funny enough that I don’t get kicked out immediately, yet alerts the driver to the issue.
Unlike Winsten’s campaign, my suggestions are not quite public health. They are one-on-one interventions whose successes I have personally witnessed.  But until policy initiatives catch up, I hope you’ll give these a try.

Sunday, May 18, 2014

Talking Sh*t About Safety... Done Right

My apologies- this blog is overdue for a resurrection.  My best explanation for this seven-month-and-counting break is that I'm not very good at preparing a dissertation proposal and maintaining a blog at the same time.  It's lame but true.  I promise we'll mount a comeback soon and in the meantime, let me share this with you: absurd, observation comedy about injury prevention, preventive medicine, and medical research.  It's everything I love, it's everything I know you'll love, and more.

Monday, October 14, 2013

Safety Done Pretty Well

(Special thanks to Sarah Riddle for bringing this to my attention.)

Like many in Boston, when I lived in that fair city, I had a love/hate relationship with the public transit system-- the Massachusetts Bay Transit Authority, or MBTA.  The heat lamps by the Silver Line bus shelters?  A nice touch.  The fact that Green Line doors get stuck and passengers are asked to move to the left side of the train to offset the weight?  Absurd in 2013.  So I was heartened to see this solid effort from the MBTA on transit safety and "distracted riding."  I love it when Boston displays Good Public Health.

Admittedly, the dancing is pretty awful.  The song could be better.  And I'm not certain what exactly the safety bounce entails.  This is no Dumb Ways to Die.  But the video raises the issue of rider safety and invites the public in with a goofy song.  And given Boston's high transit ridership (5th in the country), I liked that the video incorporated 3 languages and at least tried to incorporate faces reflective of Boston's demographics.

If you're taking notes, MBTA.  Here are some other videos to work on: accessibility, noise pollution (cough, Boylston Street station), and sanitation.

Monday, September 30, 2013

ObamaCare Done Right

The Affordable Care Act made funny, clear, and Olivia-Pope-y.  This is how you explain things.  

Budget Constraints

(At the top where we belong.  
Photo Credit: Marie Castelli via

Every Sunday when we were little, my father gave my brother and me two coins each.  We were supposed to put one in the offering box at Sunday School and keep the other as allowance, which we could then pool together to buy snacks while we waited for the adults to be done with church.  Yet much to Peter’s chagrin, I’d often get caught up in Christianly love and happily give both of my coins to Jesus — which meant that not only could he not eat my chips, but I had to dip into his share. 

Much like my brother and me, you, insurance companies, and our government all have limited resources and competing demands.  One of us may even run out of cash on Oct. 17th.  Our constraints make the study of healthcare quality a health policy priority.  Since we can’t spend money on everything, we need to make sure that we are only spending our limited funds on quality items, like Jesus, seaweed chips*, and good healthcare. 

How does one measure healthcare quality?  In the classic quality paradigm, one can measure factors related to structure (e.g. staffing structure), process (e.g. physician hand washing), and outcome (e.g. patient mortality).  Things get thorny and fun when you start debating which which measures better reflect quality.  Patient satisfaction, for example, seems like a pretty good indicator.  As a society, we probably want to spend resources on healthcare that makes patients satisfied.  But patient satisfaction is also complicated by other factors that need to be teased out, like how friendly a doctor is and how nice the hospital food is.  Sometimes, the sickest patients are the most satisfied.  A 2012 study by Dr. Joshua Fenton et al, for example, found that having high patient satisfaction was significantly associated with higher health spending, more hospital admissions, and higher mortality.  This doesn’t mean that the most satisfied patients get the worst care, or we should invest our ObamaCare Bucks on stocking hospitals with duck fat fries (we so should).  It certainly doesn’t mean that patient satisfaction is bogus.  Instead, the study reflects the complexity of the issue and demonstrates how all that health policy wrangling over performance measures in the news are worthy debates.  Quality measures are a lot sexier than you realize.  They involves your money and your healthcare. Deciding the measures and how to hold providers accountable aren’t easy matters—that’s why there’s ruckus.  But it’s necessary ruckus, ‘cause we don’t have racks on racks on racks. 

*If you asked 9-year-old-me what I missed most about Taiwan, I would have said potato chips and hot dogs.  They just taste better.