Although a majority of Americans
say they are dissatisfied with the current
health care system, they remain unlikely
to accept comprehensive reform legislation,
according to a Milbank Quarterly review of
numerous public opinion surveys. While they
are unhappy with the system, the majority
of people, middle-income people in particular,
think their own health care is just fine.
http://www.cfah.org/hbns/get Document.cfm?documentID=1390
H
I T S
A Cochrane
Library review about how to minimize the
pain of needle injections
for children was one of the best-played Health
Behavior News Stories this year. It made
the AP wire, more than 100 daily newspapers
and 30 TV stations, along with CNN, MSNBC,
Fox News, Canadian Television, Slate.com
and U.S. News & World Report. Oh - distraction
and hypnosis seem to work best.
M
I S S E S
USA
Today's Weekend edition recently offered "13 scientific breakthroughs that
could change everything" in medical care.
Although the newspaper offered a blithe caveat
that "there's no guarantee, of course," nine
of the 13 bullets in the article were ads for
drug or device manufacturers. Two of the remaining
four were about advances in genetic engineering
and only two were about improving health through
behavior: the value of breastfeeding in the
fight against child obesity and surviving breast
cancer through exercise.
Physicist Murray Gell-Mann once asked colleagues
to "imagine
how hard physics would be if particles could think."
In
the field of health behavior -- as opposed to the physical
world where things can be measured to the nth degree -- the
particles do think. They are called
people, and they not only think but they emote and talk and plan. And in
doing so, they resist the predictability of laboratory science.
These people particles
too often defy rationality, relying on faulty information tainted by experience,
fear and hope.
Jessie
Gruman President
and Executive Director
Center for the
Advancement of Health
In
this new world of "personal responsibility" and
perplexing health care choices, the accurate communication
of the risk of treatments and tests is going to be as
important as any new vaccine or miracle drug. Even if
message-communication improves, message-comprehension
may not.
As a patient, I need to have a choice between
knowing the bare minimum and then asking my doctor
to recommend an action and having the full range of trade-offs
out on the table and subject to discussion until I am comfortable with my choice.
Communicating
the risks of a treatment or test and uncertainty of
the outcome is not just about the numbers. Some researchers
attribute our inability to
understand specific risks to our innumeracy, and they believe that if only
we patients can
better translate the risk statistics onto a pie chart, we will understand
what
it means.
But as Dr. Jerome Groopman told a young adult cancer
patient who was relying on hope instead of statistics, "Statistics
don't say anything about any particular individual.
Only about groups. There can be wide variability in the
behavior of any cancer in each person because each of us is different… Putting
precise numbers on it at this point doesn't really tell us anything about
[the specific patient]."
One of the challenges I faced in writing my
new book "AfterShock: What to
Do When the Doctor Gives You -- or Someone You Love -- a Devastating
Diagnosis" was
this; I know not only how difficult it is to face a suddenly foreshortened
future, but I also know how terrifying health care looks if you know
a lot about it:
that an inexperienced surgeon can undermine your chances of surviving;
that where you live can mean that you have no choice about your treatment;
that hospitals
are dangerous; that the pressure to join a clinical trial can skew your
perception of what is best for you.
How do you give people information
so that they can answer questions like, "What
treatment will I have to endure so that I can live to see my first
grandchild"?
without undermining their ability to handle whatever comes next?
Communicating
with people -- patients -- about risk often means talking about their
lives and their choices, not talking about numbers. It
means recognizing
that while some of these choices are pretty benign, some of them
are deeply meaningful and are worthy of a discussion
more substantial than
a three-minute
informed-consent
script.
FROM THE CENTER
SPEECHES Center President Jessie Gruman gave the keynote address
at an American Academy of Nursing conference in Miami on new
roles for nurses in coaching chronically ill patients to better
participate in their own treatment. She also delivered a talk
about what discussions of risk feel like from the patient/consumer
perspective at a conference at ECRI, an independent, nonprofit
evidence-based health research agency in Philadelphia.
REVIEW
PANEL The Canadian Health Services Research Foundation
convenes an international panel to review the foundation's
programs, activities, products and outcomes over five
years. Dr. Gruman
is one of four panel members selected to perform this review.
KELLOGG
SCHOLARS The Center was host of networking dinners
for Kellogg Scholars and Fellows at the NIH conference
on Behavioral
and Social Sciences Contributions to Health Disparities Research
and at the APHA conference in Boston. More than 30 guests from
the Kellogg Community of Scholars attended each dinner.
HBNS The Health Behavior News Service will have exceeded
5,000 placements in news media, Web sites, broadcast
outlets, trade
publications and newsletters in 2006. About 58 percent of them
are on Web sites and 42 percent of them are in print, including
any clip appearing on a newspaper Web site. News and information
outlets in 30 countries used HBNS material, from Finland to
Argentina to Kazakhstan. In just one month, the news
service Web site received
hits from 53 countries, including Albania, Syria and Iran.
HEALTH AND BEHAVIOR INFORMATION TRANSFER
The
National Institutes of Health has issued a Funding Opportunity
Announcement titled "Facilitating Interdisciplinary
Research via Methodological and Technological Innovation
in the Behavioral and Social Sciences (R21)." The earliest
date for an application is Jan. 23, closing Feb. 23. http://grants.nih.gov/grants/guide/rfa-files/RFA-RM-07-004.html.
The new president of the Consortium of Social Science
Associations (COSSA) is Susan Cutter, the Carolina Distinguished
Professor of Geography at the University of South Carolina,
where she also directs the Hazards Research Lab. She succeeds
Myron Gutmann, director of the Interuniversity Consortium
for Political and Social Research at the University of
Michigan.
York University in Toronto is setting up a List-serve
on the subject of social determinants of health: the economic
and social conditions that influence the health of individuals,
communities and jurisdictions as a whole. E-mail listserv@yorku.ca
and place in the message section: subscribe SDOH yourfirstname
yourlastname.
