I still remember, driving home to school on a November morning and listening on the radio about Freddie Mercury’s death from AIDS. I still remember my friend D lamenting his death. (To this day, we say Freddie was gay only because he never met us…).

I would like to write about the most effective public health campaign ever. Granted, it is likely only a few hundreds of people saw it. It was never made national, or televised. It consisted of two small posters, drawn by hand, made by some medical students. I call it the most effective campaign because I still remember it, 22 years later.

It was 1989, and I was visiting Veracruz with my father, my mother and my brother. My mom had an AMFEM meeting, and one of the activities included touring the medical school. The posters were taped to a window. The drawings were something like blue and pink eggs (although it could’ve been the male and female symbol). The posters said, in large letters, SI DA and NO DA (a play on the Spanish acronym for AIDS, SIDA, and the phrase Si Da, you can get it.)

On the SI DA poster, you had the “eggs” engaging in activities that put you at risk of acquiring AIDS, like using drugs, having homosexual and heterosexual unprotected sex, a seropositive pregnant woman passing it on to her child, etc. The NO DA poster showed the “eggs” hugging, kissing, sharing food, dancing, swimming, etc.

Those posters stuck with me. I wish I had a photo, or knew who made them. They were clear, brief and simple, enough to attract a child’s attention, and retain it long enough for her to read and learn (granted, the child in question used to read anything in her path).

I can’t say those posters (or any AIDS campaign, for that matter) caused a change in my behavior. After all, I wasn’t old enough to partake in any of those risks. But I’m pretty sure that some of the students at the Veracruz medical school saw them, and learned, and changed their attitudes and behavior on account of those two posters.

UPDATE

Ha, nevermind. Romanticism, be gone! The posters were not made by students, but by the pros at the Ministerio de Sanidad y Consumo. Still, it was an effective campaign! You can see the posters here, here (not the originals, but a better view), and the ads below. (Thanks to Google, and all the people who posted this material)

Then I got an email by another one of my friends saying, “Don’t be alarmed, but B needs blood, please donate.”  Needless to say, people were alarmed.

Risk communication #4: Watch your language. Usually, if you start a sentence with “Don’t panic,” people are going to panic. If you say “B needs blood, please donate,” without explaining further, people are going to think there is some sort of emergency.

I called B’s wife, D, to ask what was going on. Apparently, she had been getting a lot of calls from worried friends. Later on, she sent an email explaining the reason people were asking to donate, and that everything was fine.

This made me think about past experiences and rumors. A past experience can really prompt a person’s reaction to a crisis. Think of it this way: If a boyfriend or girlfriend starts with “we need to talk,” and then breaks up with you, you might start stressing when anyone–a friend, a parent, or a teacher– says those words. The same way, if you hear that someone has been in the hospital recently (for a very serious condition) and then hear that person is in the hospital again, you might start worrying.

Take this “pre-worried” population, add some vague information, and things get even more interesting.  The original email requesting blood prompted 11 emails, most of them lamenting that they were not able to donate for different reasons (one of them being smallpox…right…), and wishing that the blood could be obtained fast.

Also, there was the blood. There is something about blood (the mere sight or mention of it) that makes most people nervous.

Risk communication is not only for corporations. It is somethings you use in your everyday life. It sounds like a cliché, but knowing a little bit of risk communication and risk perception can really help you when it comes to communicating with friends and family, or when it comes to spotting potential BS in newspaper articles.

State Farm released an ad about the correct method of frying a turkey. See, I never thought this would be an issue. I only eat turkey once a year, and thanks to my health-conscious mother, it is never fried. I had only seen Alton Brown frying a turkey (that man can fry anything and still look flawless). I had no idea the number of house fires and injuries caused by ill-fated frying attempts, but

According to the U.S. Fire Administration (USFA), nearly 4,300 fires occur on Thanksgiving causing 15 deaths and almost $27 million in property damage, many of them due to deep-frying accidents.

State Farm’s ad, which I found hilarious and effective, features William Shatner (Capt. Kirk himself!) attempting to fry a turkey. He explains the proper method for frying turkeys, and the consequences of not following the method, in his over-the-top, dramatic style. It is hilarious!!! And it is also effective. I found my self thinking about the ad when I saw deep fryers in the supermarket. I may never fry a turkey (i better leave that to the pros, like Alton), but thanks to Capt. Kirk, I know the safe way to do it. Now, how do we get Team Picard on board?

My best friend D had married B the week before. The wedding was beautiful, and the couple was now spending their honeymoon in Orlando. When I opened the email, I learned that B had ”some heart thing, and had to be rushed to the hospital.”

I immediately called D. She sounded worried, and was obviously taking care of many different things to be able to talk to me at length. She told me something about a valve that needed replacing, the aorta, and a fissure. I could go in three different directions from there. Had B had an aneurism? Was there a problem with the mitral valve? I had no idea, and my friend had no time to clear this up.

Risk Comm lesson #1: There is a gap between what the doctor says and what the patient understands. My friend was under stress, and scared, and being addressed in a language that is not her native tongue. I had to remember that there was a gap between what the doctor told her and what she understood, and between what she retained and was able to tell me.

My mom and my friends were asking me what was going on. I had no certain information.

Risk Comm Lesson #2 During a crises, there are many uncertainties, and you can’t get the whole picture until several days later. I told my mom and friends what I knew, and updated them as often as possible. I had to make very clear that I didn’t have the whole picture. It was until a week later that D told me exactly what happened to her husband.

Once the surgery was done, everyone was celebrating.

Risk Comm Lesson #3 Tell the truth, and tell it all…but be mindful of people’s feelings, and keep in mind that a crisis rarely has a clear-cut end.  After the surgery was done, I was talking to my friend M, and filling her in on the events. Should I tell her that what happened was “expected” given B’s pre-existing condition, or would I seem too cold, clinical and uncaring? Should I tell her that leaving the operating room was the beginning of a critical period and that B was certainly not out of the woods yet? I decided to mention the pre-existing condition, but decided not to mention the risks of hemorrhaging or clotting or rejection, opting to say that “now, everything depends on B’s body’s ability to heal.”

I think I did reasonably well….

UPDATE (NOV. 15):

I am happy to report that B is making a fast recovery, and will soon be moved out of the ICU!!!

Someone had the “brilliant” idea to send chicken pox lollipops to give their children. These people decide not to vaccinate their kids, because they have been told by a mom/playboy model that vaccines cause autism . In their zeal to protect their children, they decide to immunize the “natural” way, hosting or attending “pox parties” so that the kids can come in contact and hopefully contract the disease. In their eyes, vaccinations are deadly, but a rampant herpes zoster infection is menial.

For example, a parent in the Facebook group offers Q-tips, spit and lollipops licked by her sick children for 50 dollars.

Admittedly, a lot of children get chicken pox (even some vaccinated children), but varicella is nothing to sneeze at. It can lead to complications that range from a bacterial infection of the skin to cerebellar ataxia, encephalitis, or Reye’s syndrome. Also, the virus can remain in the nerves and come back as shingles, a very painful infection of herpes zoster.

fortunately, it is more likely that the parents are only wasting their money, because the virus is unlikely to survive the shipping. Still, bacteria and other viruses, like hepatitis, can remain in the lollipop.

Unfortunately, there are reports of people selling items tainted with measles, a disease that is more infectious than chicken pox and can have more, graver complications than chicken pox. People who buy this are trying to dodge the school-mandatory vaccination.

it is very sad. People are endangering their children based on a lie. People are risking a sentence of 20 years in prison, because sending diseases by mail is a federal crime.

But mostly, and insignificantly in comparison, people are making themselves subject to scorn (and are becoming a laughingstock) because what they are doing lacks scientific evidence, is dangerous, idiotic, illegal and disgusting.

What’s especially scary to me about this ad is that it’s being run on airplanes. Airplanes are like infectious disease pods traveling 35,000 feet up in the sky. Everyone crammed in together, touching each other, touching hand rails, touching your arm rest, touching their boogers because they forget that the window seat isn’t an invisibility shield, half-assed washing their hands because the water pressure is terrible and the soap dispensers are all broken. (Seriously… I don’t give a shit about crashing into the ground or bomb-strapped terrorists. I’m worried about MRSA.)

Ultimately, the Skepchick says, NVIC’s ultimate goal is to get people to visit their website, doubt their physician’s advice, start questioning vaccination and eventually stop vaccinating altogether, which will in turn increase the possibility of outbreaks.

The problem with antivaccination, if you ask me, is this: It is unethical. If a mother chooses not to vaccinate her child (a person who may not be able to make that decision for himself), she is only harming her child. And she’s also lowering herd immunity, endangering the whole community, particularly the elderly, pregnant women and immunosupressed individuals.

Antivaccination is unethical because it harms innocent bystanders, not necessarily the person who makes the choice not to vaccinate her children. Delta is being unethical for agreeing to broadcast patently false information to travelers.

The flu does exist, and it kills people. And vaccinating against it does make a difference.

Today I learned that “regularly drinking even a small quantity of alcohol could increase the risk of breast cancer.” But, moderate intake of alcohol can protect against heart disease… so, to drink, or not to drink? And if you decide to keep drinking, are you really hurting your chances?

According to the story, drinking from 3 to 6 glasses of wine a week  was linked to a 15% increase in risk of developing breast cancer.

In women who never consumed alcohol, there were 281 breast cancers per 100,000 women per year.

That increased to 333 cancers for people drinking between three and six glasses of wine per week. There was a much greater increase, to 413, for those consuming more than 19 glasses.

I suck at numbers, but I’ll do my best. I also have Mayo Clinic’s “Cancer Risk: What the Numbers Mean” article to help me along the way, as well as breastcancer.org‘s article on absolute and relative risk.

First, I want to point out that 281 out of 100 000 is a very small number, about 0.28%

I will assume they are talking about relative risk, and not absolute risk. When one talks about absolute risk one talks about the “actual numeric chance or probability of developing cancer during a specified time period”. Relative risk, on the other hand, is a comparison value. Relative risk  ”shows the strength of the relationship between a risk factor and a particular type of cancer by comparing the number of cancers in a group of people who have a particular exposure trait with the number of cancers in a group of people who don’t have that trait.

If the study is talking about  relative risk, then we can assume that a person that drinks 3 to 6 glasses of wine a week has a 15% greater chance of developing breast cancer in relation to non-drinkers.

Mayo Clinic says it much better:

A relative risk of 100 percent means your risk is twice as high as that of someone without that risk factor. A 200 percent relative risk means that you are three times as likely to develop that condition.

Risk seems greater when put in terms of relative risk. A 100 percent increase in risk may seem enormous, but if the risk began as 1 in 100 people, the risk is increased to 2 in 100.

To put it in perspective, like Mayo Clinic says, a smoker is 23 times more likely to develop lung cancer than a non-smoker, all things being equal. In percentage, a smoker is 2300% more likely to develop cancer. Then, all things being equal, a drinker has a 15% increased risk of developing breast cancer compared to a non-drinker, that is (drum roll, please) 0.15 times more likely to develop breast cancer.

Cheers.

P.S. This is why epidemiologists, journalists and risk experts say one should put the risk in perspective, distinguish between relative and absolute risk, use comparisons, etc. Really, BBC, Lundgren and McMakin said you wrote the guidelines. Use them!!!

The restaurant’s representative said Carr-Jordan was banned because her actions were disruptive to the employees and costumers.

I have no opinion on McDonald’s decision to ban Dr. Carr-Jordan (she has a PhD in developmental psychology). I understand Carr-Jordan’s concern about the cleanliness of the places where her children play.  I have been inside those play areas… they are not clean. I have seen food thrown around, ketchup stains, and the occasional vomit. I don’t doubt she found bacteria present in feces and mucus. Kids being kids, it is likely they are sticking their hands up their noses and smearing them all over the place. (I don’t agree with USAToday’s use of the word pathogen. Not all bacteria are pathogens, and these are not interchangeable terms.)

I also know that those play places are incredibly difficult to clean. The tunnels are narrow, and I don’t think it’ll be easy for an adult (or even a lanky 16-year-old) to get in there and properly sanitize them.

I also think it very likely that Carr-Jordan found S. aureus in the play places. S. aureus  is pretty common, and it’s part of the skin’s bacterial flora (You might be familiar with it, it causes folliculitis and some cases of acne) and is transmitted by direct contact. I think it is likely that Carr-Jordan found MRSA, since about 1% of the population carry this strain (and in the greater Phoenix area someone is bound to have it). I also believe this is not exclusive to McDonald’s play areas.

I think Carr-Jordan is up to something, and there’s a great opportunity to get people talking about public health and shared responsibilities (Teaching your kids to wash their hands and not to lick everything is important, as is teaching them to pick up after themselves). Right now, though, some members of the public might see her as an alarmist. The fact that she just told a bunch of costumers about the bacteria didn’t help her case at all, if you ask me.

I advice her (although I doubt she’ll read this obscure little blog) to make public the lab tests that confirm the presence of MRSA, and any other pathogenic bacteria. Perhaps repeat the swabbings, and swab play areas in other restaurants. Then, get people talking. Bacteria are everywhere, and you can’t eliminate them completely, but you can learn how to lessen your risk of catching an infection.

I hope this leads to better hygiene standards in fast-food restaurants. I have been in McDonald’s in 3 countries and the restrooms were uniformly disgusting.

Oh, and if you want to know more abot MRSA, read the awesomely scary Superbug blog.

Some news outlets have said that science is on trial, while others call the trial an “inquisition.” Ropeik says that it is not an issue of the science being on trial, but it is rather an issue of how the risk was communicated.

Everyone on that committee failed the public. They all failed to provide information that would help people make healthy judgments about their safety. They apparently never even considered that critical aspect of their responsibility. There was no one with risk communication expertise at the table during the meeting, and the experts skipped the post-meeting new conference. They thought about the risk through their narrow expertise as scientists, and either out of ignorance, or hubris – probably both – thought that was enough. They aren’t on trial for failing as risk scientists. They are on trial for failing as risk communicators.

According to the blog post,  Dr. Bernardo De Bernardinis, then deputy chief of Italy’s Civil Protection Department, said that the situation “was favorable” and that the scientific community said there was no danger. As a result of these remarks, the people let down their guards, and didn’t prepare adequately for the Earthquake. The person communicating the risk was careless, and the rest of the committee members were not present in the press conference.

A big part of risk communication is about dealing with uncertainty (from predicting an earthquake, the intensity of a hurricane, or whether exposure to a certain chemical will make you sick). Uncertainty is difficult to handle, and while scientists are comfortable dealing with uncertainty, most politicians and reporters are not. And they should be. Being able to better communicate uncertainty will be a great help to their readers and constituents, who rely on them for information about how to react.

Perhaps, if the spokesperson had been better prepared to handle uncertainty, the trial at L’Aquila would not be happening…

When I was in college I worked in a museum. I was in charge of the telescope, and spent many days looking at the Sun (With proper filters, obviously). I started working there during the solar max cycle of 2001. I got a chance to see how the Sun’s activity diminished over the years until it became a very boring yellow yolk. I missed the sunspots, and the flares, and I’m happy to see them again, after all, they are about a year late.

What does that have to do with crisis communication, you ask? Well, the presence of sunspots signal solar magnetic activity. When this magnetic activity increases, we have more flares, and more coronal mass ejections. Coronal mass ejections are “waves” of charged particles emitted by the sun. When they are sent in the general direction of the Earth, they interact with the magnetic field and Van Allen’s belt and cause pretty aurorae.

That’s all well and good, you say, because everyone likes pretty colors in the sky. Well, yes and no. The problem with coronal mass ejections is that they are charged particles. These particles can cause power lines to overcharge and cause blackouts. It has happened before. In 1989  a solar storm plunged Quebec into darkness . Even when the Earth is not directly in their path, solar storms can “kill” satellites.

How does this relate to crisis communication, then? Well, a solar storm can overcharge electrical circuits and cause blackouts. New York city gets a lot of its electricity from Canada, Quebec, to be precise… see where I’m going? Cities like New York, London or Stockholm could be plunged into darkness. The satellites that bring us entertainment, information, GPS  and cell phone service could be disrupted, turned into zombiesats that just drift aimlessly in the blackness… You can agree with me that having large areas without electricity and satellite communication down would be kind of a crisis. An event like this could seriously disturb production, transportation (planes need GPS, and subways need electricity), put a strain on hospitals and other care centers, and plunge people into boredom (no electricity means no cable, after all)

I will not even get into the irony of this happening on 2012…

Sun, by Cesar Cantu