Evidence is a Downer – But We Need It

In a season 6 episode of Parks and Recreation, City Councilwoman Leslie Knope decides to champion adding fluoride to the drinking water to prevent endemic cavities. Leslie, in her usual way, provides ample evidence in large binders supporting her position and expects everyone to join her side. However, her rival on City Council, a corrupt dentist, starts sowing uncertainty in the fluoride plan. He goes on a local news show and calls it a dangerous chemical, and when that doesn’t work to sway opinion, recruits the local candy company, Sweetums, to take over the city water system and replace the water supply with basically… gatorade.

What’s Leslie to do? Arguing against the sugary tap water is nearly futile because no one wants to listen to the evidence-based science she has supporting fluoride-treated water. In the end, Leslie reads the ingredients of the sugar-water to the town in a monotone, while her co-worker, Tom Haverford, introduces a re-branded fluoride as T-Dazzle, “which makes your teeth stronger and … starts a party in your mouth.” Constituents swayed to the newly-sexy fluoride and against the newly-boring sugar-water, Leslie wins.

So what does this have to do with public health?

Well, evidence is not so sexy in the real-world, either. Often the people who are tasked with creating laws about health (politicians) are not experts on health and ill-equipped to understand research about best practices in health policy.

A study on barriers and facilitators to use of evidence-backed research for policymakers found that many policymakers, particularly state politicians who are part-time, have little time and few resources to actual research issues that they’re making laws about. On top of that, many were unable to critically analyze research and tell what sources were reliable or not. One particular quote that hurt me to read was:

One official observed that in assessing the effectiveness of a new medical procedure, “I just did exactly what…everyone…is hoping I’m not. I talked to my brother-in-law and I Googled it” (Jewell & Bero, 2008, p. 184). (Emphasis mine.)

This is really bad for the rest of us – who have to live with hasty and ill-informed decisions made by politicians! In health sciences, evidence-based medicine is when specific decisions about the best available evidence are made to influence decisions for patients. Research is being done all the time to find out what the best types of therapy are for certain populations, or what screenings should be done for certain types of cancer, or what helps people stick to a diet or exercise plan. This information is useful, but can sit on a shelf unless medical professionals adopt it and communicate it to their patients, and in the legal realm, if policymakers don’t care to understand the latest and best available information, they’re not able to make informed decisions on what kind of legislation is going to bring the most benefit.

Making evidence easy to understand and accessible is important. We probably don’t have to go to T-Dazzle lengths to communicate benefit, but taking into consideration confirmation bias and general antipathy toward evidence and preference toward the familiar is important for making your case. As most people who have had arguments with a political opposite have experienced, throwing facts at someone usually does little to change their mind. We need evidence, but we need to push for better ways to communicate it so it can reach the people who need to hear it.

Health in a Natural Disaster – How to Help Puerto Rico

Hurricanes Harvey, Irma, and Maria have come and gone, but the destruction of these gigantic weather events remain and will remain through the visible infrastructure damage and the threats to human health.

Breaches at water treatment plants and flooded toxic waste sites in Houston pose hazards to people cleaning up and rebuilding their homes. Water-damaged structures are likely to grow mold, hospitals and medical professionals face closures or running out of resources for those in need of care.

In Puerto Rico, where the electrical grid was nearly wiped out from Hurricane Maria, hospitals are relying on gas-powered generators.  I think it’s really hard, particularly in the areas of US unaffected by these large storms, to imagine the wide-scale damage that has been done. We are very disconnected from the mechanisms that make life comfortable and in some cases, possible. Electricity is something I really rarely think about, same with gas lines, access to fuel, water and food. Cutting off any one of these things would make life more difficult, but dealing nearly all of those things being cut off or made extremely inaccessible that on top of needing specialized medical care (anything from refilling prescriptions, to receiving chemotherapy, to access to a doctor to check out a persistent cough) and needing to rebuild or find a new home are extremely overwhelming. Puerto Rico is facing months of rebuilding efforts to

If you have the means to do so, I encourage you to donate to relief efforts in Puerto Rico. Despite being a US Territory, they are really not receiving enough aid to respond to the magnitude of damage that was done. The longer Puerto Rico goes without an adequate response to Hurricane Maria (and Irma) – the more dire the health of its residents will become.

Money is particularly useful. In-kind items, unless specifically asked for, need to be sorted, inspected, transported and ultimately may be trashed if not useful (clothing donations frequently end up being on the garbage end of donations). If you can donate money, these are some organizations that are doing direct work in Puerto Rico that are particularly focused on health:

 

Links Roundup: The Wellness Industry

Maybe I’m the target demo, but wellness seems pretty inescapable right now.

In the context of the “wellness industry” that is primarily marketed toward women, wellness is not just personal health but also a kind of moral superiority. The idea of wellness that is sold by Goop, fitness influencers and celebrity chefs on Instagram is a hard nut to crack because truly, people are ill, our modern diets and lifestyles make feeling healthy and maintaining good health difficult, and striving to attain better health is something that all people should be interested in, but it’s also very aesthetically rigid, expensive, and scientifically ambiguous.

Health trends change over time (running used to be weird!), and the wellness industry that promotes everything from “clean eating,” jade vagina eggs, crystals, natural deodorant, exercise regimens, supplements, fasting, and juices (and more!) is diverse and also runs a spectrum of helpfulness.

However, like all trends, I think we should be critical of what we’re consuming (literally and figuratively) and take a step back to examine what exactly we’re being sold. I do partake in some of these kind of crunchy, wellness related fads and enjoy them (chlorophyl water is pretty refreshing, although I don’t think it had any particular impact on my wellbeing), but I try to take everything with a grain of salt. It’s hard to be a woman in the world and not know someone with some kind of disordered eating, and I admit that when I see food bloggers using words like glow, warming, and nourishing about recipes I feel kind of the same way some people do when they hear the word moist. There’s is nothing inherently wrong with it, it just feels like something’s not quite right.

I think the part of these trendy, wellnessy-marketed things that troubles me the most is the idea (sometimes overt, sometimes implied) that attaining whatever your chosen leader’s form of wellness is something that can put you on a path to self-actualization or moral superiority. I think many people can feel empowered by feeling more in control of their health and lives, but kind of how many people who aim to lose a lot of weight and do but don’t become the happy carefree people they assumed they would be when they finally reached their goal weight, there are no magic fixes to what ails you and believing there are is a slippery slope to disappointment.

Anyway, I have a lot of ambivalent feelings about wellness, but I think these articles are all really helpful for understanding the salience of this industry and what we as consumers should consider:

Why we fell for clean eating (8.11.17 via the Guardian) Really comprehensive history of the evolution of “clean eating” and the wellness industry.

You can’t found a new faith system with the words “I am publishing a very good vegetarian cookbook”. For this, you need something stronger. You need the assurance of make-believe, whispered sweetly. Grind this cauliflower into tiny pieces and you can make a special kind of no-carb rice! Avoid all sugar and your skin will shimmer! Among other things, clean eating confirms how vulnerable and lost millions of us feel about diet – which really means how lost we feel about our own bodies. We are so unmoored that we will put our faith in any master who promises us that we, too, can become pure and good.

We exercised with Nina Dobrev and the experience nearly killed us (7.20.17 via Jezebel) For a lighter take on the hegemonic aesthetics of wellness, I really enjoyed this.

Women are flocking to wellness because modern medicine still doesn’t take them seriously (6.15.17 via Quartz) I liked this article because it is more validating of seeking “wellness” than most articles (there are legitimate reasons people, especially women, look for alternatives!) but also drops some important points like this:

But it’s important to remember that the dollars we drop on salt lampsand Moon Dust aren’t the same thing as agitating for change—and that retreating into wellness is only an option for the privileged set. Medical outcomes in the US are largely predicted by race and socioeconomic status, and it is minorities and poor people who face the worst consequences when toxins get dumped and regulatory systems break down.

Dear Gwyneth Paltrow, we’re not f**king with you, we’re correcting you. XOXO, science (5.22.17 via Dr. Jen Gunter) Dr. Gunter is a damn delight, and taking on the snake  oil salesman ways of Goop is a frequent topic on her blog. This is one of several take downs Dr. Gunter has done, all of which are informative, science and fact-based, and often hilarious as she deconstructs Goop’s latest fad with incredulity.

Wellness, womanhood, and the west, how Goop profits from endless illness (4.28.17 via Jezebel)  Stassa Edwards is really fantastic and you should read this whole thing.

Learning to chew, swallow, and shit at Viva Mayr, an Austrian Detox spa for the ultra wealthy (3.15.17 via Jezebel) I read this with an open, non-judgemental mind, just because I think it was really interesting to hear about how Detox spas like this work. It reminded me of an older article from the Cut on a celebrity weight loss “wellness” retreat, and I think both articles provide some important observations on the pros and cons of these spas/camps/retreats that you really cannot make without some first hand experience.