Reporting public health and medicine

Thomas Abraham

Today’s class

Introduction to health and medical reporting

Course objectives and course outline Organizing our course work

"The observed number of two GBS cases among vaccinated persons so far lies within normal expectation of baseline incidence that would occur in a population of 170,000 (regardless of vaccination history), adjusted for age and seasonal effects," the spokesman said.

This is about life and death

Experts are often divided There are often commercial, political

and personal interests at play The public depend on you for

information on which they can act

Life and death at a global level: global health issues

“AIDS is not just another public health threat, but now belongs in the league of make-or break issues of our times-together with mass poverty, climate change and terrorism.” Peter Piot, former head of UNAIDS

Today, 12,000 people are likely to be infected with HIV/AIDS and 6,000 are likely to die

http://www.globalhealthfacts.org/topic.jsp?i=1#table

Other diseases

2,500 children, mostly under the age of five, are likely to die today in sub Saharan Africa of malaria.

Diarrhoeal disease kills 1.5 million children every year.

Tuberculosis kills 1.8 million people a year By reporting on these issues, intelligently

journalism can persuade governments to take action

Why study health and medical reporting?

If you are good at it, you can make a difference!

Three areas of health and medical reporting

Health policy Medicine Public health

1. Health policy

How should health care be provided? By the government, or by private businesses and foundations?

Should the cost of health care be borne by individuals, or by society as a whole?

Should all members of a society have a right to health care regardless of their ability to pay?

How much should a society spend on health care?

2. Medical reporting

Largely about new treatments for diseases

Three main sources-articles in scientific journals-scientific conferences-press conferences by scientists

The challenges of medical reporting

1. Understanding and interpreting medical trials, and the principles of evidence based medicine

http://www.cbsnews.com/video/watch/?id=7123744n&tag=cbsnewsSectionsArea.3

Understanding the power of money

2. Understanding the power of money: the global pharmaceutical industry is a US $500 billion dollar a year industry, facing severe competitive, regulatory and economic pressures

http://www.youtube.com/watch?v=lNFuEcy5ekg

Understanding the power of money

“Some of the expensive drugs available today have only modest therapeutic benefits, while many inexpensive medicines are highly effective and safe.”

“Manufacturers provide a stream of new products for the medicines market place, usually at higher prices than existing products.”

WHO Report “The World’s Medicines Situation

Understanding the power of money

Medical research is fuelled by money:-from industry-from foundations-from governments and public money Even scientific journals are commercial

enterprises

3. Public health

Public health is concerned with the health of communities and societies

Clinical medicine on the other hand focuses on disease in individual patients

Public health studies ways to improve community health through disease prevention

Public health interventions to improve community health include improving sanitation, promoting healthier lifestyles, vaccinations etc.

Some definitions of public health

“The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society” Sir Donald Acheson

“What we as a society do collectively to assure the conditions in which people can be healthy” Institute of Medicine. USA

Which of these headlines is about public health, and which is not?

“Government unveils new measures to reduce road side pollution”

“New surgical treatment increases success rate of liver transplants”

“Vietnam announces fresh outbreak of bird flu”

“Outbreak of diarrhoea forces kindergarten closure”

“New drug dramatically reduces high blood pressure”

John Snow (1813-1858) and public health

Cholera

From around 1830, Britain and Europe were struck by several waves of cholera, causing hundreds of thousands of deaths

In those days, doctors believed that cholera was caused by “miasma” or poisonous gases from sewers and swamps.

Snow was not convinced- why did coal miners who worked far from sewers get cholera? Also, the first symptoms were always digestive- so he thought it must be to do with food or water

Snow became convinced the water supply was responsible

During an outbreak in 1853, he studied the water supply to 44 households with cholera cases.

He knew that all residences in London were supplied by one of two water companies.

Company A drew its water from a section of the Thames river polluted with sewage

Company B drew its water from a section of the river that was farther away from the city and less polluted

Snow went to each house and where there had been a death and asked which company they got their water from

He found that 38 of 44 cases were in houses that got their water from Company A

He expanded his study to 334 cases, and found that 286 had their water from company A

Snow thought he had “very strong evidence of the influence that which drinking water containing sewage has on the spread of cholera”

Snow’s critics were not impressed-there was no evidence of any kind of infectious agent in the water

Snow’s technique- collecting data on the incidence and distribution of a disease to determine probable cause, is a basis of modern epidemiology

Snow’s vindication In August 1853, Cholera broke out on Broad

Street, close to Snow’s home in London. He noticed that most of the fatalities were

close to a public water pump on the street. He got a list of all the victims, and calculated

the distance from their houses to the pump 73 of 83 deaths were in homes closer to the

Broad Street pump than any other pump. Of the 10 remaining, 8 had drunk at the

pump- some were children who used to drink at the pump on the way to school

Snow persuaded health authorities to remove the handle from the pump so it could not be used- cases of cholera decreased.

Importantly- also established that those living close by who had a separate source of water did not fall ill.

Logical principles behind epidemiology that Snow demonstrated

Cause of a disease will lead to higher rates of illness among those exposed to the cause, then those not exposed

Cause can be found by analysing patterns of occurrence of the disease in a population

http://www.ph.ucla.edu/epi/snow/snowbook.htm

The Broad Street pump

Reading

For more on Snow http://www.ph.ucla.edu/epi/snow.html

Read Wikipedia entry on public healthhttp://en.wikipedia.org/wiki/Public_health Visit the website of the Centre for Health

Protection in Hong Kong (www.chp.gov.hk) and get an idea of what the major communicable diseases are in Hong Kong, average life expectancy, major causes of death etc.

The demand for health and medical journalism http://www.reuters.com/news/health http://www.bbc.co.uk/news/health/ http://www.nytimes.com/pages/health/index.html http://www.cbsnews.com/2718-500202_162-489.html?tag=related www.bmj.com www.thelancet.com http://www.kaiserhealthnews.org/ http://www.cidrap.umn.edu/

Course objectives

To get a broad understanding of public health, the scope of public health reporting, possible careers in public health reporting.

To understand the principles of good public health and medical reporting

To understand the sources of scientific and health information and how to use them

To learn to understand and interpret scientific and health information and turn them into clear, intelligent news reports.

Home work

Sign up for news alerts with Pro-Med(www.promed.org), the Lancet (www.thelancet.com), the New England Journal of Medicine, Science and Nature

Follow the Eurekalert web site http://www.eurekalert.org

Course work

You will chose a topic in medicine or public health you are interested in ( ie cancer, HIV/AIDS, influenza, mental illnesses etc) and write 3 stories of around 400-500 words each based on a paper in a scientific journal (40% of grade)

You will complete on line courses in HIV/AIDS, tuberculosis and malaria at http://www.globalhealthlearning.org/login.cfm ( 40% of grade)

You will read and review one book written for a general audience on a medical or health topic (list of books will be distributed in class)

Deadlines and details in the next class..