Communicating the doubtfulness of Public Health Sciences

Asbestos causes lung cancer. Smoking is responsible to the majority of lung cancers. A specific genotype increases your risk of breast cancer, and measles is a virus that if not prevented can cause brain damage or in sever cases death.

All the above statements are scientifically supported facts, identified through public health research. Unfortunately, the world of Public Health Sciences is not all facts. Lots of possible connections, probably associations and complex causal structures determine our wellbeing, health and life span. Read any peer-reviewed health journal and many of the articles will have titles such as ‘indication of…’, ‘probable…’, ‘likely association…’ and the conclusions will be full of reservations and expression of the need for further research. In many ways it illustrates the premises of science: that answering one questions gives rise to a whole bunch of new ones.

The complexity and uncertainty in much health research is one of the reasons that headlines on news papers may change between “Chocolate can kill you”, “Or this is how chocolates saves your life”. In addition, public health is not ‘owned’ only by scientific researchers. Public health is exactly public health and the public may contribute to the picture with their own experiences, such as “Soya milk cured my child from chronic ear infections” or “My child became autistic shortly after it had its first measles immunization.” All of which may contribute to confusion on what is true and what is false.

Research studies are only very rarely 100% conclusive and it is therefore practically impossible for researchers to make clear-cut statements about health risks of various exposures. And this can be used to the advantage of industries or people for whom doubt is enough to sell a product or an idea. This is very well illustrated in this small video called “Doubt” made by The Climate Reality Project. The video shows how scientists inability to draw unambiguous conclusions can be turned to the advantage of for example tobacco companies and climate change sceptics. Add to that a lot of propaganda and the scientific community are up against a tremendous challenge, illustrated by this short quote from the film:

If doctors smoke – are the scientists wrong?

“They [the tobacco companies] realised that the science doesn’t need to be disproven – it was enough to create doubt in the minds of the public to keep them from recognising the truth”.

The video, which takes the case of smoking as an example of how disagreement among scientists or their inability to make non-debatable conclusions (at least in the early stages of research), illustrates that public scepticism towards and doubt in what scientists argue has existed and flourished long before social media came into existence. In this case it is the damaging effects of smoking, but acid rain or nuclear risks are other examples.

Today, social media surely plays an important role in the scepticism towards eg. vaccines and climate change. And it enables it to spread quickly. What is the solution to that? That we close our eyes and say that social media is dangerous because it spreads non-scientific ideas? That seems a bit naive. Social media is unlikely to disappear, and so are all the blog posts, Twitter discussions and Facebook postings warning against measles vaccines etc. From my perspective the solution is for scientists, research institutions and others representing the scientific community ALSO to get out there, and make their view, knowledge and opinion head. Just like social media is a platform to quickly spread incorrect knowledge, it is equally good for spreading correct (in the eyes of science) knowledge and not let the allegations go unanswered. Of course social media would or could never stand alone, but it is an important communication channel not to overlook or rule out because of fear. If fear of misunderstandings of researchers blogging or tweeting or doubt in the credibility of social media rules the science community’s use of social media then the researchers are no better than the public who responds to doubt and fear…

The challenge of recruiting new scholarly tweeters

I have blogged about this topic several times: How do you get other scholars onboard Twitter? Unless they are already there, they can be difficult to convince of the benefits of Twitter. Time constraints; horror stories of misinformation, fake profiles and a channel for spreading evil rumours; and assumptions that Twitter is the essence of annoying Facebook status updates keep popping up as reasons not to join Twitter.

And I’m not alone in experiencing this phenomena. Eva Alisic, a fellow scholarly tweeter, is also struggling with getting her colleagues to join in on Twitter discussions. Inspired by the #hcsmanz chats and #phdchat she has set up a Twitter Journal club on Mental Health Research (#traumaresearch). The challenge is however to get people on board Twitter. In order to make it easy for new Twitters to join, she has made this short video “Twitter for Academics: Instruction video”. It’s tailored to mental health researchers but contains general information as well.

It covers how to:
1. Create a Twitter account
2. Fill out your profile and send your first tweet
3. Find trauma & PTSD experts to follow
4. Use hashtags, with examples specific for research and mental health
5. Join the #traumaresearch journal club via Twitter or Tweet chat

The video is very simple and a good starting point for to-be Twitters, who are ready to face their prejudice of being bombarded with useless information about their friends everyday life, fake profiles and tons of rumours and non-trustworthy information. I hope Eva’s first #traumaresearch journal club, which took place on Friday 23. February went well and that her video has helped new tweeters to join the rest of us 🙂

What’s the point of this “academic twittersphere”?

“I don’t have time to Tweet.” “I’m not interested in what various celebrities are doing.” “I don’t know what I would get from it.”

These are typical responses I encounter when I ask academics if the are on Twitter. And I don’t blame them for their replies. Until you’re into the Twitter world it is difficult to grasp what it is all about and how in the world it can be of any use in professional academic life. For some reason it is just really hard to explain in words. The LSE Twitter Guide called Guide to using Twitter in university research, teaching and impact activities is a great starting point, but explaining what it is useful for is still difficult.

On the LSE Blog Impact of Social Sciences, Mark Carrigan, a third year PhD student in Sociology at the University of Warwick, gives an attempt at explaining the point of Twitter in an “academic twittersphere”. He outlines what academics can get out of the social media service and tries to illustrate that motives for academics to be on Twitter may be no more different from what motivates academics to give presentations at conferences. The reasons to go onto the podium and give a presentation or a talk may be different from person to person:

Twitter is no different. It’s a spot on the internet that’s staked out as yours. What you do with it is up to you. Some people choose to wander over to their podium every now and again, make an announcement and then wander off. Some people give their presentation at the podium and then leave, only returning when they want to give another. Some do their presentation but thrive on the Q&A afterwards. Some might not like the feel of the podium and eschew a formal presentation to go and chat more directly with their audience. Likewise some people just want to listen and ask questions of other speakers. Others would rather ditch the conference and go straight to relaxing at the pub.

Most academic users of Twitter fall into one or more of these categories. Likewise people move between categories. But the interpersonal dimensions of it are fundamentally no different to a conference

Illustrating reasons to use Twitter for academic purposes by passing on the experience from various academics gives a good feel to what Twitter can be all about and why a lot of people end up finding it incredibly useful.

Academics who are not yet on Twitter, but are considering it may find reading Mark Carrigan’s blog post useful. I at least found some good arguments to use next time I enter into a Twitter discussion with a non-tweeter.

The responsibility of public health people to communicate

Public Health is a broad field, and finding ones place in the palette of colours that public health consists of is tricky. I have been around many corners ranging from international health, health statistics and information systems to planning of care, health policy and governance. And lately public health communication. I don’t know if I have found my shelf, actually I kind of hope not, but I must say that the communication side of public health is crawling under my skin. Perhaps because it seems such a natural part of public health and in many ways a neglected part.

As I blogged about earlier this month, I have been reading “The Panic Virus” by Seth Mnookin. It’s a book that takes you through a historical journey from the invention of vaccines to its successes, failures and not least the role communication played/plays in both. Ranging from the communication done by experts, the media to laypeople and celebrities. The book is well written and based on a great amount of research. I finished reading it yesterday and despite having enjoyed it a lot it also left me with a slightly discouraged feeling. It is a perfect example of how panic can grab a bunch of worried parents, about how ‘Mommy instinct’ becomes superior to scientific research and how the media at times can put aside rationale in order to follow the conflict, the emotional story and forget the premises of scientific research which makes giving absolute ‘yes or no’ answers extremely difficult. My discouragement was very much: Well what do we do about this, how can we take on mommy instincts and heart breaking stories and scientists who do not apply to scientific standards? Risk is difficult to communicate, communicating all the things we don’t know makes risk seem even more scary. So what do we communicate, how much do we communicate and in what way? And where does public health communication specifically fit into all of this?

I then realised that public health communication is perhaps exactly where some of the communication in the whole vaccine story went wrong. The media attention was taken over by people who took their starting point in individuals – in their own nine patients, their own child or grandchild or their own gut feeling. Even though organisations like the CDC, whose focus is population health, of course did and are doing their best to communicate the benefits of vaccines both to individuals and societies and draws attention to what the majority of the research findings is telling, I believe it is to some extend is still the failure of public health communication that may be to blame here. As I was taught from the very first day in my very first class in Public Health, Public health is exactly about the population perspective and we should be obliged to be much better at communicating this. Public health people should be the holders of that expertise – it is not the responsibility of the medical doctors or the statisticians or sociologists. We should be better at communicating risks and what they mean and be better at explaining what it is we don’t know. Most of public health research, whether it is done by numbers or by qualitative methods is about finding trends, causation in large groups etc that we can utilise to ensure or improve the wellbeing of the individual as well as the broader population. And we need to be better at communicating this. Not only to the public but also across scientific disciplines, across levels of society from decision makers to funders of health initiatives etc.

Taking my own public health training as my reference, I must admit, that I was not given much guidance on the communication side of public health. I was told that my expertise is that I have an insight into many disciplines and can bridge these disciplines, but how actually to carry out this bridging function I wasn’t given tools for. I hope I can be able to ‘catch up’ on this skill and that I can share my experiences with others. To a start I recommend people to read “The Panic Virus” and learn what the consequences can be if we don’t pay attention to the communication side of public health sciences.

European Public Health Association and the missing communication category

Yesterday, I got an email congratulating me, that I am now a member of EUPHA – The European Public Health Association. With a public health background this is naturally an association I feel it only right that I be a member of and I assumed that I would be able to find myself as a natural member fitting right in. So, I rushed to my profile page (as the email encouraged me to) and completed my profile data. My feeling of identification with EUPHA was however challenged from the very first moment.

The profile page is pretty straight forward – name, address, nationality etc. That is easy and as soon as the letters were typed in, I could easily identify with the person on the page. But when I came to ticking off the boxes under “EUPHA sections“, “Field of expertise” and “Topic areas” it was almost impossible to find myself. No where was there referral to anything that has to do with public health communication! I must admit I was really very surprised about this. Under Sections the closest thing to fit me was the “Public Health Practice and Policy-section”. Under Field of expertise there was again no communication related option (see below), so in order just to tick something, I saw “health information” as the best option although this could also refer to be health data (which I luckily also have some expertise in): And finally, under Topic Areas there was neither any reference made to communication, unless you could assess it to fall within “Health Promotion” or “Health Behaviour”.

All in all, I must admit that didn’t really feel represented in EUPHA categories. And I can’t help wonder why communication is not a least a topic area for EUPHA. Is public health communication not a priority? Is it just something that is assumed to fall as a sub-component of other public health topics and expertise? Or is this not something a public health person need worry about because we’ll have the communication staff to take care of about this?

On the EUPHA website, communication is not entirely missing. Thus, the association refers to EACH The European Association for Communication in Healthcare – which is an interdisciplinary non-profit organisation which brings together researchers and trainers in the field of communication in healthcare.

I am however still disappointed in the severely misrepresentation of communication in EUPHA. Public Health is about the health of the public and communicating health messages, research findings etc. to the appropriate people (whether they be the public, policy makers, other researchers etc.) is in essence the back bone of successful public health research and maintaining a healthy population. It should in my opinion at least qualify for a Topic Area in EUPHA’s profile page options.

Viral public health science communication

My new bedtime reading is made of dramatic stuff. It is about children with dangerously high fevers, about parents fearing for the life of their offspring, and about healthy maids milking cows. It is about the enthusiastic joy of getting closer to immortality and the birth of fears so great that people turn their backs on what their parents just a decade earlier glorified to the skies. It’s about vaccines and infectious diseases!

At Science Online 2012, I was so fortunate to win a copy of “The Panic Virus” by Seth Mnookin, and with a long stopover in Chicago on my way back to Copenhagen this was a perfect way to pass time and close Scio12 with a well written story about the role of public health science communication! I have not yet finished the book, but will most likely return with a separate blog post on it when I’m done. There is lots of interesting stuff in that book.

I will however just share a poster or infographic that I came across the other day. Actually, it kind of summarizes a big part of “The Panic Virus” or is at least a response to the panic which, among other things, a false report of a link between vaccines and autism created among parents. A panic that still has a strong take on many people today. The poster is created by Medicalcodingcareerguide.com and uses data on vaccine and disease by the CDC (Centers for Disease Control and Prevention).

I like the poster for several reasons. Firstly, I find the layout very appealing. There is something very retro about it. The yellow colour, the choice of font and the style of the images. Secondly, I like that it plays with the format of a poster. It doesn’t use a conventional format, but plays with the proportion. Thus, it is long and thin (a little bit like a syringe) and it tells a continues story. You can jump in anywhere, but you can also let the poster tell you a story from beginning to end. Thirdly, the numbers are to the point. No excess information or complicated graphs. It gets the message across without being overly complicated, but not naively simple either. That goes for the text too. There isn’t a fear of using latin words, but it is still informative. And then again, it is just a poster/infographic so it can’t contain all the complexity. I still like it however.

One element of critic could be that the two crossing syringes in the title could be interpreted as a crossing out of the word vaccination – which is definitely not the intention by the designers I assume.

Voila the poster, an example of public health science communication:

Created by: Medical Coding Career Guide

Science Online pluses and minuses

How long can a conference continue after it has ended? I don’t know the answer, but I know that Science Online 2012 is definitely not over yet, despite the fact that the last plenary session ended more than two weeks ago. On the Wikipage of the conference the list of blog coverage after the conference just seems to keep growing, and on Twitter #scio12 tweets keeps rolling in. People I didn’t meet at the conference, I am now meeting two weeks later, meaning that I can still add names to the list of “people I met at Science Online”. Quite amazing.

It is great to read other people’s reflections on the conference, their follow-up sharing and their excitement over Science Online 2013, although it is almost one year away (a wikipage for planning Scio13 is already going strong).

As many of the Science Online related blog posts already portray, it is easy to become a fan of this little big unconference. Even though this was my first experience with the original Science Online conference (I attended Science Online London 2011), I felt so very welcome and almost automatically as member of a group or family I didn’t know I was a part of until I joined them there live, in Raleigh, NC.

The hundreds of interesting topics which came up during Scio12 could fill hundreds of blog posts, but here I’d just like to share two things that I really like about the conference, and articulate two of the weaknesses which I encountered.

Science Online 2012 pluses (two reasons why Science Online is great!)

• It is full with passionate people. People who have a passion for communicating science, whether they are scientists, journalists, editors, communication officers etc. Beginners, longtime experts – they are all there with a passion which they are willing to share!
• Titles are not important. On the name tag what is important is communicated (a great example of science communication to the point!). And this it not what your title is, which institution you represent, or where in the world you are from. Your first name is central (because this is by which you should approach other people). Second comes your last name, so that you actually have a fair chance of finding people  later on; and third of course their Twitter name, so that you can contact them! Especially the non-existence of titles and affiliations makes you feel equal with your fellow conference participants. No worries in approaching someone who then might turn out to be your favorite blogger or head of communication in the coolest organization.

Science Online minuses (A little bit of critique)

• The conference brings together enthusiasts of science and communication. Most of them are either already good communicators or are thriving to become so. This provides a basis for valuable sharing of experiences and ideas, but not in all cases does it create a forum for fruitful for discussions. The eternal ‘battle’ of the ‘mean journalist’ and the non-communicating scientist often ended up dominating the discussions. And without the presence of either the bad journalist or the narrow-minded scientist, the discussion could at times end up a bit cliché and useless (or ‘in a rabbit hole’ as one of the people I follow on Twitter wrote). This was a shame for some of the discussions. I (perhaps naively) expected that at a Science Online conference focus would be more forward-looking and centered around how the social web might improve this journalist/scientist relationship. If the other discussion is wanted it might be better to bring in some bad journalists and some scientists who prefer staying hidden away in their lab or behind their desk and have them participate in the discussion.
• What is science? To my knowledge there is no rule to how broadly science at Science Online should be defined. And that is how it should be. However, despite having met participants at the conference who do research in language, risk and other less ‘fact-based’ science, many of the discussions I participated in tended to centre around science which can be done in a lab, can be boiled down to numbers or relates to  theoretical science like physics and math. These are often difficult topics to communicate, so they deserve all the attention on the communication side that they can get. However, it would sometimes have been nice to have a more articulated discussion about how to communicate the much less fact-based science. I come from the area of public health. An area where there a lots of facts, but even more theories and unknowns. Ethical concerns, moral values, personal opinion, theoretical stand points all matters and makes communication of research in for example the wellbeing of asylum children, the best approaches to prevent stress from causing disease, behavior change’s role in preventing obesity etc. extremely difficult. It would be great if the challenges of communicating less ‘fact-based’ research could be discussed also at Science Online. Or at least that it is made clear that science is a broad thing and that the discussions may become blurry when they are all put under the one hat of “science”.

I guess my two ‘minuses’ could actually be converted into a suggestion for future sessions at Science Online 2013. For example the “Health/Medicine track” is still empty. Maybe this was a occation to make sure that the less medicine-oriented side of public health is also represented at Science Online. Will let the thought boil a little bit in my head..

Dear students: In this class you will have to have your mobiles turned ON

Do term papers have to be written with pen and paper? No, luckily not anymore. Is it necessary to hand in a printed version of your exam paper? No, universities (at least in Denmark) now let you submit online. Would most people use programmes like Word etc for writing their assignments? Probably yes. But how about putting it all online? And making it public. By using a blog format?

The idea seems very relevant in a course on Public Health Science Communication, which will also cover how social media can play a role in communicating science. At least the idea is very inviting to me. And several universities have already tried out the concept. For example the University of British Colombia used student blogging for their course on Social Media in Health and Medicine.

Since I myself have no experience with using blogs in teaching situations, I was happy to learn that Science Online 2012 had several sessions relating to using the blog as a tool in lecturing. Unfortunately, I only managed to make it to one of the four sessions that circled around the topic. Blogging in the Undergraduate Classroom. As with other sessions at #scio12 there was no ‘fixed’ agenda or presentation, but more an informal sharing of experiences, ideas and questions, led by two moderators (Jason Goldman and John Hawks), who both have used blogs in their teaching.

I have tried to but together a small Storify of the tweets from the session. A link to the Storify is here and at the end of this post. I’m not sure that I managed to capture all tweets, so apologies to those who feel their tweets have been overlooked).

In summary some of my main take-home-messages were:

Advantages

• The goal of having the students blog is to teach them to communicate themselves – it is as simple as that!
• Blogging can also be a tool for teaching students how to read papers! By asking them to blog about the papers they read it teaches them not just about writing but also about reading papers and commenting on them.
• Students are much more aware of their audience (their peers and others who had access) and therefore work harder at their writing. (As someone commented: Their mothers might be reading along!)
• Using blogs, Twitter etc in the classroom makes you the teacher where it’s OK use mobile devices during class – you’re the cool teacher and may create a new classroom culture, which in return can be inspiring/motivating for the students.

Challenges

• Consider the privacy issue carefully. Should the blogs be public or restricted? Should the students blog under their own name etc.
• One of the risks of introducing blogs is that you may end up spending all your time training to use platform, become technical support. Take this into consideration and choose your platform carefully
• In grading it is important to be sensitive to the students technical skills, internet access, time frame for assignment etc.
• The blog may invite to more informal, loose behavior. Make sure to make deadlines for “handing in” assignments – and stick to them.

Suggestions for how to use the blog

• Forming student blogging teams can be an advantage. Eg. in teams of three where on student posts a blog, one person edits it and, one person comments on the final product. It can also be a way of involving the more shy students and give them room to express themselves
• Let the students choose a topic of interest to blog about. They write much better if it is something they have an interest in and care about. Highlight that If they wouldn’t want to read it no one else would!
• Blogs can be used to assign readings and students may be required to post and comment
• Start out with a scaffolding the process, eg. Reading & commenting, later on write blogposts
• Wiki-entries is a good alternative to blogs.

Other experiences

Doing a Google search of using blogs in the classroom, reveals that there are lots of experiences to learn from and also tools made available. (as with any Google search it can be a little chaotic to find out what is useful and what is not). One thing that looks useful that I just came across is something called Edublogs.org, which is an educational blogging services. Will have to explore that some more. There seems to be many ideas and services. And should any of you have experiences, lessons learned etc. you’d like to share they’ll be more than welcome!

Before I end I thought I’d also just share this SketchNote that, one of the participants in the #scio12 bloggin session (Lali DeRosier) did the below SketchNote:

Link to the Storify (Collection of tweets from the Session Blogging in the Classroom)

[View the story “Blogging in the classroom” on Storify]

Update 6. February 2012: Andrea Novicki, from Duke Center for Instructional Technology wrote his conclusions from the session here – very useful overview