A Plea for Plain Language

Tara Smith, PhD, Professor of Epidemiology at the Kent State University College of Public Health.

Tara Smith, PhD, Professor of Epidemiology at the Kent State University College of Public Health.

Be honest. When was the last time you discussed the rising tide of antibiotic-resistant disease, say over coffee at work or over dinner at home?

You know, the issue the World Health Organization says is “a global health crisis … [where] interventions, like organ transplantation, joint replacement, cancer chemotherapy, and care of preterm infants, will become more difficult or even too dangerous to undertake.”

Here’s the thing: It’s not so much that we don’t discuss it – it’s that we can’t discuss it – because we don’t really know what antibiotic resistance means.

That’s what a survey of over 10,000 people conducted by the World Health Organization told us just two years ago: Up to 75% of the people were found to be “confused about this major threat to public health and do not understand how to prevent it from growing.”

So is there a way to engage the public in a conversation about a critical health issue that the majority of us are “confused” about?

Kent State’s Dr. Tara Smith did something refreshingly unique with a paper she published last month – in an open access journal – about the unexpected prevalence of MRSA on public beaches in Ohio. She added this:

Plain Language Summary

Previous studies have examined the presence of the bacterium Staphylococcus aureus on marine beaches, but a rigorous study of freshwater beaches was lacking. We investigated S. aureus presence and proximity to wastewater treatment plants on 10 beaches in Northeast Ohio. We found S. aureus in 22.8% of our samples (64/280). Prevalence was higher in summer than fall. Prevalence was also higher in sites with wastewater treatment plants close to the beaches.

 

Plain Language/Plain English summaries are making their way into legal reporting too. For instance, the preeminent website for the U.S. Supreme Court is SCOTUSblog. One of its attractions is its Plain English/Cases Made Simple feature. It’s by no means law for dummies: it’s legally reasoned analysis of important cases before the court – without the jargon. For example, in “Wedding Cakes v. Religious Beliefs?: In Plain English,” you’ll find their breakdown of the pending and highly important “cake case” which asks the question, Can a maker of wedding cakes refuse service to a gay couple because of his religious belief that marriage should be limited to opposite-sex couples?

A few years ago in front of a live audience at the Harvard School of Public Health, Stuart Levy, MD, a pioneer in the field of antibiotic-resistant infections, made a rather bold statement. He said that if he had $800,000 to spend on fighting infectious disease, he’d spend $700,000 of it on educating the community because “They need to be a partner in using antibiotics properly.” A co-panelist agreed, saying “We’re all in this together.”

We’re all in this together but unfortunately we’re not all on board. So maybe the thinking of Dr. Levy, and the examples of Dr. Smith and and the U.S. Supreme Court reporters publishing plain language summaries, are worth a serious look.

Because with the ever-increasing presence of genetics (what is the difference between a gene, DNA, and a chromosome?) in science and medicine, this issue will only become more important over time.

 

 

 

Where does disease come from?

Political determinants

 

The bugs can’t do it alone. For them to cause the greatest possible harm they need our help and unfortunately we seem to be giving it, increasingly so. For example, this month the U.S. Senate refused to extend government health insurance for the nearly 9 million kids and roughly 370,000 pregnant women it protects.

The polite term used in the medical literature for aiding and abetting disease is “the political determinants of health.” The British Medical Journal puts it this way: “Health is a political choice … health is unevenly distributed, many health determinants are dependent on political action, and health is a critical dimension of human rights and citizenship.” (My emphasis.) Thus, if health is a political choice, then so is disease.

Unusual insight into what this means was provided over the weekend in a series of heartfelt tweets (below) from pediatrician Chad Hayes (@chadhayesmd) who practices in rural South Carolina. When you read what Dr. Hayes has to say, keep in mind that it’s well-established in the literature that two other politically-influenced factors, poverty and crowding (e.g., in homes, hospitals, schools, prisons, and shelters) increase the rates of MRSA and other bug-driven infectious disease.

Before I went to medical school, I had little interest in politics. I grew up in a conservative upper-middle class family with two working parents, went to private school for several years, and faced relatively little adversity. (1/x)

I was vaguely aware that there were people who struggled, but rarely encountered them personally. It was children that changed my mind. Not my own, but the ones I care for at work. Kids who, due to a variety of societal problems, aren’t set up for a great future. (2/x)

Today, I woke up yet again in a country where our government has failed to #PutKids1st. We have placed the interests of corporations and the wealthy above those of families who are struggling to survive and children who must strain their eyes to envision a promising future (3/x)

(4/x) It has been over two months since Congress failed to reauthorize CHIP, presumably because the money is needed to fund tax breaks for those who will never have to worry about how to pay their medical bills. We are failing children and putting our nation’s future at risk.

(5/x) I am no longer a conservative. And I am now quite political. And to the politicians who voted for this tax bill, I extend an open invitation to spend my lunch hour in my pediatric office in rural SC, as I struggle to find help for a teen mom with severe depression,

(6/x) a family with 10 people in a single-wide trailer because the house where half of them lived burned down and they have no money to rebuild or replace their belongings, or families where the biggest concern is not whether to contribute to their child’s IRA or college savings,

(7/x) not which private school to use, or which luxury SUV would be the best way to get them there. Their concerns are buying food and infant formula, paying for gas to get to the doctor, and hoping the power company doesn’t shut off their heat this winter.

(8/x) Many are necessarily so concerned about providing for their children today that they have little time, energy, or money to devote to the future. And they are the ones that we are trampling in to minimize the tax burden of people who could lose millions without noticing.

(9/9) I respect that not everyone shares my political views, but for anyone who doesn’t see a problem with this, I’d encourage you to spend some time with the less fortunate. They have changed my perspective, and they may change yours as well. Happy holiday season.

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