This blog contains mostly essays about various LIS- or EMS-related things. Posts for a specific class (e.g. INFO 281, Crisis and Disaster Health Informatics), will be categorized by course code (i.e. INFO 281). LIS-related things will go in the category Lisemily and EMS-related things go in the category Diesel Therapy. The Off Topic category denotes posts inspired by a class, but not in response to a specific assignment or activity. Posts that follow up on a previous post are, predictably, found in the Follow Up category, and reviews of platforms and services are, also predictably, filed under the category Reviews.
This post comes on the occasion of there having been brought to my attention an article about vaccines (specifically the influenza vaccine) which was published by what appears to be a fake news site, a site called Earth We Are One. EWAO in turn links to an article on yournewswire, a known fake news site and purveyor of pseudoscience (although the url and branding now identifies it as News Punch, in the Earth We Are One article, it is identified as a yournewswire article). I will hereafter refer to this set of fake news and pseudoscience as EWAO/etc. Its premise is the standard antivaxxer fare: vaccines do nothing, they have all sorts of bad things added to them, getting vaccines is worse than getting the illness they are supposed to prevent. So on and so forth.
The part on which I want to comment is the issue of this fake science article paraphrasing a statement that implies the Centers for Disease Control and Prevention is aware that vaccines are really no more effective than going unvaccinated. One of the principal ways these sorts of pseudoscience articles succeed in successfully provoking anti-vaxx hysteria is by paraphrasing seemingly legitimate sources (such as the CDC) without providing a link so that the reader can verify the citation. In this case, the CDC was allegedly quoted in an article published in the British Medical Journal by Peter Doshi, PhD.
I managed to track down the BMJ article in question and do some poking around about this Peter Doshi fellow. To begin with, the supposed-expert Dr. Doshi is an anthropologist and not a specialist in vaccines in particular or even epidemiology or virology in general.(1) Secondly, the BMJ article, Influenza: marketing vaccine by marketing disease, was published in 2013, which in the timeframe of medical literature and publishing, is not exactly cutting edge.(2) Also, although the article was published in the high-profile British Medical Journal, it was not a research article but an opinion/editorial piece, and really shouldn’t be paraded about as though it were a research article.
But to make things even curiouser, the CDC was not quoted in Doshi’s article exactly as EWAO/etc claimed. The misleading quotation is as follows: “When read carefully, the CDC acknowledges that studies finding any perceived reduction in death rates may be due to the “healthy-user effect” — the tendency for healthier people to be vaccinated more than less-healthy people. The only randomized trial of influenza vaccine in older people found no decrease in deaths.” (I am not linking to the EWAO/etc article because that trash does not need to be spread further.)
First of all, in Doshi’s 2013 BMJ op-ed (2), there are two citations for the “healthy-user effect”—and neither of them are from the CDC. (3,4) The healthy-user effect is mentioned only obliquely in the actual text cited from the CDC (5), and the CDC citation is only in reference to a small subset of all of the available evidence for the effectiveness of the flu vaccine (not all of the evidence, as the EWAO/etc article suggests). Additionally, the CDC report does not state that the “only randomized controlled trial of influenza vaccine in older people” “found no decrease in deaths” (as EWAO/etc claimed) but only that “the estimate of efficacy among participants aged ≥70 years could not exclude no effect”. You must admit that the extrapolation of “no decrease in deaths” from the statement that an estimate “could not exclude no effect” is quite a leap.
Doshi’s issue with the flu vaccine and the CDC’s recommendations seems to come down to this: he wants the evidence for the flu vaccine’s effectiveness to be held to high standards—which for the record, is something I am totally here for, being a big fan of evidence based everything. But he’s playing a zero-sum game: it seems that in his mind, the flu vaccine is only evidence-based and thus “good” if it has a rock-solid 100% efficacy rate, documented by evidence that meets his exacting standards. If it doesn’t, well, you must be better off without it, because just think about it—who knows what they’re putting in those things? Jeepers!
And the anti-vaxx movement loves this. They probably don’t really care about the details of the research methods Doshi talks about and they probably don’t give a plague-infected rat’s ass about improving the quality of healthcare in general or vaccines in particular. Doshi has given them what they want and what they need to feed their movement: an article in a high-profile, high-impact journal that they can quote and parade around as a way to legitimize science that is as fake as their news media.
5 – https://www.ncbi.nlm.nih.gov/pubmed/20689501
ctrl+F (search) for “(134,135,232,241–244)” (without the quote marks) to get to the pertinent section
On May 29, 2017, a photo post on Facebook appeared with the following caption:
Please look before gassing up there putting infected HIV needles In the gas stations plz warn every friend of yours and family members. Guys plz share share share
It was posted by the user Jesse Barbosa Costa with a photograph of a gas pump handle with a hypodermic needle affixed to the handle in such a way that whoever picked it up would receive an allegedly HIV-positive needle-stick injury. The hypodermic needle is circled several times in red.(1)
I found the post to be suspect given that it follows the format of many health-related internet hoaxes: shock photo and/or text, emotional appeal taking advantage of public fears, few (if any) relevant sources cited. I discussed a similar sort of thing in my post No Justice No EMS. In that case, the public fear was that protestors in the streets were preventing the transport of patients to the hospital; in this case, the public fear is that innocent people will be infected with HIV. (Note also how the fear in both cases is influenced by public attitudes towards minority groups viewed as threatening (protestors) and/or immoral (HIV-positive).)
When I did a quick Google search, I discovered that my gut instinct was correct: the gas pump needle-stick story is false. There was an email hoax that went around in 2000 that made the same claim as the May 29 post and was proven false. This hoax relied on passing on via email forwarding a message supposedly from the fictitious Abraham Sands of the nonexistent Jacksonville Police Department (Jacksonville’s law enforcement agency is the Jacksonville Sheriff’s Office)(2-3).
Towards the end of last month, which is to say May 2017, there was a—”a” as in singular—report of a man in California who suffered a needle-stick injury via the same mechanism of injury as the email hoax from 2000. The case is currently under investigation, and the man has reportedly tested negative for HIV at this time. However, there is no evidence to support claims of a widespread outbreak of HIV-positive needle-stick injuries from gas pump handles.
Unpaywall is a browser extension available for Firefox and Chrome that allows the user to find free, legal access to academic articles that would otherwise require purchase of the article in question. From the extension description in the Chrome web store:
In the wake of the surprising results of 2016’s presidential election, from which Donald J. Trump emerged as President-Elect, protests and demonstrations have been taking place throughout the country. On November 15, one week after Election Day, a report of anti-Trump protestors blocking an ambulance—with fatal results—began to circulate on social media. The report, which appears to be a screenshot of a Facebook private message, claims that the message’s author was transporting a patient, the father of a 4 year-old girl, when the ambulance was blocked from reaching its destination by a group of anti-Trump protesters, resulting in the death of the patient. The message in its entirety reads:
This post was originally written for the third blog post assignment of the class INFO281, Fall 2016. It was revised and updated May 2017.
This week’s guest speaker from the National Library of Medicine’s Disaster Health division highlighted the need for information in one’s go-bag, and specifically having a “digital go-bag” on a mobile device where one can store disaster health apps for easy access. This got me thinking about the place of information in a go-bag for more routine EMS operations than a large-scale disaster, and so I thought for this unit’s post I would go through my personal go-bag (that I use when I am not working with an agency that has their own equipment) with the aim of
1. seeing how information fits in, and
2. identifying possible ways to further incorporate information into my go-bag.
`Then you should say what you mean,’ the March Hare went on.
`I do,’ Alice hastily replied; `at least–at least I mean what I say–that’s the same thing, you know.’
`Not the same thing a bit!’ said the Hatter. `You might just as well say that “I see what I eat” is the same thing as “I eat what I see”!’
`You might just as well say,’ added the March Hare, `that “I like what I get” is the same thing as “I get what I like”!’
`You might just as well say,’ added the Dormouse, who seemed to be talking in his sleep, `that “I breathe when I sleep” is the same thing as “I sleep when I breathe”!’
`It IS the same thing with you,’ said the Hatter, and here the conversation dropped…
Communication during an emergency, disaster, crisis, etc. is crucial, but it is all to easy for communication systems to break down. A loss of electrical power can effectively knock out communications by television, internet, and radio; if cell towers are overwhelmed, it is difficult for phone traffic to get through. However, even when all communication infrastructure is fully operational, it is still possible–and even common–for ineffective communication to persist. The reason for this is surprisingly simple: people either can not or will not say what they mean.
In the passage from Alice in Wonderland quoted above, the issue of saying what you mean is presented as an issue of semantics and logic. Alice considers the statement “I mean what I say” to be equivalent to “I say what I mean”. The Hatter, March Hare, and Dormouse all chime in with their own examples in an attempt to illustrate how this is not true. Ultimately they and Alice move on to another topic of discussion, but the tension between “meaning what one says” and “saying what one means” is a salient one to consider further in the context of emergency communications, and the implications of each.
For example, many people use idioms to describe medical phenomena. An example of one such idiom is the use of the term “awake” to mean “conscious.” In the context of a person who is awake (as in, not asleep) and to some degree alert, this is close enough so as to be an acceptable means of communicating that person’s mental status–i.e. the speaker is saying what they mean and means what they say. However, if the person is not awake (i.e. asleep) or is unconscious, saying that the person is “not awake” provides limited information to others who may not be on scene to evaluate the person’s mental status themselves.
In the case of a person who is unconscious, when you say that that person is “not awake”, you “mean what you say”–that the mental status of the unconscious person is what you would express as “not awake”–but you are not “saying what you mean”, i.e. that the person is unconscious. This results in inefficient communication between you and the person to whom you are speaking, such as a dispatcher responsible for getting medical assistance to your location and who thus needs the best information possible. If someone does not know how to “say what they mean”, this may prolong the time until medical assistance arrives, as additional communication is necessary to determine what is meant when someone says “not awake”. For example:
Dispatcher: “Is he conscious?”
Caller: “He’s not awake.”
D: “But is he breathing?”
C: “He is breathing.”
D: “Does he respond when you call his name?”
Unfortunately, there is no easy solution to this communication challenge. Ultimately, solving this challenge depends on educating the public on how to communicate information in medical emergencies, disasters, crises of various sorts, etc. An example of this in practice is the Tweak the Tweet syntax1 used to communicate information about needs and resources in disaster areas using machine-readable Twitter messages. In this case, the public was educated about how to use the format by distributing (via tweets and retweets) a number of prescriptive tweets that illustrated the syntax for particular types of posts. This is an example of how social media can be incorporated into public education about emergency communications, but more traditional methods (public service announcements on television and radio, mailing flyers, hosting local information sessions) are just as important as newer information communication technologies in reaching as wide an audience as possible. This is no inconsequential task, but it is a necessary one in order to promote effective communications in situations where this is most critical.
- Starbird, K., Palen, L., Liu, S. B., Vieweg, S., Hughes, A., Schram, A., . . . Schenk, C. (2012). Promoting structured data in citizen communications during disaster response: an account of strategies for diffusion of the ‘Tweak the Tweet’ syntax. In C. Hagar, Crisis information management: Communication and technologies (pp. 43-63). Oxford: Chandos Publishing.
On the 1st of September, many people in my social network on Facebook were extremely upset about the loss of millions of honeybees in South Carolina as a result of an aerial insecticide spray intended to kill Zika-carrying mosquitos. This was indeed a great tragedy, as the bee populations have already suffered so greatly from the widespread use of insecticides in agriculture. However, I found it troubling that so many people were so willing to join in the vilification of this spraying when the goal was to prevent the spread of the Zika virus and protect human health and lives. I wrote an extensive reply, which you can read here.
That was last week. Yesterday, I found this image making the rounds on Facebook:
I don’t want to essentially rewrite my entire Facebook rant, so here are some of the things that I think are the key points:
- Zika is increasingly being found to be linked to birth defects, loss of pregnancies, and increased risk for Guillain-Barré Syndrome;
- There have been reported and confirmed cases in all US states and territories except Wyoming, Alaska, Guam, and the Northern Mariana Islands;
- There is no vaccine for Zika nor is there any treatment for it other than palliative treatment (i.e. reducing fever, pain, etc.);
- Zika is transmitted both by mosquito bite and via sexual contact;
- An uninfected mosquito that bites an infected person can become infected and go on to infect others;
- Almost all cases reported in the US are travel-associated, which includes cases caused by sexual transmission;
- However there is local transmission in Miami-Dade County, Florida.
There seems to be a perception of the anti-Zika sprays being an attack on bees, which can be seen on Twitter in the #SaveTheBees hashtag, where many posts are addressing the bee casualties from anti-Zika sprays (the image included above makes an appearance, for example). I find this concerning for multiple reasons.
For one, it implies to me that there is a lack of awareness in the US about the threat Zika poses, as well as the scope of the geographical areas that could be affected by it. Because Zika (and many other mosquito-born diseases) are mainly tropical diseases, I think it is easy to fall into the trap of thinking “Well, I don’t live in a tropical area, so I’m safe.” So there is this mindset of “Zika is something that happens to other people, but not me”, which I also find concerning. Not only is there the geographical aspect of perceived risk, but there is also the population aspect due to the population being most heavily hit being pregnant women. On top of that, the symptoms of Zika, in the grand scheme of things, aren’t terrible: fever, headache, joint or muscle pain, rash…all things that most anyone can expect to encounter more than once in their lives. And the symptoms can be so low-key that infected people may never even suspect that they might have Zika. So for many people, Zika does not pose an immediate threat, which I think makes it easier to focus on “hot button” issues like the massive losses of bees.
There is a hashtag on Twitter—#ZapZika—that addresses efforts to prevent Zika. For the most part, it addresses primarily small- or local-scale things, like removing standing water near your home, and the health issues highlighted are those that Zika causes for pregnant women and their fetuses. I feel that the #ZapZika discussion needs to expand beyond that into the realm of educating the public as a whole of the dangers posed by Zika and the need to fight it aggressively. I feel that if we can expand the conversation, people may be able to see that it shouldn’t be #SaveTheBees versus #ZapZika—both are extremely important issues, and both needed to be addressed for the sake of human health. But we will not be getting anywhere fast if we continue to make it an issue of one or the other.