I read an array of medical literature, both technical and public. But despite my education, experience, and reasonable intelligence, I find myself bewildered by the overwhelming deluge of information and recommendations: frequently contradictory, at times inaccurate, and often meaningless, that presently inundates individuals. If I can be befuddled, what about the average person with a high school diploma or a bachelor’s degree and little medical experience?
Perhaps there is so much information that people no longer bother to address what may be beneficial, like nurses’ deafness to multiple ICU alarms. Can individuals even discern what is beneficial, given that physicians in high offices, professional organizations, and pseudoscientific authorities make pronouncements absent scientific evidence? Would it be advisable to reduce the number of messages to only those necessary? But who decides which ones are necessary? Does Alzheimer’s dementia take precedence over non-alcohol-related fatty liver disease? Do heart diseases trump both? Can all of these cerebral vascular accidents and several other ailments be subsumed under the concept of healthy living without detailing each disease separately? However, not all-important conditions can be so easily encapsulated: vaccinations, HIV, or parasitic infections, for example.
Should we even inform people about conditions over which individuals presently have no control? Can a (biological) woman do anything to prevent early menarche or late menopause? Aside from possibly generating anxiety about potential future ill effects, what value can such information have to her? Though both states could possibly be modified by hormones or hormone blockers, what long-term effects might these have, and would they even be desirable?
And then there are rodent and in vitro studies. Why are these even announced publicly as they are only of value to other researchers, and invariably the lay media misrepresents these findings, often announcing them as likely near-term treatments while neglecting to mention that what occurs in rodents may not represent what transpires in humans, that subsequent human studies may find a medication ineffective, that a drug may exhibit too severe side effects in individuals, or that even if human studies are successful, the possible cure nattered about today will likely not be available for a decade or longer and of no value to present-day sufferers!
Health education literature often presents an “all or none” picture, implying that if the guidance is not followed precisely, an individual will experience a negative outcome. All this strictness accomplishes is to generate anxiety about being less than perfect or induce one to not even try. And yet, it is not perfection that is determinative, but general adherence and an occasional misstep do not result in abject failure. However, indicating this may well result in patients ignoring too many recommendations. Then, too, the literature does not account, in the public’s reasoning, for the individual who does everything correctly but yet contracts or dies from the condition, which can give an individual the impression that they should not bother with preventative measures.
Generally, medical/health advisories come in two forms that have evolved little over time: informational and fear-inducing. Informational presentations work best with better-educated populations but inclusively have an effectiveness rate of ≈ 10 percent. Fear induction is more effective, ±60 percent, especially with less educated populations, but is haphazard in its effectiveness.
Commercial marketing campaigns are significantly more efficient. In large part marketers have budgets that allow for frequent focus groups to determine target populations, their particular interests, and motivations, and from these data, tailor campaigns to specific groups and frequently modify their messages. Medical/health information is commonly built on limited budgets and frequently uses a “one size fits all” approach focusing on the lowest or near the lowest level of literacy and/or comprehension and is rarely modified. I have viewed the same pamphlets in offices and clinics year after year, and in reading them, it was not atypical to find outdated information. Perhaps those who write these materials may produce better products if their training included classes in marketing or advertising or consulted with these specialists in information development, and if budgets were increased to allow occasional updates.
As I reported previously, general literacy reflects comprehension, one’s ability to conceptualize and problem-solve. Health literacy is not comparable to general literacy but builds upon it and is only partially determined by education and intelligence, as most people do not routinely need to acquire medical knowledge. Only ±12 percent of the population is medically literate, while the remainder has limited to no literacy in the medical sciences. Can we provide the necessary education to this majority without first having to increase their general literacy? Likely not, but general literacy cannot and should not be a health care responsibility. Sadly, present-day education, public and private, falls short of graduating literate students, as many high school graduates have an average reading comprehension level equivalent to eighth grade, and a substantial portion of the population functions on a basic literacy (fifth grade) level.
Additionally, the majority of individuals lack critical thinking skills, and these, too, need to be taught. This should begin in elementary school, and curricula exist to accomplish this. Unfortunately, this topic can too easily become politicized as rational thought becomes wrongly conflated with values, and certain groups would argue that these should be taught at home or in church and not in public schools.
M. Bennet Broner is a medical ethicist.
