Attitudes and Public Health

Increasingly there is a cultural trend toward health care freedom and empowerment. This trend is partly a reaction to the paternalism of the past, and reflects an overall change in attitude by the public toward all institutions and authority. Within medicine there has also been a move toward the partnership model of practice – where patients are well-informed full partners in the decision-making process. But this trend has also been fueled by providers who want the public to have the freedom to choose their unconventional treatment, even if it does not meet reasonable standards for evidence or even ethics.

In addition the public must deal with an increasingly free health care market with an expanding array of products, and claims to back them up. The internet has served to facilitate and accelerate this process.

Therefore public education about common health matters is more important than ever. Part of the mission for this blog is to improve public health education, to correct common misconceptions, help put recent research into proper perspective, and to counter false or misleading propaganda or marketing claims. There seems to be an intense need for such correction, and mainstream media and the internet are full of misinformation. News outlets are a mixed-bag, sometimes providing helpful information, but more often emphasizing unusual or dramatic health risks while ignoring far more important but less interesting ones.

A new global survey reveals that the public is indeed largely misinformed about the risk factors for cancer, which is a reasonable marker for overall health care attitudes. Further, the survey shows that high-income countries are often more misinformed than low income countries. This might reflect the effect of marketing efforts made in higher-income countries.

Here are the key findings of the survey:

- People in high-income countries were the least likely to believe that drinking alcohol increases the risk of cancer. In that group, 42% said alcohol does not increase the risk. That compares with only 26% of respondents in middle-income countries and 15% in low-income countries saying that alcohol use does not increase the risk of cancer. In fact, cancer risk rises as alcohol intake increases.

- In high-income countries, the hazards of not eating enough fruits and vegetables scored more highly as a perceived risk (59%) than alcohol intake did (51%), even though the scientific evidence for the protective effect of fruit and vegetables is weaker than the evidence that alcohol intake is harmful.

- In rich countries, stress (57%) and air pollution (78%) scored higher as perceived risk factors for cancer than did alcohol intake. However, stress is not recognized as a cause of cancer and air pollution is a minor contributor compared with alcohol consumption.

- People in low- and middle-income countries have more pessimistic beliefs about cancer treatment than those in high-income countries. One of the more important problematic beliefs in lower-income countries concerned perceptions about the curability of cancer. The survey found that in such countries 48% said that “not much can be done” to cure cancer or that they didn’t know whether anything could be done. That compares with 39% in middle-income countries and 17% in high-income countries. Such a misbelief is worrying because it might deter people from participating in cancer screening programmes, which are important for saving lives.

- In general, people in all countries are more ready to accept that things outside of their control might cause cancer (such as air pollution), than things that are within their own control (such as overweight, which is a well-established cancer risk factor).

- An astonishing 75% percent of people in low-income countries said their preference was for their doctor to make all the treatment decisions. Only 8% said the doctor and patient should decide together and 9% said the patient should decide. That compares with a preference in rich countries for a more equitable decision-making style that emphasises self-determination, with 72% saying either that the decision should be made together or rest with the patient alone.

In countries like the US and the UK the public wants to be more involved in their own health care decisions and yet they were poorly informed about the scientific data regarding basic cancer risk factors.

It is not surprising to me that in wealthy countries people overestimate the impact of diet and stress on their cancer risk. This is in line with much “alternative” health marketing, which emphasizes all things “natural” as a marketing strategy. Improved nutrition and stress reduction are central to the claims of many dubious products and alternative ideologies.

There is also a great deal of propaganda aimed at sowing distrust in the institutions of medicine. Popular author Kevin Trudeau (who has been sanctioned by the FTC for false advertising), for example, has made millions telling the public not to trust their doctors, and that nutrition and “natural” treatments can prevent and even cure cancer. Scientific information about cancer risk factors is often diluted in a sea of misinformation, or is often dismissed as the self-serving lies of “the cancer treatment industry” or “big pharma” with the government as their lap dog.

This recent survey suggests that the propaganda is working and as a result the public has distorted and misleading beliefs about cancer risk factors – all in conjunction with the belief that people should be taking more personal responsibility for their health.

This points to the need for more efforts toward public education about basic health issues – especially those that affect their personal choices. How to deal with the misinformation is a much more difficult issue. As Kevin Trudeau discovered, he could easily get around the FTC sanctions by simply selling misinformation rather than products, because information is protected free-speech. There does not appear to be regulations in place to deal with the deliberate marketing of false or misleading information for its own sake (as the product itself) nor is it clear what form such regulations would or should take, if any.

For now the only remedy is to work toward a more skeptical and scientifically literate public.

Posted in: Public Health

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13 thoughts on “Attitudes and Public Health

  1. weing says:

    I wonder if this misinformation is another contributing factor to the poor return on investment in medical care we have in the US compared to other countries? As this misinformation is exported to other nations we can expect their costs to go up and outcomes to fall.

  2. James Fox says:

    I’m aware of the air pollution, alcohol, genetic and of course smoking association/connection with cancer risks. However I recall recently reading (whish I could remember where) that the fruit-veggy-food cancer risk connection was tenuous at best and more likely just a correlation with other healthier life style choices, like not smoking, better health care, earlier screening; and that no direct evidence as to the benefits of eating X-amount of fruit and vegetables had been shown to reduce the incidents of any cancer. Many CAM cancer cures, as you mention, tout a vegetarian diet or lots of fresh fruit and veg as part of a bogus cure. I’m not aware of any study that shows any benefit in cancer treatment that is directly diet associated; so I’d be interested if there was a study that was not simply a demonstration of correlation with regard to cancer cause/cure and diet.

  3. DBonez says:

    I’m not even slightly surprised alcohol findings in the high-income countries. A few anecdotes:

    A relative of mine purposefully added red wine to his daily diet because of all the media-touted heart and health benefits. Maybe it’s true, but I find it hard to believe that a healthy diet + red wine is superior to just a healthy diet.

    A close friend of mine is on meds for hypertension plus statins for high cholesterol. He purposefully lied to his doctor about his excessive alcohol consumption because he knew he’d be encouraged to quit his partying lifestyle if he told the truth. Plus his drinking might end up in his records and possibly reported back to his insurance company.

    A woman I work with switched from antiperspirant to plain deodorant to avoid “all the cancer risks,” yet continues to smoke. Um, okay – whatever.

    It’s a long road to a scientifically literate public.

  4. jdc says:

    Re: the mainstream media [and internet] being full of misinformation, and DBonez’s mention of the media writings on health benefits of red wine – the Bad Science blog recently had a piece on a misleading newspaper healdine about red wine and breast cancer. [Please note, some people found the accompanying photographs of breast cancer and spina bifida sufferers a bit graphic for their taste]

  5. DavidCT says:

    Some sources of misinformation come in unexpected places. I do not have the date of the article but I distinctly remember a little goblet of wine off to the side of a picture of the “new” food pyramid in Scientific American.

    If I give up my bottle of wine a week will I live forever or will it just feel that way? I hate it when science interferes with my favorite vices!

  6. wisdom says:

    Good post. It is important for the public to understand how their own lifestyle choices can affect their risk of cancer.

    I am glad that this blog is aims to “help put recent research into proper perspective, and to counter false or misleading propaganda or marketing claims.” Keep up the good work.

  7. Jurjen S. says:

    Since when is “overweight” a noun rather than an adjective?

    I also do have to wonder to which extent this survey’s findings might possibly confuse correlation with causation. Is it possible, for example, that people in rich countries are more likely to be overweight, and also to run an increased risk of cancer because they’re less likely to die from malnutrition, TB, cholera etc. before they ever get a chance to develop cancer?

    Also, call me strange, but I notice the article in Medical News Today is listed in the categories “Alcohol / Addiction / Illegal Drugs” and “Smoking / Quit Smoking,” and these categories suggest to me that the publication might have a predetermined agenda with regard to certain substances. Lumping alcohol in with “illegal drugs” seems rather odd, given that alcohol is legal in the US.

    Most problematically, there is no mention of, or link to, the raw data upon which this survey’s results are based, especially the actual questions that were asked. One thing I’ve learned over the years is to never trust the results of any survey unless you know what the actual questions were that were posed to the respondents (Zogby, for example, is know to take contracts and tailor the questions to produce the results the commissioning party desires), and even, tread carefully.

  8. Sean Leather says:

    Two things:

    1. You’re using anecdotal evidence with that Kevin Trudeau story.

    2. Marketing needs to be fought with marketing. In order to educate the public now, we need to market the message. In order to educate the public of the future, we need to change the approaches of educating children.

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