Media, Science and Emerging Pathogens – Communications in a Time of Outbreak

Accuracy and consistency in communications is always important.  On important issues, misinformation can lead to serious consequences.  That is especially true in the field of public health.

In watching the media coverage of the outbreak of  Middle East Respiratory Syndrome – known as MERS – one cannot help but to be reminded of the early days of the AIDS epidemic.  And of the SARS outbreak in 2002-2003.

In the earliest days of AIDS, the disease was identified by those whom it seemed to most affect – homosexuals – and so the first name for it was Gay Related Immune Deficiency or GRID.  As the epidemic spread beyond the initial epicenter, it was proposed that the name be Acquired Immune Deficiency Syndrome or AIDS.

MERS has its name based on its place of origin – the Middle East.  But cases have been spreading both numerically and geographically, with the first cases imported into the U.S. this month, followed by the first case of transmission.  SARS – which like MERS is a coronavirus – was an outbreak that began in 2002 in Asia and spread to other regions around the globe.  SARS stood for Severe Acute Respiratory Syndrome and did not have a name based on its geography of origin.

It is better for public health officials to avoid using a name for an emerging pathogen that is tied to a geography or a particular group of people who are affected for three reasons. First, when the pathogen moves on from either the geography or people, the name is no longer really accurate – but historical.  And second, disease – particularly communicable disease – stigmatizes. Stigma is an enemy of public health for  host of reasons. Third, people outside the target zone may feel a sense of false security.

The reporting on MERS has picked up in the U.S. since the appearance of some imported cases and one apparent transmission in this country.  As a consequence, that means more people are writing about a condition not wholly understood, increasing the likelihood of speculation and error. Under those circumstances, consistency can easily be disrupted which in turn, can undermine public understanding and confidence in what is being reported. In addition, circumstances change as medical understanding advances. In this article from 1982 on AIDS, it is stated that “epidemiologists have found no evidence that the condition is spread from person to person like influenza or measles. Therefore, they say, the general public need not fear an epidemic.”  In other words, understanding is going to evolve.

A great public service – either on the part of a governmental agency or a non-profit – would be to provide a writer’s guide for journalists on emerging pathogens where the latest information could be housed – not just on MERS, but on Ebola, H7N9 or whatever else comes our way. This would be beyond Q&A, but would provide insight into the nuances of each as well as providing insights into best reporting practices from a public health perspective. It could be especially useful in today’s environment where many reporters are generalists and not healthcare specialists and many are citizen journalists.  And the beauty of an electronic writer’s guide is that it could be regularly updated with information from several sources.

Everyone has learned a lot since the early days of the AIDS epidemic, no doubt.  But there is always room for improvement.

Photo:  CDC/Maureen Metcalf; Azaibi Tamin

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Weekly Roundup 5.16.14

The Weekly Roundup is late after a much-needed day of respite.  Sorry about that.  A little bit of Spring Fever mixed with a lot of need to catch up on things around home.

In any case, there is a little that happened this week, some of which is of great interest.

  • Lower Starting Dose for Sleep Drug - A label change was announced this week when FDA decided to lower the recommended staring dose for sleep aid Lunesta (eszopicione).  The move was to avoid the possibility that levels in some patients may be high enough the morning after that activities and alertness could be impaired and therefore the agency was recommending that the starting dose be cut in half from 2 milligrams to 2 for both men and women, leaving less drug remaining in the body in the morning hours.  Last year, FDA also announced dose reduction for other sleep drugs containing zolpidem.
  • HIV Prevention Through Medication –  PrEP – or pre-exposure prophylaxis is accomplished through the use of a single pill that contains two medications used to treat HIV.  CDC is recommending that individuals who are at high risk of HIV exposure that daily use of these medications can be a prophylaxis strategy to consider.  The agency is recommending that PrEP is for people who do not have HIV, but are at substantial risk – which is considered to be someone, for example, who is in a relationship with an individual who has HIV.  CDC will be holding “Grand Rounds” on the topic this Tuesday, May 20 from 1-2 PM.
  • MERS On the RiseWHO noted this week a number of MERS cases – the Middle East Respiratory Syndrome – and while the reported cases appear to rise in number, there has also been a growing geography with not only the first imported cases into the U.S., but also reports of the first in-country U.S. transmission in Illinois – a case where the exposure did not apparently result in illness.  The news prompted an update from the Centers for Disease Control, a transcript of which can be found here.

That’s it for me this week.  Sorry about the tardiness.  Hope you all had a good weekend.

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Looking Beyond Patient Engagement for Pharma and Social Media

As we wait for the anticipated guidance from FDA regarding the use of social media by the pharmaceutical industry, one of the many aspects discussed as been that of patient engagement with the industry.  The Internet is highly utilized for the pursuit of health care information and social media – as part of the Internet experience – is a forum where people can seek, exchange and comment on that information – with or without the industry.

For some in industry, it has been without.  As a highly regulated industry, some medical product manufacturers have been reticent to participate and become involved.  Others have established big and wide social media footprints.  Of those involved, most are involved on a corporate level with varying degrees of engagement, while still others have been involved on a product level.  And many good articles have been written on the subject of how consumers of health care information may or may not wish to engage with industry.  A lot of the focus on social media and pharma has been on the topic of patient engagement.

But especially for the medical products industry – pharma, biotech and devices – there is important reason to be involved with social media beyond the matter of patient engagement. That is because it is an essential component in the way that we communicate in general and in the reporting that goes on by media.

It used to be that a television reporter would provide a broadcast news outlet with very limited reporting on a regular basis.  On the evening news, there would be a segment about a newsworthy item likely to appeal to a mass audience.  Social media – twitter in particular – opened the way for reporters to report on several items a day – as many as they like – and the subject matter could be quite granular.  Social media has engineered a new kind of journalism for many in the business.  And if one looks on twitter, there are a huge number of health care beat journalists who are quite active on twitter.

Likewise the investor community – and investor reporters – are quite active social media users.

Finally, a topic I have mentioned before – while the number of overall users of Twitter does not match that of Facebook – Twitter is the medium for reporting news and at medical meetings there is a lot of news to report, and hence, a good deal to follow.  Reporters, scientists, physicians, patient groups are all commenting and reporting on what they are seeing and hearing that is of interest at meetings and the increase in twitter use at medical meetings from year to year is huge, with particular increases reported for the ASCO and ASH meetings.  This is also why pharma web sites (and medical society websties) need to be optimized for mobile, because people aren’t walking around medical meetings using their laptops – they are on their phones.

I touched on this topic as part of a posting about a larger topic – the Sunset on the ROI question for social media, but I thought it important enough to give it its own posting following a talk I was giving where people in the audience seemed so focused on patient engagement.  Social media is patient engagement, but it is much, much more.

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Weekly Roundup 5.9.14

Spring lasted about 20 minutes. It was very cool and rainy. Then it was sunny and temperate. Now, temperatures in the 90s are predicted for early next week.  Spring was sort of short, but it was lovely. The azaleas are going wild, the hydrangeas don’t look to excited, but my peonies are standing tall and boasting a lot of buds ready to blossom, which is a vast improvement over last year when I had only a handful of blooms – it was embarrassing really.

We do not have a wealth of blossoms out of FDA this week, but there was a little news worth reporting and here it is:

  • FDA, Aspirin and Heart Health – The agency issued advice this week on the daily use of aspirin as a means of preventing a first heart attack stating that after a review of available evidence and data, the agency does not believe that the evidence supports the general use of aspirin to prevent a first heart attack – which will be news to my physician.  In any case, they state that there is a favorable benefit-risk ratio for secondary prevention for a heart attack.  It does not say how the agency arrived at this decision, but they did note that there are clinical trials currently underway that would provide new information which could change the recommendation in the future.  That may be in keeping with a purely scientific approach, but won’t do much from a communications approach for patients and consumers.
  • New Drug Approved to Help Reduce Risk of Heart Attacks and Strokes – But on the other side of the coin – This week the agency announced approval for Merck’s Zontivity (vorapaxar) – a first-in-class called a protease-activated receptor-1 to reduce risk of heart attack, stroke or cardiovascular death and to resstore blood flow to the heart in patients with a previous heart attack or blockage.  The drug is an anti-platelet agent which decreases the formation of blood clots thereby decreasing the risk of a heart attack or stroke.  The drug label will include a Boxed Warning about the issue of increased risk for bleeding.
  • Exciting Prosthetic Arm Gets FDA Marketing Allowance – A bit late with the Weekly Roundup this week, but glad so that this story could be included.  FDA announced it would allow the marketing of the first prosthetic arm that can translate signals from a person’s muscles to perform complex tasks.  Electrodes in the artificial arm are able to detect electrical activity close to where the arm is attached.  The electrodes convey the signals to a built in computer processor that then translates them into specific movement.  It is the same shape and weight as an adult arm.  In addition, the system can accommodate people who have suffered limb loss at the shoulder, mid-upper arm or mid-lower arm, though not at the elbow or wrist joint.

That’s it for me this week.  I hope you all have a wonderful weekend and that you enjoyed Spring.

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Emerging Viral Outbreaks

Last Friday, May 2, at around 3 PM, the Centers for Disease Control and Prevention (CDC) in Atlanta held a press conference about the first detected case in the United States related to the coronavirus known as Middle East Respiratory Syndrome (MERS).

According to the CDC press release, the case was confirmed in someone who traveled to the United States from the Middle East in late April, first to Chicago and then to Indiana. To date, the release notes, there have been 401 confirmed MERS cases across 12 countries. The transcript of the agency’s press briefing on the issue can be found here.  A link to the badge material to the right can be found here.

June 5 will be the 33rd anniversary of the 1981 publication of the CDC’s Morbidity and Mortality Weekly Report (MMWR) which carried the first notice about a series of rare cases of pneumonia in five previously healthy gay men in Los Angeles.  Less than a month later, the New York Times carried an article about 41 cases of a rare cancer seen in gay men.  These were the first reports of the beginning of the AIDS epidemic, though it was not called that yet.  By the end of that year, there were 270 cases of immune deficiency reported with 121 deaths.  We all know the ultimate story of numbers and scope.

While MERS received headlines in the U.S. on Friday, it is one of many pathogens that have been worth noting.  There as also been an active outbreak of Ebola in Western Africa and there has been on-going watch over cases of H7N9 influenza in Asia, primarily in China.

For those interested in tracking these pathogens other than when they hit headlines, the World Health Organization provides regular updates on these and other troublesome outbreaks through its Global Alert and Response (GAR) System.  GAR provides resources where you can look at profiles of individual countries; check out profiles of specific diseases; or subscribe to regular updates via Disease Outbreak News which provides nearly daily updates of reports.  You will get updates number of reported cases, laboratory confirmations, geographies affected, and recommendations.

There is a lot going on in the world.  Big things can cause big problems.  So can microbes. Best to keep an eye on them – thanks to WHO for the resources.

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