2013 was a big year for public health. We were thrust to the forefront again with disease outbreaks, and have had to deal with increased skepticism of the nature of what we do from the public. Meanwhile, within the establishment, rifts have been growing between groups, as different professional organizations vie for power and control. Here are my top five public health stories for 2013, presented in no particular order, but I’d love to hear yours in the comments.
1. Polio in Syria
Polio is a crippling disease that has been covered on the blog before. It’s been almost completely eradicated, but is still endemic to certain parts of the word. However, following civil unrest in Syria, polio has started to spread again and has, to date, crippled 17 children. Before the March 2011 uprising, vaccination rates were estimated to be above 90%. However, since then, estimates for vaccination rates hover around 68% – enough to prevent the benefits of herd immunity from kicking in. In order to increase immunization rates, the UN is trying to mobilize a vaccine drive. However, due to political and safety concerns, they are having a hard time ensuring that all children are vaccinated. To quote NPR:
Polio does not stop at borders or military checkpoints. Without a comprehensive response to stop the virus, aid workers fear that the outbreak could become a public health catastrophe.
2. Celebrity Medicine
It’s an odd world when we question the motives and knowledge of people with 10+ years of medical training, but trust those with a semester of high school biology and a degree from “The University of Google.” (Go Fighting Androids!!) There’s the obvious negative consequence of this where celebrities spread misinformation, pseudoscience and outright falsehoods. However, there’s also the opposite side: when celebrities (Celebriscitists? Scientrities?) provide well thought out medical information, but information that ultimately doesn’t apply to the masses.
This year, Angelina Jolie wrote a very thoughtful op-ed about how she found out that she had the BRCA1 mutation; a mutation that puts you at considerably higher risk for breast cancer. She laid out her reasoning well, and I’m not going to comment on her decision – ultimately she made an informed choice that was true to her. However, since that op-ed was published, testing for the BRCA1 and BRCA2 mutations have gone up – and not because more people need the test. Dr Timothy Caulfield, one of my favourite presenters (if you ever get a chance to see him speak, do it. He’s awesome), published a paper with colleagues at the University of Alberta looking at how newspapers covered Jolie’s story. From Forbes:
The researchers confirmed that the coverage of Jolie’s preventative mastectomy decision was widely viewed as positive, with her decision being depicted as “brave and courageous” in almost 40% of the articles and “empowering, inspiring, and a role model for women” in 13%. These message frames were similar in occurrence across the three countries.
But despite limiting themselves to the highest quality newspapers, Caulfield’s team found that 70% of the articles failed to note any aspect of the rarity of Jolie’s case among all breast cancers: that BRCA1/2 mutations were rare (0.25% across the general female population and 2% of all breast cancer cases), that Jolie’s mutation pattern placed her at an unusually high risk for breast cancer, or any other mention that Jolie’s case cannot be applied to the vast majority of breast cancers.
I’m not faulting Jolie for what she did, and I think her decision was the right one for her. However, the media needs to be careful how it reports these stories to avoid misinforming the public, and public health professionals need to capitalize and use these moments when the issue is at the forefront of the public consciousness to educate and inform people. Stirring up fear in the population is irresponsible at best, and dangerous at worst.
Kamenova, Kalina, Amir Reshef, and Timothy Caulfield. “Angelina Jolie/’s faulty gene: newspaper coverage of a celebrity/’s preventive bilateral mastectomy in Canada, the United States, and the United Kingdom.” Genetics in Medicine (2013). Available online at: http://www.nature.com/gim/journal/vaop/ncurrent/full/gim2013199a.html
3. Obesity classified as a disease by the AMA
This one is an interesting one – but not for the reasons you might think. Much of the discussion here centered around whether calling obesity a disease would result in more or less stigma for those with excess weight, and how this would impact their lives. As Dr Yoni Freedhoff says:
The fact is that right now the accepted global viewpoint is that if obesity is a disease it’s a disease of willpower, of gluttony, of sloth. Consequent to that viewpoint we see tremendous, hateful and harmful weight bias that starts as bullying in elementary school and continues unabated for life. Stereotype and bias targeting those people with obesity impacts upon their access to healthcare, employment, human rights and societal acceptance.
However, what is perhaps most interesting here is how, by calling obesity a disease, it enables people to get treatment that they might otherwise be unable to afford such as access to a dietician, occupational therapist or nutritionist, who would previously not be covered by insurance plans. These changes take time though, and 2014 should lead to changes and improvements in policies and treatment. To quote friend of the blog Dr Sharma:
If governments, healthcare professionals, payers, media and individuals viewed obesity as a disease, we can perhaps create a world where health professionals are remunerated for providing treatment services, where people with obesity can seek medical assistance with confidence, and where public and private funders see the provision of obesity prevention and treatment resources and related research as a priority.
Another interesting perspective comes from our PLOS colleagues at Obesity Panacea who held a debate on this issue prior to the AMA’s decision.
4. Infant “functionally cured” of HIV
An infant born to a mother positive for HIV underwent aggressive antiretroviral therapy that started as soon as 30 hours after birth, and continued on treatment for the next 18 months. After a year, the child remains HIV free, and this suggests that this may be a potential treatment option that will be further explored through clinical trials. While some are skeptical of the findings, this does support the hypothesis that preventing HIV from establishing a reservoir is one potential avenue for treatment. We have to proceed with caution, but this does provide hope for treating this devastating disease.
5. Batkid saves San Francisco
This is my favourite story of 2013. Sometimes, no matter our best efforts, things don’t work out. In this case, it was a small child being diagnosed with leukaemia. However, while we can’t go back and time and undo his diagnosis, what we can do is make his life better in any way we can.
One way to do that is to make his wish come true.
In a nutshell, the citizens of San Francisco made this kid’s dream of being Batkid come true. He “saved” the city from the Riddler, and eventually got a key from the mayor of the city, capturing the world’s attention in the process.
I love this story. It shows just how much we can do when we band together.
Finally, we at PLOS Public Health Perspectives are celebrating our first year. We’re absolutely thrilled with the progress we’ve made over the 2013 year, and hope to continue growing in the future. We’d like to thank the PLOS blogs community manager Victoria Costello for her constant support, and finally, a heart felt thank you to all our readers. If you do have anything you’d like us to cover, feel free to message us via Twitter or comment on the blog and let us know!
So these are my choices for the biggest public health stories of 2013. There were several other big stories – the Affordable Care Act and Middle East Respiratory Syndrome come to mind. What are yours?
Finally, if you enjoyed this post, take a read of The Biggest Sci-Ed Stories of 2013, over on PLOS Sci-Ed! (link goes live Dec 31st)