Wednesday, June 3, 2015

What Are We Telling Mothers When We Say “Breast is Best"? Today on The Scientific Parent

I have recently joined The Scientific Parent as an Editor at Large. Today I'm getting a little personal and talking about why I chose to formula feed my preemie. I also put my public health hat on and discuss why I am concerned that we haven't learned how to promote breastfeeding without stigmatizing formula feeding.

There is a great discussion happening in the comment section of the article "What Are We Telling Mothers When We Say “Breast is Best"? Please join us!

Friday, May 1, 2015

Sofia Vergara, Nick Loeb, and a Bioethics Dilemma

Image Credit: NY Times
On April 29, 2015 Nick Loeb, actress Sofía Vergara’s ex fiancé, published an op-ed in the New York Times outlining why he should be able to bring their frozen embryos to term against her objections.

I am thrilled to welcome Macey L. Thompson Henderson, JD, PhD (ABD) to Pop Health today to discuss the bioethics and public health implications of this case.

Question: From your perspective, what are the key bioethical considerations in this case?

The principle of respect for autonomy involves respectful action as well as attitude. Beliefs and choices shift over time and problems can arise when a person’s present choices, desires or actions contradict previous choices. The ethical question to ask over the principle of autonomy in frozen embryo cases would be: “Is this person autonomously revoking their prior decision?” Informed consent is inherent to the ethical principle of autonomy.

The media coverage of the present case itself could very well be considered an ethical issue. What is the role of the celebrity voice in raising public health awareness? It would be my hope that can we use this legal dispute to engage the public in a thought provoking conversation about prevention and advance planning for all areas of one’s healthcare. Nick Loeb’s ability to coin a New York Times OpEd and to subsequently gain publicity across international media outlets about a personal issue he admittedly originally intended to keep private could be examined with an ethical lens as well. I find it interesting how the timing on Loeb’s personal revelations directly coincide with the release of a new movie starring Sofia Vergara.

Question: Loeb writes, “When we create embryos for the purpose of life, should we not define them as life, rather than as property?” Should a couple’s intentions at the outset of IVF impact how embryos are later defined? Why or why not? 

American courts have never deemed frozen embryos as children. Frozen embryo case law appears to follow a logical and straightforward application of the abortion cases which the United States Supreme Court has upheld. The rationale for upholding these cases is based on a mother’s right to privacy and control over her own body versus any right of a nonviable fetus.

See: Webster v. Reproductive Health Services, 492 U.S. 490 (1989); Roe v. Wade, 410 U.S. 113 (1973); Davis v. Davis, 842 S.W.2d 588 (Tenn.)

Media coverage seems to focus less on the debate about the classification of embryos as property versus children and more tuned into reproductive choices in general.  I am happy to see a trend where the reproductive rights and decisions of all adults are valued and the conversation about parenthood choices have been promoted by various celebrities and media personalities.

If the question really becomes about a “right to life” for the frozen embryos versus the “right to parenthood with Sofia Vergara” for Loeb, we could begin the public discussion about embryo adoption versus destruction which has more ethical implications.

Question: Loeb writes, “In my view, keeping them frozen forever is tantamount to killing them.” These are powerful words. In using them, he addresses a long-standing ethical debate regarding when life actually begins. How should this debate be addressed in the context of this case?

I don’t agree that Loeb actually addresses a debate about the beginning of life with his claims that keeping frozen embryos are tantamount to killing them. Instead, I think Loeb opens the door for us to discuss important processes and educational efforts (including basic education about contracts) that should be in effect before people utilize assisted reproductive technology to aid infertility, delay parenthood, or for any other reason—medical or not.  This is an opportunity to explore these public health communication opportunities from the perspective of patients, providers, and the public surrounding assisted reproductive technology.

Loeb’s point makes me think about the ethical issue of post-mortem sperm retrieval. Is killing involved if you fail to procure a man’s viable sperm after death for potential fertilization of future embryos? What are the impacts on the future child and society?

Question: In thinking about this from a public health perspective: what system or policy-level changes could/should be made in reproductive health technology to avoid these types of disputes in the future? 

Assisted reproductive technology has left areas of American jurisprudence shuffling between gaps in family law, constitutional, statutory, and common law over family decision-making rights.  Courts will remain key players in the debate in absence of state legislation. Is legislation always the best thing? Many would argue that unless contracts go against public policy, there is no need for the government to interfere. Parties in a contractual agreement can even agree to follow the laws of different states (which is common), therefore it can be challenging to get consensus on how much government involvement is necessary.

In this case Loeb wants to void a contract based on a procedural problem with a form. “We signed a form stating that any embryos created through the process could be brought to term only with both parties’ consent. The form did not specify — as California law requires — what would happen if we separated. I am asking to have it voided.” This is where a public health perspective is important. There can be more attention paid to how healthcare forms are created and evaluated. Standardization of forms at the state level could help these types of challenges in the future.

Health communicators can aide in providing patient education about all health planning, whether for reproductive and family planning or other types of advanced care planning like end of life care. It is obvious that Loeb and Vergara are “lawyered” up and that their celebrity status aids their ability in resolving these disputes especially with the public watching. I am more concerned about the couple in small town USA who might be going through a similar thing without the same resources. I think we have the duty and obligation to take celebrity cases involving health care decisions like this seriously in public health because we often fail to realize that television is one medium for which many individuals consume health information.

Please add additional comments/resources for readers here:

Macey L. Thompson Henderson, JD, PhD (ABD) is a Health Policy and Management PhD Candidate focusing on implementation science and donation and transplantation. She has a law degree and extensive training in bioethics, data science, and public communications.  Finding ways to utilize patient voices, media, and technology to improve living organ donor follow-up care is the focus of her doctoral dissertation. She currently teaches bioethics and health policy to public health and medical students. You can connect with Macey on Twitter and LinkedIn.

Friday, April 17, 2015

Health Awareness Days: Sufficient Evidence to Support the Craze? A New Commentary in AJPH

My regular readers know that I have some hesitations about campaigns that focus on "raising awareness". The phrase is vague and its definition often varies depending on who you ask.

So I'm excited to share that I recently published a new commentary on the topic with my colleague Dr. Jonathan Purtle at the Drexel University School of Public Health. "Health Awareness Days: Sufficient Evidence to Support the Craze?" was published by the American Journal of Public Health yesterday. Drexel University posted a great press release that summarizes the article and includes comments from us regarding recommendations and next steps.

I hope you will all read and share the commentary!

Thursday, April 16, 2015

Celebrity Moms Who Side With Science: Today on The Scientific Parent

I have recently joined The Scientific Parent as an Editor at Large. Today I'm talking pop health on the site with "Celebrity Moms Who Side With Science". I'm giving a shout out to celebrity moms who side with science and passionately advocate for vaccination. I also break down their messages to see how closely they align with the barriers we know stand between children and their vaccinations. Please join us there for the conversation!

Friday, April 10, 2015

"Unbreakable Kimmy Schmidt"…Comedy and Public Health?

Image credit:
Over the past year, I've enjoyed binge watching various TV shows after my son’s bedtime. I've been hooked on anything from old school Gilmore Girls to The Good Wife. My husband and I recently started watching Unbreakable Kimmy Schmidt on Netflix. We currently find ourselves 5 episodes into the series.

The show has a funny female lead and a great cast of supporting characters (reminiscent of Parks and Recreation) I think it can be easy to forget that we are watching a character who has just survived a serious trauma. In eighth grade, Kimmy Schmidt was kidnapped by the Reverend of a doomsday cult. She and several other women spent years hidden away in an underground bunker. In the pilot episode, the women are rescued from their bunker and Kimmy decides to start her life over in New York City.

In a recent essay for The New Yorker, Emily Nussbaum did an incredible job reviewing this show, discussing Kimmy’s resilience, and highlighting an increasing trend to portray sexual violence survivors on popular TV shows.

While the show is clearly a comedy, it still highlights several public health issues related to experiencing and surviving trauma. And these are important discussion points:

  • The “Right” Language: When I worked in rape crisis services, there was much discussion about the terms “victim” and “survivor”. We were encouraged to use the term “survivor” because it conveyed strength and hope. However, some people seeking services do not connect with that term initially (or ever). Therefore, it is important to ask people what terms they are comfortable with. There is no "one size fits all" in terms of how people label themselves afterwards and how much they do (or don't) want to discuss the experience or have it be a part of their lives going forward. We see this distinction in the very different approaches the bunker survivors take to moving on with their lives.
  • Posttraumatic Growth: The term posttraumatic growth, coined by Drs. Tedeschi and Calhoun, refers to the kinds of positive changes individuals experience in their struggles with trauma. These changes can include improved interpersonal relationships, exploring new possibilities for one's life, etc. This show is all about Kimmy's posttraumatic growth! If you look at the episode guide for the show, each episode explores a new experience for Kimmy (e.g., "Kimmy Gets A Job!" "Kimmy Goes To School!")

What Do You Think?

  • Does the show do an effective job of balancing comedy with real-life challenges for a trauma survivor? (i.e., re-entering the workforce, experiencing PTSD/flashbacks)
  • Is it possible that some trauma survivor organizations (or individuals) will be offended by the show for its comedic approach to such a serious subject? Why or why not?
  • How could the show integrate more effective public health messaging  for the aftermath of trauma? (e.g., "Kimmy Visits A Therapist!)

Friday, January 23, 2015

Should We Trust Similac's "The Mother'Hood"?

If any of you frequent parenting blogs, Facebook groups, or classes, you no doubt saw a link to Similac’s new video “The Mother’Hood”. Trust me- please watch…

I laughed (and cried) watching this video, because it is right on. My favorite line:
“Drug-free pool birth, dolphin assisted”.

In my 51 weeks of parenting so far (yes, my little guy will be 1 year old next week!), I have found the following issues to be HOT and often full of judgment in my circle of parenting groups:

  • Feeding- the early months (breastfeeding vs. formula feeding- or both!)
  • Feeding- the later months (purees vs. baby led weaning; organic food vs. regular food; how and when you introduced solid food)
  • Vaccination 
  • Stay at home vs. parents who work outside the home (and many parents, fall into both camps depending on the day!)
  • Car seats (how long you stay rear-facing; whether you use them on planes)
  • Cloth vs. disposable diapers (and other decisions which impact the environment)
  • Sleep practices (cribs vs. co-sleeping, crib bumpers, sleep training)
  • The type of childcare you select (day care center, in-home daycare, nanny, au pair) 

The list could go on and on….and these are just the hot topics I’ve found in the infant world!

The Mother’Hood Message: Why Does It Help?

The reality is that new parents can often feel very isolated and judged. This has many public health implications, especially for women at risk for postpartum depression. So for that reason, I like the primary message of the campaign which is that we should focus on the things that unite us, not divide us. At the end of the video, we read:

“No matter what our beliefs, we are parents first”.

And although the “cliques” (e.g., the bottle feeding group, the breast feeding group) are meant to show our separations…I also think it can mean that you will find others to spend time with who have a similar approach to parenthood that is compatible with yours. And that is reassuring.

This video is part of a larger campaign from Similac called “The Sisterhood of Motherhood”. The tag line for the campaign is, “Where moms get encouragement, not judgment”.

Can We Trust This Message From a Formula Company?

When I watched the video, I thought to myself- “makes sense this comes from Similac, their customers know a thing or two about being judged”. As I have previously written, it concerns me that public health has not found an effective way to promote breastfeeding without stigmatizing formula feeding.

So I was a little surprised to see (in social media and news article comments) that many viewers liked the video until they realized it came from Similac. Some expressed feelings that the message was less genuine since Similac stands to benefit financially when there is less public stigma about formula-feeding. One commenter wrote, “I was all for this, until I found out that it was created by Similac”.

Tell Me What You Think:

  • Does the fact that the video comes from a formula company make the message less meaningful or genuine? 
  • Why or why not?

And Can We Trust A Message That Forgot About Dads?

I was really excited to see Dads in the video! They were baby wearing and caring for their kids- it was great. They were even included in the tag line “No matter what our beliefs, we are parents first”…but in the next screenshot, we find out they were excluded from the campaign overall: “The Sisterhood of Motherhood”.

Many online commenters focused on this exclusion. Several asked, “Why not call it “The Parent’Hood”.

In my opinion, this is an unfortunate miss in an otherwise funny, relevant, and moving video. Why include Dads in the video just to exclude them at the end? What about families that have two fathers or a father who serves as the primary caregiver?

Tell Me What You Think:

  • Was the video and overall message ruined for you because fathers were excluded? 
  • Why do you think that the video and campaign developers made that decision? 
  • Do you think they regret it now?

Friday, January 9, 2015

Vaccination is a Work of Art

Vaccination is one of the most important issues we work on and champion in public health. This week we’re talking about nine confirmed cases of measles at Disneyland in California. We just had a measles scare locally in Philadelphia at the beloved Please Touch Museum. News that this year’s flu vaccine is less effective due to a mutated strain has started a public debate about the “worth” of the shot (spoiler alert: you should still get your flu shot!) And internationally, many health workers put their lives at risk every day to deliver vaccines that are so desperately needed.

Over the years, there have been many attempts to creatively and effectively communicate the value and safety of vaccines to key audiences (parents, health care workers, etc.) For example, efforts have included (1) incorporating themes from popular movies/TV shows (check out this Star Wars PSA from the 1970’s!), (2) engaging celebrities as champions, and (3) creating engaging documentaries. The newest effort comes from the Bill & Melinda Gates Foundation. Their campaign, “The Art of Saving a Life” tells the story of the past success and future promise of immunization using the talents of more than 30 world-renowned photographers, painters, sculptors, writers, filmmakers, and musicians. The goal of the campaign is to increase world-wide knowledge about the value of vaccines so that the Foundation (and partners) can build momentum and raise funds in their efforts to reach millions more with these life-saving inoculations.

A few of my favorite images in the campaign:

Campaign developers are hoping that the images will be widely shared and viewed, and inspire dialogue and donations. Since the campaign is targeted towards an international audience, I think primarily using images (vs. writing) will bridge countries, cultures, and literacy levels effectively. You can follow #vaccineswork on social media to participate in the discussion.

In terms of evaluating this campaign, I am assuming (and hoping) they will track:

  • Activity on social media that uses the campaign hashtag #vaccineswork. *One thing to note is that this hashtag is not unique to this campaign. So their staff may need to sort through what is directly sharing/discussing the campaign vs. general vaccine promoting communication to get a more accurate view of the hashtag’s usage.
  • How many people go on from their campaign website to visit the sites of partnering organizations listed on the bottom of each page (CDC, PATH, UNICEF, etc.) And how many of those people go on to take action on a partner site (i.e., make a donation, sign a petition, register to volunteer, etc.) 
  • Some type of qualitative feedback on the art pieces themselves. Overall, are these images more effective for communicating with an international audience? Were certain pieces more effective than others? If so, why were they more effective and with what audiences?

Tell me what you think:

  • What images/stories in the campaign do you find most interesting or inspiring?
  • What other outcomes besides those above should be evaluated?
  • What other campaigns have effectively used art work to communicate about a public health topic?