tag:theconversation.com,2011:/fr/topics/health-information-33944/articlesHealth information – The Conversation2024-03-17T12:56:19Ztag:theconversation.com,2011:article/2241192024-03-17T12:56:19Z2024-03-17T12:56:19ZOnline wellness content: 3 ways to tell evidence-based health information from pseudoscience<figure><img src="https://images.theconversation.com/files/582218/original/file-20240315-20-1ijga2.jpg?ixlib=rb-1.1.0&rect=374%2C66%2C6941%2C4649&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health information is increasingly being shared online, and often the borders between legitimate health expertise and pseudoscience aren't clear.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>“I drink borax!” proclaims the smiling TikToker. Holding up a box of the laundry additive, she rhymes off a list of its supposed health benefits: “Balances testosterone and estrogen. It’s a powerhouse anti-inflammatory…. It’s amazing for arthritis, osteoporosis…. And obviously it’s great for your gut health.” </p>
<p>Videos like these <a href="https://globalnews.ca/news/9860780/borax-drinking-tiktok-trend/">prompted health authorities to warn the public</a> about the dangers of ingesting this toxic detergent — and away from such viral messaging that promotes unsubstantiated and medically dangerous health claims.</p>
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<a href="https://theconversation.com/a-new-tiktok-trend-has-people-drinking-toxic-borax-an-expert-explains-the-risks-and-how-to-read-product-labels-210278">A new TikTok trend has people drinking toxic borax. An expert explains the risks – and how to read product labels</a>
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<p>Health information is increasingly being shared online, and often the borders between legitimate health expertise and pseudoscience aren’t clear. While the internet can be a valuable and accessible way to learn about health, it’s also a place rife with disinformation and grift, as unscrupulous <a href="https://doi.org/10.1249/FIT.0000000000000829">influencers exploit</a> people’s fears about their bodies. </p>
<h2>Evidence and influencers</h2>
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<a href="https://images.theconversation.com/files/582219/original/file-20240315-24-myasst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Collage of quotes about drinking borax" src="https://images.theconversation.com/files/582219/original/file-20240315-24-myasst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/582219/original/file-20240315-24-myasst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582219/original/file-20240315-24-myasst.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582219/original/file-20240315-24-myasst.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582219/original/file-20240315-24-myasst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582219/original/file-20240315-24-myasst.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582219/original/file-20240315-24-myasst.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some TikTokers claimed drinking borax had health benefits. In fact, borax is toxic and shouldn’t be ingested.</span>
<span class="attribution"><span class="source">(Michelle Cohen)</span></span>
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<p>In my medical practice, I can usually track online wellness trends, such as a patient refusing a medication because of online claims — many of which are false — that it <a href="https://thefeelgoodagaininstitute.com/medications-that-lower-testosterone/">lowers testosterone</a>, or the several months when it seemed everyone was <a href="https://theconversation.com/turmeric-heres-how-it-actually-measures-up-to-health-claims-205613">taking turmeric</a> for joint pain, or the patients who request an <a href="https://theconversation.com/ivermectin-whether-formulated-for-humans-or-horses-is-not-a-treatment-for-covid-19-167340">ivermectin prescription</a> in case they catch COVID. </p>
<p>So how does someone who simply wants to learn more about the human body sift through the information? How to separate bad-faith grift from good advice? </p>
<p>Wellness influencers tap into a truth about how we process information: it’s <a href="https://lab.research.sickkids.ca/anthony/wp-content/uploads/sites/75/2019/07/Health-misinformation-and-the-power-of-narrative-messaging-in-the-public-sphere..pdf">more trustworthy</a> when it comes from a person we feel like we know. That’s why a charismatic personality’s Instagram account that uses <a href="https://doi.org/10.1177/1440783319846188">intimate stories</a> to promote <a href="https://digitalcommons.liberty.edu/doctoral/4920/">parasocial attachment</a> — the sense of being part of a community — is more memorable than a website offering dry recitations of evidence.</p>
<p>But as social media has become ubiquitous, <a href="https://www.instagram.com/daniellebelardomd/?hl=en">health experts</a> have caught on that sharing their personal side alongside reliable advice can be a good use of their platform. At first glance, these two groups may seem similar, but the following tips can help determine if the person posting health advice is actually knowledgeable on the topic:</p>
<h2>1) Are they selling something?</h2>
<p>Rarely do popular wellness influencers post out of the goodness of their hearts. Almost invariably these accounts are <a href="https://www.conspirituality.net/transmissions/the-wellness-grift-of-jp-sears">trying to profit</a> from the <a href="https://doi.org/10.1002/ace.20486">virality of their content</a>. </p>
<p>Whether it’s a <a href="https://doi.org/10.1080%2F08998280.2022.2124767">supplement store</a>, a <a href="https://www.independent.co.uk/news/health/social-media-weight-loss-diet-twitter-influencers-bloggers-glasgow-university-a8891971.html">diet book</a>, a subscription to a lifestyle community or a Masterclass series, the end goal is the same: transform social media influence into sales. Gushing over life-changing benefits from something the promoter is selling should always prompt skepticism. </p>
<p>Some legitimate health experts also sell advice, usually in the form of newsletters, books or <a href="https://www.bodyofevidence.ca/">podcasts</a>, and this is worth keeping in mind. However, there’s a big difference between selling a subscription to a <a href="https://vajenda.substack.com/">health newsletter</a> that discusses evidence and promoting your own supplement shop, where your financial motives shape how you present the information.</p>
<h2>2) What are the boundaries of their expertise?</h2>
<p>True expertise in a subject requires years of dedicated study and practice. That’s why people are rarely experts in more than one or two domains, and no one is a pan-expert on everything. </p>
<p>If a <a href="https://doi.org/10.1080/17439884.2021.2006691">wellness influencer</a> promotes themselves as erudite on all health topics, that’s actually an excellent indication of their lack of knowledge. A real health expert knows the limitations of their knowledge and can call on others’ expertise when needed. So the podcast host who opines on every health issue is substantially less worthwhile to listen to than the podcast host who brings on guest experts for topics outside their scope. </p>
<h2>3) How do they talk about science?</h2>
<p>Science is a process of discovery, not a static philosophy, so scientists emphasize talking about current evidence rather than “truth”, which is more of a faith-based concept. </p>
<p>If someone wants to post about their personal wellness philosophy or their spiritual journey and how it makes them feel, that’s fine. But dropping in biology jargon without explanation or name-checking one or two questionable studies without fulsome discussion isn’t a meaningful way to engage with the evidence on a health topic. </p>
<p>Science-based information should acknowledge where data are uncertain and where more research is needed. Using the pretext of science to lend credence to a personal “truth” is a <a href="https://www.mcgill.ca/oss/article/critical-thinking-pseudoscience/whats-trending-world-pseudoscience">form of pseudoscience</a> and should raise red flags.</p>
<p>These three principles are a good framework for deciding whether an influencer’s health content is worth consuming or whether they’re simply trying to sell a new supplement or spread viral disinformation about something like borax. </p>
<p>As online health information becomes easier to find (or harder to avoid), this framework can help people quickly scan a wellness influencer’s profile and make a more informed decision about engaging with their content. This is an important type of media literacy that anyone spending time online should cultivate — for the sake of their health.</p><img src="https://counter.theconversation.com/content/224119/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Cohen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How do we distinguish between valuable information from legitimate health experts, and pseudoscientific nonsense from unscrupulous wellness influencers?Michelle Cohen, Adjunct Assistant Professor, Department of Family Medicine, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2104432023-07-28T20:43:27Z2023-07-28T20:43:27ZInquiry must assess how Canada’s fragmented COVID-19 response lost the public’s trust<figure><img src="https://images.theconversation.com/files/540004/original/file-20230728-27977-61wdf5.jpg?ixlib=rb-1.1.0&rect=835%2C1108%2C4109%2C2798&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It is clear that some public trust in public health, science and government has been lost in Canada and around the world.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/inquiry-must-assess-how-canadas-fragmented-covid-19-response-lost-the-publics-trust" width="100%" height="400"></iframe>
<p>Over the course of the pandemic, <a href="https://health-infobase.canada.ca/covid-19/current-situation.html?stat=num&measure=deaths_total&map=pt#a2">more than 53,000 Canadians died</a> and nearly five million contracted COVID-19. </p>
<p>While Canada had lower numbers of cases and deaths and higher vaccination rates <a href="https://doi.org/10.1503/cmaj.220316">than most other G10 countries</a>, these successes mask inequities across communities, socio-economic conditions and demography. They also hide challenges in data sharing and loss of public trust over time, evidenced by the “<a href="https://www.publicsafety.gc.ca/cnt/trnsprnc/brfng-mtrls/prlmntry-bndrs/20221013/04-en.aspx">freedom convoy</a>” movement that occupied Canada’s capital, Ottawa, in early 2022.</p>
<p>These and other challenges are laid out in <a href="https://www.bmj.com/canada-covid-series">a series of articles published in the <em>British Medical Journal</em> (<em>BMJ</em>) on July 24</a>, that we co-authored with other clinical, research and public health experts across Canada. Now is the time to learn from the COVID-19 response through an action-oriented, independent inquiry focused on implementation and accountability.</p>
<h2>Loss of public trust</h2>
<p>Canada’s public health response was hampered by fragmentation in decision-making, <a href="https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html#a4">shared between federal and provincial/territorial</a> and sometimes municipal governments. The Public Health Agency of Canada, <a href="https://www.canada.ca/en/public-health/corporate/mandate/about-agency/history.html">which was created in the wake of the first SARS outbreak in 2003</a>, develops national clinical and public health guidelines while provincial and territorial health agencies make decisions for their individual jurisdictions.</p>
<p>In the absence of a co-ordinated planning and delivery authority, different public health measures were implemented in different locales. For example, measures like vaccine eligibility and mandates, masking and school closures varied among provinces.</p>
<p>The rationale and supporting evidence for these different approaches were unclear. Some variations addressed local risk factors as evidence evolved, but <a href="https://doi.org/10.1136/bmj-2023-075665">insufficient availability and sharing of data and analyses</a> — combined with a lack of transparency — made it hard to explain the variation to the public. Over time, this led to a loss of confidence in public health guidance.</p>
<h2>Fragmented data</h2>
<p>Part of the problem is outdated data infrastructure that isn’t able to support public health decision-making in real time. Health information systems lack integration and interoperability between data sources, even after <a href="https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-reports-summaries/expert-advisory-group-report-01-charting-path-toward-ambition.html">$130 million of investment over the past eight years</a>. </p>
<p>However, other problems are legal and cultural. Canada’s health data privacy and protection laws, developed before the era of big data applications, <a href="https://nccph.s3.amazonaws.com/uploads/2022/06/OCPHO_Report_David_Buckeridge_NCCMT_EN.pdf">create legal impediments to using and analyzing data across jurisdictions</a>. </p>
<p>These impediments were exacerbated by a culture of risk aversion among the custodians of data in different jurisdictions and organizations. This culture requires a shift from a safeguarding mindset to one of stewardship for public good.</p>
<p>Technological advances mean data no longer need to be pooled across jurisdictions. <a href="https://nccph.s3.amazonaws.com/uploads/2022/06/OCPHO_Report_David_Buckeridge_NCCMT_EN.pdf">Data need never leave their secure data environments</a>; instead, de-identified data may be accessed and analyzed across independent systems using federated data structures. Unfortunately, these structures were not in place at the start of the pandemic and have not been implemented over the past three years. </p>
<p>Improved data access also presumes that data are fit for purpose, and that was not the case. <a href="https://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/emergency-preparedness-response-recovery/embc/reports/covid-19_lessons_learned_report.pdf">Comparisons between jurisdictions were difficult</a> for several reasons, including policy differences in testing eligibility, types of tests, how test results were reported and how hospitalizations or deaths were attributed to COVID-19.</p>
<p>Over the course of the pandemic, most jurisdictions reported COVID-19 case numbers, but data about demographics or location were <a href="https://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/emergency-preparedness-response-recovery/embc/reports/covid-19_lessons_learned_report.pdf">withheld due to privacy concerns</a>. This lack of nuanced data left people with a lack of understanding of their personal or community-level risk factors. The lack of ability to make informed decisions contributed to <a href="https://doi.org/10.1139/facets-2021-0018">loss of public trust over time</a>.</p>
<p>Even worse, the initial pandemic response was ill-designed to address the socio-economic and structural inequities that led to disproportionate burdens of the pandemic. </p>
<h2>Health inequities</h2>
<p><a href="https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/respiratory-viruses/covid-19/covid-19-pandemic-data/covid-19-archived-dashboards/covid-19-ethno-racial-identity-income/">Highest rates of COVID-19</a> cases and deaths were among racialized people, recent immigrants, lower-wage essential workers and those living in higher density and multigenerational households. </p>
<p>Case rates were highest where high-density living intersected with high-density working conditions, and were amplified by barriers to testing, vaccination and ability to isolate. <a href="https://doi.org/10.1093/ofid/ofac690">This trend did not resolve over the successive waves of the pandemic</a>.</p>
<p>Health data that include not only locale, but also racial identity, occupations, household size and income can help unpack social determinants of infection and health outcomes, and can be used to tailor public health programs. However, the collection of such data give rise to responsibilities to reduce inequalities, not just describe them. </p>
<p>Sadly, decisions to collect such data can be politicized. Ontario only <a href="https://www.theglobeandmail.com/canada/article-ontario-mulls-collection-of-race-based-covid-19-data-some-argue-its-2/">collected relevant data</a> after pressure from community activists and Québec resisted similar community pressure to <a href="https://www.theguardian.com/world/2023/jul/25/canada-could-have-saved-more-lives-covid-crisis">collect race-based data</a>.</p>
<p><a href="https://doi.org/10.1136/bmj-2023-075666">Canada’s diversity was also not adequately represented at decision-making or advisory tables</a>, nor was it represented in research that generated evidence for the public health response. </p>
<p>Public health decisions involve health, social and economic tradeoffs that need to be informed not only by standard epidemiological data, but also by social science data. These data can illuminate the <a href="https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1">social determinants of health</a>, the spread of misinformation and disinformation and political factors, such as the rise in social unrest due to public health measures. Evidence generation needs to be inclusive of diverse voices, specifically from those communities that bore the greatest burden of the pandemic.</p>
<h2>Public inquiry and reforms</h2>
<p>It is clear that some public trust in public health, science and government has been lost in Canada and around the world. This does not bode well for future threats, such as emerging pandemics, and current threats from the opioid crisis and climate change.</p>
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Read more:
<a href="https://theconversation.com/let-evidence-not-opinion-guide-harm-reduction-policy-and-practice-in-canadas-drug-poisoning-crisis-207679">Let evidence, not opinion, guide harm reduction policy and practice in Canada's drug poisoning crisis</a>
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<p>For these reasons, we call for a different kind of inquiry, agreeing that another expert report packed with recommendations will gather dust and not serve to rebuild public trust. </p>
<p>We need political will to call an independent inquiry that is inclusive of a diversity of voices, accountable to communities and with a mandate to implement change. Reforms to data generation, access and use are essential in preparing for the next public health emergency.</p><img src="https://counter.theconversation.com/content/210443/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tania Bubela receives funding from the Canadian tri-councils, Genome Canada, Genome British Columbia, Brain Canada, ALS Canada, and other philanthropic and government funders. She sits on the boards of Canadian Science Publishing and The Institute for Health System Transformation and Sustainability. With respect to COVID-19 work: she received funding from Genome Canada to conduct COVID-19 research on return to campus/work practices and served on the BC COVID-19 strategic research advisory committee, the executive governance group for the COVID-19 Clinical Research Coordination Initiative, and the Royal Society of Canada COVID-19 Task Force. </span></em></p><p class="fine-print"><em><span>Kimberlyn McGrail receives funding from the Canadian Institutes of Health Research. </span></em></p><p class="fine-print"><em><span>Sharmistha Mishra does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Now is the time to learn from the COVID-19 response through an action-oriented independent inquiry focused on accountability. Reforms to data generation, access and use are essential.Tania Bubela, Professor and Dean of the Faculty of Health Sciences, Simon Fraser UniversityKimberlyn McGrail, Professor of Health Services and Policy Research, University of British ColumbiaSharmistha Mishra, Associate Professor of Medicine, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2014742023-03-16T19:11:52Z2023-03-16T19:11:52ZWe asked ChatGPT and Dr Google the same questions about cancer. Here’s what they said<figure><img src="https://images.theconversation.com/files/515362/original/file-20230315-22-4sacw5.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C1280%2C850&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/stressed-black-male-entrepreneur-working-on-laptop-in-park-4560092/">Ketut Subiyanto/Pexels</a></span></figcaption></figure><p>You may have heard the buzz about <a href="https://openai.com/blog/chatgpt">ChatGPT</a>, a type of chatbot that uses artificial intelligence (AI) to write essays, turn computer novices into programmers and <a href="https://theconversation.com/will-ai-tech-like-chatgpt-improve-inclusion-for-people-with-communication-disability-196481">help people communicate</a>. </p>
<p>ChatGPT might also have a role in helping people make sense of medical information.</p>
<p>Although ChatGPT won’t replace talking to your doctor any time soon,
<a href="https://academic.oup.com/jncics/advance-article/doi/10.1093/jncics/pkad010/7049531">our new research</a> shows its potential to answer common questions about cancer.</p>
<p>Here’s what we found when we asked the same questions to ChatGPT and Google. You might be surprised by the results.</p>
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Read more:
<a href="https://theconversation.com/dr-google-probably-isnt-the-worst-place-to-get-your-health-advice-73835">Dr Google probably isn't the worst place to get your health advice</a>
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<h2>What’s ChatGPT got to do with health?</h2>
<p>ChatGPT has been trained on massive amounts of text data to generate conversational responses to text-based queries.</p>
<p>ChatGPT represents a new era of AI technology, which <a href="https://theconversation.com/bard-bing-and-baidu-how-big-techs-ai-race-will-transform-search-and-all-of-computing-199501">will be paired with</a> search engines, including Google and Bing, to change the way we navigate information online. This includes the way we search for health information. </p>
<p>For instance, you can ask ChatGPT questions like “Which cancers are most common?” or “Can you write me a plain English summary of common cancer symptoms you shouldn’t ignore”. It produces fluent and coherent responses. But are these correct?</p>
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Read more:
<a href="https://theconversation.com/bard-bing-and-baidu-how-big-techs-ai-race-will-transform-search-and-all-of-computing-199501">Bard, Bing and Baidu: how big tech's AI race will transform search – and all of computing</a>
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<h2>We compared ChatGPT with Google</h2>
<p>Our <a href="https://academic.oup.com/jncics/advance-article/doi/10.1093/jncics/pkad010/7049531">newly published research</a> compared how ChatGPT and Google responded to common cancer questions.</p>
<p>These included simple fact-based questions like “What exactly is cancer?” and “What are the most common cancer types?”. There were also more complex questions about cancer symptoms, prognosis (how a condition is likely to progress) and side effects of treatment.</p>
<p>To simple fact-based queries, ChatGPT provided succinct responses similar in quality to the <a href="https://support.google.com/websearch/answer/9351707?hl=en">feature snippet</a> of Google. The feature snippet is “the answer” Google’s algorithm highlights at the top of the page.</p>
<p>While there were similarities, there were also broad differences between ChatGPT and Google replies. Google provided easily visible references (links to other websites) with its answers. ChatGPT gave different answers when asked the same question multiple times.</p>
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<a href="https://images.theconversation.com/files/515366/original/file-20230315-21-r1ikyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman in lounge room coughing into fist" src="https://images.theconversation.com/files/515366/original/file-20230315-21-r1ikyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515366/original/file-20230315-21-r1ikyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515366/original/file-20230315-21-r1ikyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515366/original/file-20230315-21-r1ikyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515366/original/file-20230315-21-r1ikyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515366/original/file-20230315-21-r1ikyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515366/original/file-20230315-21-r1ikyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Is coughing a sign of lung cancer?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-sick-sore-throatcough-isolated-1518791273">Shutterstock</a></span>
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<p>We also evaluated the slightly more complex question: “Is coughing a sign of lung cancer?”.</p>
<p>Google’s feature snippet indicated a cough that does not go away after three weeks is a main symptom of lung cancer. </p>
<p>But ChatGPT gave more nuanced responses. It indicated a long-standing cough is a symptom of lung cancer. It also clarified that coughing is a symptom of many conditions, and that a doctor would be required to get a proper diagnosis.</p>
<p>Our clinical team thought these clarifications were important. Not only do they minimise the likelihood of alarm, they also provide users clear directions on actions to take next – see a doctor.</p>
<h2>How about even more complex questions?</h2>
<p>We then asked a question about side-effects to a specific cancer drug: “Does pembrolizumab cause fever and should I go to the hospital?”.</p>
<p>We asked ChatGPT this five times and received five different responses. This is due to randomness built into ChatGPT, which may help communicate in a near human-like way, but will throw up multiple responses to the same question.</p>
<p>All five responses recommended speaking to a health-care professional. But not all said this was urgent or clearly defined how potentially serious this side-effect was. One response said fever was not a common side effect but did not explicitly say it could occur. </p>
<p>In general, we graded the quality of responses from ChatGPT to this question as poor.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/515368/original/file-20230315-16-q4peeq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman on sofa with towel one forehead and thermometer in hand" src="https://images.theconversation.com/files/515368/original/file-20230315-16-q4peeq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515368/original/file-20230315-16-q4peeq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515368/original/file-20230315-16-q4peeq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515368/original/file-20230315-16-q4peeq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515368/original/file-20230315-16-q4peeq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515368/original/file-20230315-16-q4peeq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515368/original/file-20230315-16-q4peeq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Does pembrolizumab cause fever and should I go to the hospital?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhealthy-millennial-indian-woman-struggle-high-1924486937">Shutterstock</a></span>
</figcaption>
</figure>
<p>This contrasted with Google, which did not generate a featured snippet, likely due to the complexity of the question. </p>
<p>Instead, Google relied on users to find the necessary information. The first link directed them to the manufacturer’s product website. This source clearly indicated people should seek immediate medical attention if there was any fever with pembrolizumab.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/chatgpt-has-many-uses-experts-explore-what-this-means-for-healthcare-and-medical-research-200283">ChatGPT has many uses. Experts explore what this means for healthcare and medical research</a>
</strong>
</em>
</p>
<hr>
<h2>What next?</h2>
<p>We showed ChatGPT doesn’t always provide clearly visible references for its responses. It gives varying answers to a single given query and it is not kept up-to-date in real time. It can also produce <a href="https://openai.com/blog/chatgpt">incorrect responses</a> in a confident-sounding manner.</p>
<p><a href="https://blogs.bing.com/search/february-2023/The-new-Bing-Edge-%E2%80%93-Learning-from-our-first-week">Bing’s new chatbot</a>, which is different to ChatGPT and was released since our study, has a much clearer and more reliable process to outline reference sources and it aims to keep as up-to-date as possible. This shows how quickly this type of AI technology is developing and that the availability of progressively more advanced AI chatbots is likely to grow substantially. </p>
<p>However, in the future, any AI used as a health-care virtual assistant will need to be able to communicate any uncertainty about its responses rather than make up an incorrect answer, and consistently produce reliable responses.</p>
<p>We need to develop minimum quality standards for AI interventions in health care. This includes ensuring they generate <a href="https://onlinelibrary.wiley.com/doi/10.1111/ans.18263">evidence-based</a> information. </p>
<p>We also need to assess how AI virtual assistants are <a href="https://www.nature.com/articles/s41591-022-01981-2">implemented</a> to make sure they <a href="https://www.nature.com/articles/s41591-021-01614-0">improve people’s health</a> and don’t have any <a href="https://onlinelibrary.wiley.com/doi/10.1111/ans.18263">unexpected consequences</a>.</p>
<p>There’s also the potential for medically focused AI assistants to be <a href="https://www.nature.com/articles/s41591-022-01981-2">expensive</a>, which raises questions of <a href="https://www.nature.com/articles/s41591-021-01614-0">equity</a> and who has access to these rapidly developing technologies.</p>
<p>Last of all, health-care professionals need to be <a href="https://www.nature.com/articles/s41591-022-01981-2">aware of</a> such AI innovations to be able to discuss their limitations with patients.</p>
<hr>
<p><em>Ganessan Kichenadasse, Jessica M. Logan and Michael J. Sorich co-authored the original research paper mentioned in this article.</em></p><img src="https://counter.theconversation.com/content/201474/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashley M Hopkins receives funding from the National Health and Medical Research Council, Flinders Foundation, The Hospital Research Foundation, and Tour De Cure.</span></em></p>If people rely on ChatGPT or Google for complex medical questions, they could come unstuck.Ashley M Hopkins, NHMRC Investigator Fellow, leader of the Clinical Cancer Epidemiology Lab, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1968472023-01-22T13:33:12Z2023-01-22T13:33:12ZHow can health data be used for public benefit? 3 uses that people agree on<figure><img src="https://images.theconversation.com/files/505224/original/file-20230118-11-g3s32x.jpeg?ixlib=rb-1.1.0&rect=118%2C9%2C2929%2C1694&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Support for use of health data is conditional on whether the use has public benefits.</span> <span class="attribution"><span class="source">(Brittany Datchko/Graphic Journeys)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Health data can include information about health-care services, health status and behaviours, medications and genetic data, in addition to demographic information like age, education and neighbourhood. </p>
<p>These facts and statistics are valuable because they offer insights and information about population health and well-being. However, they can also be sensitive, and there are legitimate public concerns about how these data are used, and by whom. The term “<a href="https://www.hdrn.ca/en/reports/social-licence-uses-health-data-report-public-perspectives">social licence</a>” describes uses of health data that have public support. </p>
<p>Studies performed in <a href="https://doi.org/10.9778/cmajo.20180099">Canada</a>, the <a href="http://dx.doi.org/10.1136/medethics-2014-102374">United Kingdom</a> and <a href="https://doi.org/10.1186/s12910-016-0153-x">internationally</a> have all found public support and social licence for uses of health data that produce public benefits. </p>
<p>However, this support is conditional. Public concerns related to privacy, commercial motives, equity and fairness must be addressed. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of a health-care practitioner and a patient discussing a list of medications." src="https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public support for use of health data is conditional on things like public benefits, attention to privacy and fairness.</span>
<span class="attribution"><span class="source">(Brittany Datchko/Graphic Journeys)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our team of health policy researchers set out to build upon prior studies with actionable advice from a group of 20 experienced public and patient advisers. Studies have shown that health data use, sharing and reuse is a complex topic. So we recruited people who already had some knowledge of potential uses of health data through their roles advising research institutions, hospitals, community organizations and governments.</p>
<p>We asked these experienced advisers to exchange views about uses of health data that they supported or opposed. We also gathered participants’ views about requirements for social licence, such as privacy, security and transparency.</p>
<h2>Consensus views</h2>
<p>After hours of facilitated discussion and weeks of reflection, all 20 participants agreed on some applications and uses of health data that are within social licence, and some that are not. </p>
<p>Participants agreed it is within social licence for health data to be used by:</p>
<ul>
<li><p>health-care practitioners — to directly improve the health-care decisions and services provided to a patient.</p></li>
<li><p>governments, health-care facilities and health-system administrators — to understand and improve health care and the health-care system.</p></li>
<li><p>university-based researchers — to understand the drivers of disease and well-being.</p></li>
</ul>
<p>Participants agreed that it is not within social licence for:</p>
<ul>
<li><p>an individual or organization to sell (or re-sell) another person’s identified health data.</p></li>
<li><p>health data to be used for a purpose that has no patient, public or societal benefit.</p></li>
</ul>
<h2>Points of disagreement</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man and a woman sitting at a table with a computer screen" src="https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=460&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=460&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=460&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The participants also had different views about what constitutes an essential requirement for social licence.</span>
<span class="attribution"><span class="source">(Brittany Datchko/Graphic Journeys)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Among other topics, the participants discussed uses of health data about systemically marginalized populations and companies using health data. Though some participants saw benefits from both practices, there was not consensus support for either. </p>
<p>For example, participants were concerned that vulnerable populations could be exploited, and that companies would put profit ahead of public benefits. Participants also worried that if harms were done by companies or to marginalized populations, they could not be “undone.” Several participants expressed skepticism about whether risks could be managed, even if additional safeguards are in place. </p>
<p>The participants also had different views about what constitutes an <a href="https://www.hdrn.ca/sites/default/files/2022-11/Appendix%20C%20-%20Social%20licence%20for%20uses%20of%20health%20data%20-%20HDRN%20Canada%20%26%20GRIIS.docx">essential requirement for social licence</a>. This included discussions about benefits, governance, patient consent and involvement, equity, privacy and transparency. </p>
<p>Collectively, they generated a list of 85 essential requirements, but 38 of those requirements were only seen as essential by one person. There were also cases where some participants actively opposed a requirement that another participant thought was essential. </p>
<h2>Using the findings</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman working with data at a desk" src="https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=541&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=541&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=541&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=680&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=680&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=680&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Potential benefits of health data use include better patient care, better health system planning and better understanding of disease and wellness.</span>
<span class="attribution"><span class="source">(Brittany Datchko/Graphic Journeys)</span></span>
</figcaption>
</figure>
<p>This work was funded by the Public Health Agency of Canada to inform the <a href="https://www.canada.ca/en/public-health/programs/pan-canadian-health-data-strategy.html">Pan-Canadian Health Data Strategy</a>. In parallel, an <a href="https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-reports-summaries/expert-advisory-group-report-03-toward-world-class-health-data-system.html">expert advisory group for the strategy</a> recommended that one or more public assemblies be established to provide advice and guidance. </p>
<p>We strongly agree with the expert advisory group’s recommendation to “give voice to people” as the Pan-Canadian Health Data Strategy is implemented. </p>
<p>The findings from our work may help focus the work of the Pan-Canadian Health Data Strategy and other initiatives aimed at expanding uses of health data. These initiatives should start by focusing on uses of health data that have clear public support. </p>
<p>We note that there could be many important benefits just from the users of health data that the 20 participants in our project supported: health-care practitioners; governments, health-care facilities and health system administrators; and university-based researchers. These benefits include better patient care, better health system planning, and better understanding of disease and wellness. </p>
<p>Our hope is that the work described in this article will be a step forward in a concerted and continuous effort to identify and act on increasing the uses of health data that members of the public support.</p><img src="https://counter.theconversation.com/content/196847/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>P. Alison Paprica receives funding from the Public Health Agency of Canada and national and provincial research funders.</span></em></p><p class="fine-print"><em><span>Annabelle Cumyn participates in a research program that receives funding from CIHR. She is affiliated with the University of Sherbrooke and is a member on the Interagency advisory panel on research ethics. </span></em></p><p class="fine-print"><em><span>Kimberlyn McGrail receives funding from the Public Health Agency of Canada and national and provincial research funders. </span></em></p><p class="fine-print"><em><span>Julia Burt and Roxanne Dault do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are concerns about how health data are used, but research shows support for uses with public benefits by health-care providers, governments, health-system planners and university-based researchers.P. Alison Paprica, Professor (adjunct) and Senior Fellow, Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of TorontoAnnabelle Cumyn, Professor of Medicine, Université de Sherbrooke Julia Burt, Public Engagement Fellow, Faculty of Medicine, Memorial University of NewfoundlandKimberlyn McGrail, Professor of Health Services and Policy Research, University of British ColumbiaRoxanne Dault, Research coordinator, Groupe de recherche interdisciplinaire en informatique de la santé, Université de Sherbrooke Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1802782022-08-15T19:13:29Z2022-08-15T19:13:29ZThe rise of ‘Dr. Google’: The risks of self-diagnosis and searching symptoms online<figure><img src="https://images.theconversation.com/files/468376/original/file-20220613-28923-zjfuv1.png?ixlib=rb-1.1.0&rect=0%2C2%2C1994%2C1239&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Googling symptoms to self-diagnose is not the same as virtual health care. </span> <span class="attribution"><span class="source">(Canva)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/the-rise-of--dr--google---the-risks-of-self-diagnosis-and-searching-symptoms-online" width="100%" height="400"></iframe>
<p>Virtual health care was <a href="https://doi.org/10.9778/cmajo.20200311">adopted more widely during the COVID-19 pandemic</a>, with many people accessing health-care providers remotely. However, easy and convenient access to technology means some people may choose to bypass health care and consult Dr. Google directly, with online self-diagnosis. </p>
<p>Here is a common scenario: picture someone sitting at home, when suddenly their head starts pounding, their eyes start to itch and their heart rate rises. They reach for their phone or laptop to quickly Google what can possibly be wrong. </p>
<p>It’s possible that the search results could offer accurate answers about the cause of the person’s symptoms. Or the search might erroneously suggest they’re well on their way to an early death.</p>
<p>As a researcher in the <a href="https://theconversation.com/virtual-care-still-has-a-place-in-post-pandemic-health-care-171401">virtual care domain</a>, I’m aware that online self-diagnosis has become very common, and that technology has shifted the way health care is delivered.</p>
<h2>Paging Dr. Google</h2>
<p>Online health information took on a new importance during the pandemic, when using <a href="https://doi.org/10.1038/s41598-022-13053-z">online sources to assess COVID-19 symptoms and self-triage</a> was encouraged. However, the act of self-diagnosis online is <a href="https://doi.org/10.1515/dx-2016-0045">not new</a>. </p>
<p>In 2013, it was reported that more than half of Canadians polled said they used Google search to <a href="https://globalnews.ca/news/752415/more-than-half-of-canadians-use-doctor-google-to-self-diagnose/">self-diagnose</a>. In 2020, 69 per cent of Canadians used the internet to search for <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/210622/dq210622b-eng.htm">health information</a>, and 25 per cent used online sources to track their fitness or health.</p>
<p>Virtual care and online self-diagnosis share some beneficial traits, such as the convenience of not having to schedule an appointment, saving travel time to the doctor’s office and avoiding waiting rooms. However, the key difference between virtual care and Googling symptoms is that there is no direct communication with a physician when self-diagnosing online. </p>
<p>Some may choose to self-diagnose because they feel it gives them greater control over their health, while others may find it helps them better communicate symptoms to their physician. Some patients may <a href="https://doi.org/10.2196/14679">fear misdiagnosis</a> or <a href="https://www.ctvnews.ca/health/patients-who-suffer-from-medical-errors-face-rigged-system-critics-say-1.4507664">medical errors</a>. </p>
<figure class="align-center ">
<img alt="A woman in casual clothes on a sofa, looking at her phone with her hand to her face, looking concerned" src="https://images.theconversation.com/files/478157/original/file-20220808-9095-u6dphb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478157/original/file-20220808-9095-u6dphb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478157/original/file-20220808-9095-u6dphb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478157/original/file-20220808-9095-u6dphb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478157/original/file-20220808-9095-u6dphb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478157/original/file-20220808-9095-u6dphb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478157/original/file-20220808-9095-u6dphb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Googling symptoms and self-diagnosing can increase anxiety about health.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Over time, people can get better at diagnosing using the <a href="https://www.cbc.ca/radio/asithappens/as-it-happens-tuesday-edition-1.5969736/why-this-doctor-wants-you-to-consult-with-dr-google-to-help-diagnose-your-symptoms-1.5971609">internet</a>. Online sources can provide information and support for a specific medical condition. They may also be useful for people with ongoing symptoms who have been unable to get a diagnosis from <a href="https://patient.info/news-and-features/does-self-diagnosis-work-and-what-are-the-dangers">health-care professionals</a>. </p>
<p>Using the internet to <a href="https://doi.org/10.1016/j.ijmedinf.2005.07.032">learn more about a condition</a> after being diagnosed by a health-care provider may be useful and may decrease the stress of a diagnosis if the sites consulted are trustworthy.</p>
<p>However, trying to select credible sources and filter out misinformation can be an overwhelming process. Some information found online <a href="http://doi.org/10.1001/amajethics.2018.1052">has little to no credibility</a>. A study focusing on the spread of fake news on social media found that false information <a href="https://doi.org/10.1126/science.aap9559">travelled faster and wider than the truth</a>. </p>
<h2>Risks of self-diagnosis</h2>
<p>The risks of using online health resources include <a href="https://doi.org/10.3390%2Fijerph17030880">increased anxiety and fear</a>. The term <a href="https://betanews.com/2022/03/27/cyberchondria/">cyberchondria</a> can be defined as someone experiencing a high amount of <a href="https://doi.org/10.1080/15398285.2013.833452">health anxiety</a> from searching symptoms on the internet. </p>
<p>Self-misdiagnosis is also a danger, especially if doing so means not seeking treatment. For example, if a person confidently self-diagnoses their stomach pains as the stomach flu, they may hesitate to believe their doctor’s diagnosis of appendicitis. </p>
<p>There is also a risk of becoming so certain that one’s self-diagnosis is correct that it is difficult to accept a different diagnosis from a <a href="https://www.verywellhealth.com/perils-of-using-the-internet-to-self-diagnose-4117449">health-care professional</a>. Misdiagnoses can even be very serious if it results in failure to detect a possible heart attack, stroke, seizure or tumour. </p>
<p>Further risks may include increased stress on both the patient and doctors, ineffectively taking or mixing medications and increased costs for <a href="https://etactics.com/blog/problems-with-self-diagnosis">treatments or medicines that may not be necessary</a>.</p>
<h2>Social media and mental health</h2>
<p>Social media has given people a voice to <a href="https://doi.org/10.1145/2556288.2557214">share personal health-related remedies and stories</a>. The number of active social media users in Canada has increased by <a href="https://www.theglobalstatistics.com/canada-social-media-statistics/">1.1 million since 2021</a>. This raises the question of how people may be influenced by what they see online and if it may affect health choices.</p>
<p>In 2018, a Canadian internet use survey examined reports of the negative effects of using social media. It revealed over 12 per cent of users <a href="https://www150.statcan.gc.ca/n1/pub/36-28-0001/2021003/article/00004-eng.htm">reported feeling anxious or depressed, frustrated or angry, or envious of the lives of others</a>. </p>
<p>Conversely, social networks have also enabled people with mental health problems to feel unity by sharing experiences and support. However, this may also have contributed to self-diagnosis (and potentially self-misdiagnosis) of <a href="https://www.verywellmind.com/people-are-using-social-media-to-self-diagnose-5217072">mental health issues, such as anxiety and personality disorders</a>. This can put people at physical and mental risk if it results in inappropriate treatments.</p>
<p>The reality is that online self-diagnosis cannot be prevented. But those consulting Dr. Google should be aware of the potential risks, confirm information found online with a health-care provider and ask health-care providers for credible online sources of information about their diagnoses.</p><img src="https://counter.theconversation.com/content/180278/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taleen Lara Ashekian does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Searching symptoms online has become so common there is a name for the condition of health anxiety induced by self-diagnosis on the internet: Cyberchondria.Taleen Lara Ashekian, Health Sciences Researcher & PhD Student, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1753012022-06-05T12:22:50Z2022-06-05T12:22:50ZListening to asthma and COPD: An AI-powered wearable could monitor respiratory health<figure><img src="https://images.theconversation.com/files/466825/original/file-20220602-14-yjybej.jpg?ixlib=rb-1.1.0&rect=858%2C0%2C3445%2C2832&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even with optimal treatment, asthma and COPD patients encounter unpredictable flareups of their conditions, which can become life-threatening and need immediate medical attention.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>A neck patch that monitors respiratory sounds may help manage asthma and chronic obstructive pulmonary disease (COPD) by detecting symptom flareups in real time, without compromising patient privacy. </p>
<p>Asthma and COPD are two of the most common chronic respiratory diseases. In Europe, the <a href="https://www.erswhitebook.org/chapters/adult-asthma/epidemiology/">combined prevalence</a> is about <a href="https://www.erswhitebook.org/chapters/chronic-obstructive-pulmonary-disease/epidemiology/">10 per cent</a> of the general population. In Canada, an estimated <a href="https://health-infobase.canada.ca/datalab/asthma-blog.html">3.8 million</a> people experience asthma and <a href="https://health-infobase.canada.ca/datalab/copd-blog.html">two million people experience COPD</a>.</p>
<p>The chronic nature <a href="https://www.lung.org/blog/asthma-self-management-skills">of asthma</a> <a href="https://www.blf.org.uk/support-for-you/copd">and COPD</a> requires continuous disease monitoring and management. Patients with these conditions share many <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/asthma-copd-overlap-syndrome">similar clinical symptoms</a> such as frequent coughing, wheezing and shortness of breath. These symptoms can worsen from time to time and situation to situation, such as exposure to smoke. </p>
<p>Even with optimal treatment, patients encounter unpredictable flareups or exacerbation of their conditions. These can become life-threatening and need immediate medical attention. Effective and predictive tools, which enable continuous remote monitoring and early detection of exacerbation, are crucial to prompt treatment and improved health. </p>
<p>An international collaboration between Canada and Germany with expertise in upper airway health, audio/acoustic engineering and wearable computing is developing a wearable device to monitor these respiratory symptoms. </p>
<h2>Privacy concerns</h2>
<p><a href="https://doi.org/10.1007/s11882-020-00927-3">Wearable technologies</a> have been widely applied for remote monitoring of asthma and COPD. Most of these devices have built-in microphones to collect audible clinical symptoms, such as coughs, from patients. However, such designs hamper patients’ full compliance because of privacy concerns about continuous monitoring of all sounds in their daily life encounters and home environment. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&rect=7%2C2%2C1564%2C1272&q=45&auto=format&w=1000&fit=clip"><img alt="Cropped image of a man in a gray T-shirt with a small round sensor patch on his neck just above the neckline of his shirt" src="https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&rect=7%2C2%2C1564%2C1272&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=811&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=811&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=811&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1019&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1019&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1019&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The sensor is placed on the skin of the neck.</span>
<span class="attribution"><span class="source">(Li-Jessen)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="https://www.wired.com/insights/2014/10/algorithms-wearable-tech-frontier/">Efficient and intelligent algorithms</a> are required for health wearables to meaningfully interpret data as soon as it’s fed into the system. Recent advances in <a href="https://www.ibm.com/topics/artificial-intelligence-medicine">artificial intelligence (AI)</a> have rapidly changed many fields of medical diagnosis and therapy monitoring. </p>
<p>However, the AI “black-box” problem also creates <a href="https://doi.org/10.1007/s43681-022-00141-z">ethical and transparency concerns in biomedicine</a>. Most AI tools only allow us to know the algorithm’s input and output (for example, turning an input X-ray image into a predicted diagnosis as output) but not the processes and workings in between. That means we don’t know how the AI tools do what they do.</p>
<p>Also, implementing real-time analytics in wearable devices is challenging due to constrained computational resources in these devices, but is essential for timely detection of airway symptoms. The development of trustworthy and cost-effective “<a href="https://www.wired.com/insights/2014/12/wearing-your-intelligence/">wearable AI</a>” is crucial to this project.</p>
<p>To address these unmet challenges, our AI-powered wearables will have the capacity to protect speech privacy and perform near-real-time data analysis to empower patients and clinicians to take informed actions without delay. </p>
<h2>Listening with protected speech privacy</h2>
<p>At McGill University, the Canadian team is developing a <a href="https://doi.org/10.3390%2Fapp10031192">wearable device</a>, similar in size to a Fitbit, to track and monitor the health status of the upper airway during daily activities. The device is based on mechano-acoustic sensing technology. </p>
<p>In a nutshell, a <a href="https://doi.org/10.3390%2Fapp9071505">small, patch-like skin accelerometer</a> is customized to be placed on the neck. When a person experiences upper airway symptoms such as cough, hoarse voice, etc., the characteristic body sounds of those symptoms create acoustic waves that spread across to the neck skin and turn into mechanical vibrations detectable by the skin accelerometer.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A small mechanical devices with a connection to a small remote controller, and a schematic diagram." src="https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=594&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=594&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=594&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A small, patch-like wearable device can be placed on the neck to detect when a person experiences upper airway symptoms such as cough, hoarse voice etc.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.3390/app9071505">(Zhengdong Lei et al, 2019.)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Most features of recognizable speech are within the high-frequency range (around six to eight kilohertz). Human neck tissues serve as a filter that only low-frequency components of a signal can pass through. That means identifiable speech information is detectable as sound by our sensors but inaudible by human ears, preserving users’ speech privacy. </p>
<p>We are now working to develop a smartphone application that will connect to the wearable device. This mobile app will generate a diary summary of upper airway health for patients. Also, with users’ consent, the report can also be sent to their primary healthcare providers for remote monitoring. </p>
<h2>Small and intelligent AI</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Closeup of a person's neck with a small round patch near the base of the neck with a white wire leading down from it" src="https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The device is currently capable of identifying cough, throat clearing and hoarse voice with over 80 per cent accuracy, which is important for accurately determining symptom severity.</span>
<span class="attribution"><span class="source">(Li-Jessen)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>At Friedrich-Alexander-Universität Erlangen-Nürnberg, the German team has developed <a href="https://doi.org/10.1038/nature14539">deep neural networks</a>, a specific subfield of AI, that are very lean and only need very small computational memory of less than 150 kilobytes. Also, continuous monitoring generates a large and complex data source. In a <a href="https://doi.org/10.1002/aisy.202100284">recent publication</a>, we reported that our algorithms are on par with state-of-the-art algorithms, even though they fit on a low-cost microcontroller. </p>
<p>Our current project will build upon these findings and expand these cost-effective AI algorithms to automate the analysis of mechanical acoustic signals. That information, together with other user-specific data (such as local air quality and reliever used), can be used to predict a patient’s risk of asthma/COPD symptom exacerbation. </p>
<p>At present, the device is at the testing stage. By looking at the magnitude and pattern of these neck surface vibration signals, our AI-based technology is currently capable of identifying symptoms related to airway health such as cough, throat clearing and hoarse voice with over 80 per cent accuracy, which is important for accurately determining severity. </p>
<p>Early detection of asthma and COPD flareups remains an unmet clinical need, but this technology may be useful for other conditions, too. For example, we anticipate that this application can be extended to monitor “<a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/long-covid#Heading4">long COVID</a>” because some of its symptoms — such as shortness of breath and coughing — overlap with those of asthma and COPD. </p>
<p>With advances in wearable monitoring technology, we hope to empower and engage patients to take charge of their airway health.</p><img src="https://counter.theconversation.com/content/175301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Li-Jessen receives funding from Canada Research Chair, Fonds de recherche du Québec–Santé, Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, Natural Sciences and Engineering Research Council of Canada and National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Andreas Kist receives funding from BayFOR (Bavarian Research Alliance)</span></em></p>Researchers are developing an AI-powered device to detect asthma and COPD symptoms in real-time for faster treatment. The ‘patch’ listens to airway sounds, but filters out speech to protect privacy.Nicole Y.K. Li-Jessen, Associate Professor of Communication Sciences and Disorders, McGill UniversityAndreas M. Kist, Assistant Professor, Artificial Intelligence in Communication Disorders, Friedrich–Alexander University Erlangen–Nürnberg (FAU)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698162021-12-15T22:02:37Z2021-12-15T22:02:37ZSupport and collaboration with health-care providers can help people make health decisions<figure><img src="https://images.theconversation.com/files/437711/original/file-20211215-25-1nxtdxn.jpg?ixlib=rb-1.1.0&rect=282%2C67%2C3403%2C2084&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shared decision-making is a patient-centred approach to health choices that considers a patient's values as well as clinical evidence.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The COVID-19 pandemic has resulted in an unprecedented <a href="https://blogs.lse.ac.uk/politicsandpolicy/science-society-covid19/">interest in science</a>, as people everywhere were <a href="https://penntoday.upenn.edu/news/decision-making-and-anxiety-time-covid-19">faced with making decisions</a> that affected their health. These included decisions such as following public health protective measures, getting vaccinations and accessing health-care services.</p>
<p>All of this has taken place in rapidly evolving, uncertain environments. The events related to the COVID-19 pandemic have highlighted the importance of <a href="https://www.cdc.gov/vaccines/vac-gen/evalwebs.htm">what constitutes credible information</a> or evidence (research-based information) and how evidence is communicated and used to make decisions. At the start of the pandemic, <a href="https://doi.org/10.1038/s41591-021-01293-x">little was known about COVID-19</a>, and making health decisions was a challenge.</p>
<p>The <a href="https://theconversation.com/omicron-faq-how-is-it-different-from-other-variants-is-it-a-super-variant-can-it-evade-vaccines-how-transmissible-is-it-160359">ongoing pandemic</a> has given rise to what is characterized as an “<a href="https://iris.paho.org/bitstream/handle/10665.2/52052/Factsheet-infodemic_eng.pdf">infodemic</a>” due to the sheer quantity of information available, including the rapid spread of misinformation or fake science reporting. From media outlets reporting in a 24/7 news cycle to the reliance on social media influencers, in many instances with a strong editorial bias, the information environment <a href="https://theconversation.com/people-want-to-use-bleach-and-antiseptic-for-covid-and-are-calling-us-for-advice-168660">is bewildering and difficult to navigate</a>.</p>
<p>The amount of information can pose <a href="https://doi.org/10.1098/rsos.201199">daunting challenges</a> to those who are seeking information to make informed health-care decisions. For example, misinformation has been found to negatively affect people’s <a href="https://doi.org/10.1038/s41562-021-01056-1">willingness to get vaccinated</a> and can lead to <a href="https://doi.org/10.1177%2F0033354919874074">risky behaviours</a>. </p>
<p>Making decisions that impact health has been a nearly universal experience during the pandemic: it affected everyone. Often these decisions were made <a href="https://doi.org/10.1186/s12913-021-07019-6">without support from health-care providers</a>. Our health systems have been challenged to better support people to make health-care decisions, such as <a href="https://doi.org/10.1001/jama.2020.27121">exploring options</a> to determine how to <a href="https://voxeu.org/article/how-nudge-covid-19-vaccination-while-respecting-autonomous-decision-making">support informed, values-based COVID-19 vaccination decisions</a>.</p>
<p>We are members of an interdisciplinary, international team of patient partners, health-care providers, educators and researchers that include the perspectives of patients in a leadership capacity. We have been seeking to understand and advance an approach to preparing patients for health decisions called shared decision-making.</p>
<h2>Support for people to take charge of their health</h2>
<p>“Shared decision-making” is when a person experiencing a health issue <a href="https://doi.org/10.1016/j.pec.2005.06.010">works together</a> with their health-care providers to make decisions about <a href="https://www.kingsfund.org.uk/sites/default/files/Making-shared-decision-making-a-reality-paper-Angela-Coulter-Alf-Collins-July-2011_0.pdf">screening, treatments or managing chronic conditions</a>. Shared decision-making upholds <a href="https://www.who.int/news/item/28-05-2016-world-health-assembly-adopts-framework-on-integrated-people-centred-health-services">person-centred care</a> and supports people to take an active role in their health-care decisions. </p>
<p>Standard care provides patients with evidence-based information about health choices. However, with shared decision-making, the person’s individual preferences, beliefs and values are considered in making health decisions, as well as clinical evidence.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437710/original/file-20211215-13-wza95z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse sitting by patient's bed in hospital" src="https://images.theconversation.com/files/437710/original/file-20211215-13-wza95z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437710/original/file-20211215-13-wza95z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437710/original/file-20211215-13-wza95z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437710/original/file-20211215-13-wza95z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437710/original/file-20211215-13-wza95z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437710/original/file-20211215-13-wza95z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437710/original/file-20211215-13-wza95z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Shared decision-making upholds person-centred care and supports people to take charge of their health.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Importantly, shared decision-making is a process that supports people to understand the risks and benefits of different options through <a href="https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making">discussion and information sharing</a> with their health-care providers. </p>
<p>In fact, shared decision-making has been called “<a href="https://projects.iq.harvard.edu/files/shared_decision_making/files/sdm_pinnacle_of_patient_centered_care.pdf?m=1446225643">the pinnacle</a>” of person-centred care. A key feature of shared decision-making is the <a href="https://doi.org/10.1007/s11606-012-2077-6">exploration of patient values and priorities</a> and it can be facilitated by using evidence-based decision support tools and approaches. </p>
<h2>Decision coaching</h2>
<p>Patient decision aids and decision coaching support people to have an active role in making decisions. <a href="https://doi.org/10.1002/14651858.CD001431.pub5">Decision aids</a> include <a href="https://decisionaid.ohri.ca/AZinvent.php">booklets, videos and online tools that</a> make the decision clear, provide options and the pros and cons, and help people clarify what matters to them. </p>
<p>They may be used by patients alone or in consultation with a health-care provider. They have been shown to help people feel more knowledgeable, better informed and clearer about their values. In addition, people probably have a more active role in decision-making and more accurate risk perception.</p>
<p>Our team viewed it as important to determine the unique contribution of decision coaching, an intervention with strong potential to help people prepare for health-care decisions. <a href="https://doi.org/10.1002/14651858.CD013385.pub2">Decision coaching</a> is delivered by trained health-care providers to support people facing decisions, with or without the use of an evidence-based tool (such as a patient decision aid).</p>
<p>We conducted a systematic review to <a href="https://www.cochrane.org/CD013385/COMMUN_decision-coaching-people-making-healthcare-decisions">assess the effects of decision coaching</a>. The review included 28 studies that covered a range of medical conditions with treatment and screening decisions. </p>
<p>While further research is needed on many outcomes, we found that decision coaching may improve participants’ knowledge (related to their <a href="https://doi.org/10.1016/j.pec.2013.10.031">condition, options, outcomes, personal values, preferences</a>) when used with evidence-based information. Our findings do not indicate any significant adverse effects (for example, decision regret, anxiety) with the use of decision coaching.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/egJlW4vkb1Y?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Although we began our systematic review before the COVID-19 pandemic, our exploration of decision coaching is even more relevant given the decision demands of the pandemic and accompanying <a href="https://theconversation.com/should-children-get-the-covid-19-vaccine-153431">difficulty of the decisions</a>.</p>
<p>Experiences with the COVID-19 pandemic have shown that, in rapidly changing complex health-care environments, strategies that <a href="http://rimed.org/rimedicaljournal/2020/09/2020-09-10-commentary-knopov.pdf">uphold person-oriented health care</a> are critical. Shared decision-making tools and approaches, ideally using decision aids and decision coaching, can contribute to shaping person-centred health-care services that puts people first and upholds the principle of “<a href="https://ugc.futurelearn.com/uploads/files/19/40/19408460-e688-4a99-84bb-d5114eca9c97/2.3_Making-shared-decision-making-a-reality-paper-Angela-Coulter-Alf-Collins-July-2011_0.pdf">no decision about me, without me</a>.” To make the best health decisions for themselves and their families, people need support and opportunities to work with trusted health-care providers. </p>
<p><em>Maureen Smith, chair of the Cochrane Consumer Network Executive, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/169816/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Jull has received funding from the Canadian Institutes of Health Research and Ontario Institute for Cancer Research to conduct studies about shared decision making and decision coaching.</span></em></p><p class="fine-print"><em><span>Dawn Stacey receives funding from the Canadian Institutes of Health Research and the Canadian Cancer Society to conduct studies about decision coaching. </span></em></p><p class="fine-print"><em><span>Sascha Köpke receives funding from German Ministry of Research & Education, German Ministry of Health, German Innovation Fund (federal funding), German Statuary Health Insurance ("Techniker Krankenkasse").</span></em></p>Shared decision-making upholds person-centred care and supports people to take charge of their own health: their views, input and experiences are important contributors to health plans.Janet Jull, Assistant Professor, School of Rehabilitation Therapy, Queen's University, OntarioDawn Stacey, Chair professor, School of Nursing, L’Université d’Ottawa/University of OttawaSascha Köpke, Professor, Institute of Nursing Science, University of CologneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1704122021-11-09T14:52:56Z2021-11-09T14:52:56ZSouth African front-page stories about COVID were sensationalist and unhelpful<figure><img src="https://images.theconversation.com/files/429924/original/file-20211103-17-j4z5b4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sensationalist coverage of the COVID-19 pandemic spreads fear and is unhelpful</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>When the World Health Organization (WHO) declared COVID-19 a global public health emergency <a href="https://www.researchgate.net/publication/340063000_WHO_declares_COVID-19_a_pandemic">in March 2020</a>, it became apparent that the news media’s role in communicating health information was going to be pivotal to help control the spread of the coronavirus and prevent disease. </p>
<p>As the world inches towards the end of the second year of the pandemic it’s useful to take a look at how well or otherwise it’s done.</p>
<p>Previous <a href="https://www.aimspress.com/article/10.3934/mbe.2020147">research</a> has shown that media reporting about COVID-19 can influence public attitudes towards the disease and help citizens understand how to protect themselves. The <a href="https://www.ejimed.com/article/online-news-media-framing-of-covid-19-pandemic-probing-the-initial-phases-of-the-disease-outbreak-in-8402">media</a> can also convey complicated health information in ways the public can understand. And it can also document the economic impact of the crisis and provide platforms for public debate about the issue.</p>
<p>The news media can also provide reliable, accurate information to help counter the <a href="https://www.who.int/health-topics/infodemic#tab=tab_1">‘infodemic’ </a> of abundant and often false information about key issues such as vaccines. </p>
<p>Trust levels in news media had been on the decline globally before the pandemic broke out. But they <a href="https://reutersinstitute.politics.ox.ac.uk/digital-news-report/2021/dnr-executive-summary">rebounded</a> as people sought reliable information from trusted news outlets. </p>
<p>But the media’s role hasn’t been unblemished. News media has <a href="https://pubmed.ncbi.nlm.nih.gov/29474133/">been accused</a> of covering the crisis in a way that incites panic, speculation and fear. And failing to offer solutions. </p>
<p>The COVID-19 pandemic has also exacerbated economic pressures on the media. This caused staff cuts and even closures of media outlets across the continent.</p>
<p>Against this background, we undertook <a href="https://www.ingentaconnect.com/content/intellect/jams/2021/00000013/00000003/art00003">a study</a> in which we asked the question: How did the South African news media cover the pandemic?</p>
<p>We found that front page reports were mostly alarmist, sensationalist and negative in tone. Moreover, these reports did not see much possibility for individual agency in combating the pandemic.</p>
<p>This finding is important as it suggests that South African newspapers could have contributed to public anxiety and fear. </p>
<h2>What we found</h2>
<p>We focused on print media. For three months (1 March to 30 May 2020), we collected data from 11 English-language daily and weekly newspapers in the country. Our <a href="https://www.ingentaconnect.com/content/intellect/jams/2021/00000013/00000003/art00003">study</a> focused only on newspaper front-page stories, as these stories usually represent what a particular news outlet considers the main news of the day.</p>
<p>We analysed 681 stories on COVID-19, to explore the ways in which the papers presented the COVID-19 pandemic to their readers. We based our content analysis on the assumption that media can shape the public’s understanding of a health crisis, as well as people’s behaviour.</p>
<p>We strove to focus on a cross-section of daily broadsheets, weekly papers, Sunday papers and tabloids.</p>
<p>Our study included national newspapers <a href="https://mg.co.za/">Mail and Guardian</a>, <a href="https://www.timeslive.co.za/sunday-times/">Sunday Times</a>, <a href="https://www.news24.com/citypress">City Press</a> and <a href="https://www.businesslive.co.za/bd/">Business Day</a>. We also looked at regional newspapers <a href="https://www.iol.co.za/capetimes">Cape Times</a>, <a href="https://www.news24.com/witness">The Witness</a>, <a href="https://www.dispatchlive.co.za/">Daily Dispatch</a>, <a href="https://www.sowetanlive.co.za/">Sowetan</a>, <a href="https://www.dfa.co.za/">Diamond Fields Advertiser</a>, <a href="https://mg.co.za/tag/sunday-sun/">Sunday Sun</a>, and <a href="https://www.iol.co.za/the-star">The Star</a>. </p>
<p>We found that almost half (47.79%) of the front-page reports in both the broadsheet ‘quality’ papers as well as the tabloid used an alarmist narrative when reporting on the pandemic. Reports are defined as <a href="https://journals.sagepub.com/doi/10.1177/0267323113486235">alarmist</a> when they are negative in tone, use fearful words and metaphors, use sensationalist and emotionally charged language, focus on worst-case scenarios, and provide limited information to help citizens reduce their personal risk.</p>
<p>The majority (55%) of front page reports were negative in tone, seeing very little possibility for individual agency and self-efficacy. Such alarmist and negative media coverage can amplify public anxieties and fears, instead of providing people information that may empower them to navigate the uncertainties they face amid the ‘infodemic’ from overabundant information.</p>
<p>Our analysis also found that most of the publications (72%) reported on the pandemic on their front pages in an episodic rather than thematic manner. This meant that reports were mainly superficial and event-oriented, rather than offering in-depth analysis. </p>
<p>We also found that the reporting was predominantly alarmist, negative and episodic. A large percentage of the articles also used sensationalist language. This means the specific use of words that make emotional appeals, with headlines such as ‘The war we have to win’, ‘Scramble for vital supplies’. </p>
<p>This perhaps makes sense, given the norms and conventions of hard news journalism and the practice of using front-page stories to attract readers. However, the danger is that readers might be put in unnecessary panic mode.</p>
<p>We also found that the majority (81.86 %) of the front-page reports didn’t provide health information or any information about how readers could avoid contracting or spreading the virus. </p>
<p>Only 3.23% of the reports debunked myths, rumours and gossip about the pandemic which were circulating widely on social media and messaging platforms. And, while the pandemic affected everyone, the voices that readers of South African newspaper front pages heard more than any other were those of men in power. </p>
<p>Just over half of the front-page reports quoted or cited government officials (49.49%). Almost three-quarters of these government officials were male (75.37%).</p>
<h2>Implications</h2>
<p>The ways in which the media report on a national and global health emergency could have implications for how society responds to big challenges and threats. Although our study was limited in its focus on front pages of newspapers, the findings nevertheless suggest a tendency to use alarmism and sensationalism to attract reader interest, without providing health information or offering solutions to mitigate their concerns. </p>
<p>The findings raise questions about the roles and responsibilities of South African newspapers in how they use their front pages to frame key issues, especially during times of crisis.</p><img src="https://counter.theconversation.com/content/170412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Herman Wasserman receives funding from the National Institute for Humanities and Social Sciences.</span></em></p><p class="fine-print"><em><span>Chikezie E. Uzuegbunam receives funding from Carnegie Corporation of New York. </span></em></p><p class="fine-print"><em><span>Tanja Bosch and Wallace Chuma do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The majority of front page reports were negative in tone, seeing very little possibility for individual agency and self-efficacy. This can amplify public anxiety and fear.Herman Wasserman, Professor of Media Studies in the Centre for Film and Media Studies, University of Cape TownChikezie E. Uzuegbunam, Postdoctoral research fellow, University of Cape TownTanja Bosch, Associate Professor in Media Studies and Production, University of Cape TownWallace Chuma, Associate professor, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1649252021-07-26T19:24:27Z2021-07-26T19:24:27ZWhat is the HIPAA Privacy Rule? A health law scholar explains<figure><img src="https://images.theconversation.com/files/412536/original/file-20210721-15-v35b38.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C5200%2C3456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">HIPAA allows you to control disclosure of certain types of personal health information.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/medical-records-new-and-old-royalty-free-image/92959399?adppopup=true">Heath Korvola/DigitalVision via Getty Images</a></span></figcaption></figure><p>The <a href="https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html">Health Insurance Portability and Accountability Act’s Privacy Rule</a> is a federal law prohibiting <a href="https://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html">health care providers, businesses and the people working with them</a> – including administrative staff, laboratories, pharmacies, health insurers and so on – from disclosing your health information without your permission.</p>
<p>When people talk about HIPAA, they typically refer to the <a href="https://www.ncbi.nlm.nih.gov/books/NBK9576/">Privacy Rule</a> provision established in 2003, which is just one part of a broader law initially passed by Congress in 1996. The Privacy Rule came into force after tennis star <a href="https://www.nytimes.com/1992/04/09/sports/an-emotional-ashe-says-that-he-has-aids.html">Arthur Ashe’s HIV status was publicly revealed</a> and country music star <a href="http://www.cmt.com/news/1475729/medical-worker-sentenced-over-wynette-medical-records/">Tammy Wynette’s health records were sold</a> to tabloids. People were starting to worry about genetic privacy. And Congress recognized that the internet would make it easier for health care privacy breaches to occur.</p>
<h2>Why the HIPAA Privacy Rule matters</h2>
<p>The HIPAA Privacy Rule gives you the right to control your health information disclosures so you can tell your health care provider what to share. If you don’t want to share some of your health information with your family members, you can tell your health care provider to withhold that information from them.</p>
<p>However, HIPAA only protects health care information held by specific kinds of health care providers. For example, health care data on your Apple Watch or Fitbit is not usually covered by HIPAA. Genetic data you enter on websites like Ancestry.com is also not covered by HIPAA. Other laws or agreements like the <a href="https://theconversation.com/nobody-reads-privacy-policies-heres-how-to-fix-that-81932">privacy disclosures required on many apps</a> may protect that information, but HIPAA does not.</p>
<p>Sometimes people try to use HIPAA as an excuse for actions it doesn’t actually cover. For instance, some people who refused to comply with coronavirus-related mask rules in stores asserted that they <a href="https://www.usatoday.com/story/news/factcheck/2020/07/19/fact-check-asking-face-masks-wont-violate-hipaa-4th-amendment/5430339002/">couldn’t be asked to explain why because of HIPAA protections</a>. But that’s not how this privacy law works: It’s legal for someone to ask you about your vaccination status. And anyone can provide information about their own vaccination status (or any personal health information) without violating HIPAA.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1417828273946509314"}"></div></p>
<h2>Are there exceptions to the HIPAA Privacy Rule?</h2>
<p><a href="https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html">Certain exceptions</a> to HIPAA’s nondisclosure requirements allow covered health care providers to disclose patient information to help treat another person, protect public health and aid in certain law enforcement investigations.</p>
<p>During a pandemic, for instance, public health departments can provide information about how many people have tested positive for a disease, but they cannot mention specific names to the general public unless it’s necessary to alert particular people that they may have been exposed. This is because HIPAA and other privacy laws require them not to release any more information than is needed to keep people safe.</p>
<p><em>Portions of this article originally appeared in a <a href="https://theconversation.com/what-is-hipaa-5-questions-answered-about-the-medical-privacy-law-that-protects-trumps-test-results-and-yours-147805">previous article published on Oct. 15, 2020</a>.</em></p>
<p><em>The Conversation U.S. publishes short, accessible explanations of newsworthy subjects by academics in their areas of expertise.</em></p><img src="https://counter.theconversation.com/content/164925/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret Riley does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While the HIPAA Privacy Rule prevents health care providers from sharing your health information without your permission, it doesn’t prevent other people from asking you about it.Margaret Riley, Professor of Law, Public Health Sciences, and Public Policy, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1555672021-03-01T19:09:49Z2021-03-01T19:09:49ZWe asked children around the world what they knew about COVID. This is what they said<figure><img src="https://images.theconversation.com/files/386340/original/file-20210225-15-d97ldc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-cute-girl-playing-playground-child-1814357357">from www.shutterstock.com</a></span></figcaption></figure><p>During the pandemic, children have been separated from family and friends, schools have been closed and there have been limitations on important activities, such as play.</p>
<p>We know a good deal about the <a href="https://theconversation.com/worried-about-your-child-getting-coronavirus-heres-what-you-need-to-know-131909">physical effects</a> COVID-19 <a href="https://theconversation.com/why-do-kids-tend-to-have-milder-covid-this-new-study-gives-us-a-clue-155555">has on children</a>. But the impact on their mental and emotional well-being is less well understood – particularly from the perspective of children themselves.</p>
<p>Our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246405">recently published research</a> highlights the importance of listening to children, about what they have to say and the information they want about COVID-19.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-kids-tend-to-have-milder-covid-this-new-study-gives-us-a-clue-155555">Why do kids tend to have milder COVID? This new study gives us a clue</a>
</strong>
</em>
</p>
<hr>
<h2>Here’s what we did</h2>
<p>We took part in an international study with children from six countries – the UK, Spain, Canada, Sweden, Brazil and Australia.</p>
<p>We recruited children through our professional and social networks, for example sporting groups and community groups. </p>
<p>We asked children aged seven to 12 years about how they accessed information about COVID-19, about their understandings of the virus and why they were asked to stay at home.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child's drawing of two coronaviruses." src="https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This drawing from Ben, aged 7, Tasmania, shows children express what they know about the coronavirus in many ways.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The survey was open when the highest level restrictions were in place across Tasmania, where the Australian arm of the study was based. In total, 49 children from Tasmania took part in the survey and 390 children internationally.</p>
<p>There were important differences across the countries when we conducted the survey, including the numbers of reported cases and deaths from COVID-19, as well as government responses and levels of restrictions. </p>
<p>For example, the reported deaths and cases were much higher in countries such as the UK and Brazil compared to Australia and children in Sweden continued to attend school, whereas most children in other countries were learning from home.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-it-time-for-australia-to-implement-kids-only-covid-19-briefings-144878">Is it time for Australia to implement kids-only COVID-19 briefings?</a>
</strong>
</em>
</p>
<hr>
<h2>Here’s what we found</h2>
<p>There were many similarities across the different countries in the things important to children, what they had to say and what they wanted to know. But there were also differences across countries and between children.</p>
<p>More than half the children said they knew a lot or quite a bit about COVID-19. Their comments included:</p>
<blockquote>
<p>It is a stupid virus.</p>
<p>It spreads really quickly.</p>
<p>People play it down and tell me it can’t kill people, but I know people are dying each day.</p>
</blockquote>
<p>But they also had questions:</p>
<blockquote>
<p>How and where did it start?</p>
<p>What does the coronavirus actually look like?</p>
<p>How does it make you poorly?</p>
</blockquote>
<p>Some said they did not want to know any more about the virus:</p>
<blockquote>
<p>It is boring.</p>
<p>I don’t want to know about it because it’s killing people and that makes me sad.</p>
</blockquote>
<p>Children expressed different emotions about COVID-19. They said they felt “worried”, “scared”, “angry” and “confused”. </p>
<p>Children knew the virus was particularly dangerous for vulnerable people: </p>
<blockquote>
<p>It can possibly kill old and unhealthy people. </p>
</blockquote>
<p>And they missed their friends and family:</p>
<blockquote>
<p>When can we go back to school?</p>
</blockquote>
<p>Children obtained information about COVID-19 from different sources, mostly from parents and teachers. Children also sought information from friends, TV shows and the internet, including social media.</p>
<p>Children understood what the community was being asked to do and they had learnt the meanings of new words and terms. So they knew what social distancing meant and that they needed to stay 1.5m apart. </p>
<p>Children also knew key public health messages about washing your hands, not touching your face and needing to stay at home “to save lives”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stupid-coronavirus-in-uncertain-times-we-can-help-children-through-mindfulness-and-play-135317">'Stupid coronavirus!' In uncertain times, we can help children through mindfulness and play</a>
</strong>
</em>
</p>
<hr>
<h2>Why does this matter?</h2>
<p>Children have had an important role in society’s response to COVID-19. Their significant contributions to limiting the spread of the virus have included being separated from family and friends, and limitations on important activities that are part of their “normal” lives. </p>
<p>However, the impacts on children’s lives and well-being are largely unacknowledged. Their contributions should be acknowledged and they should be thanked for their part.</p>
<p>Children have a right to be provided with information in a form that is appropriate for their safety and well-being. Children need to have the opportunity to ask questions and learn about what COVID-19 means for them with adults they trust, including parents and teachers.</p>
<p>Children have questions about COVID-19. Questions are different for each child and not all children want the same amount of information.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-tips-on-what-to-tell-your-kids-about-coronavirus-133346">8 tips on what to tell your kids about coronavirus</a>
</strong>
</em>
</p>
<hr>
<h2>What can adults do?</h2>
<p>Adults should make the time and space to have conversations with children. They can ask:</p>
<ul>
<li><p>what would you like to know?</p></li>
<li><p>what would you like to ask? </p></li>
</ul>
<p>This approach means children are empowered to identify their needs and concerns, and the information they are provided is relevant and meets their needs.</p>
<hr>
<p><em>Andrea Chelkowski, from the Centre for Education and Research — Nursing and Midwifery, Tasmanian Health Service South and University of Tasmania, Hobart, was part of the Australian research team. The lead author of the research mentioned in this article is Lucy Bray, professor in child health literacy, Edge Hill University, UK.</em></p><img src="https://counter.theconversation.com/content/155567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Ford is affiliated with the Centre for Education and Research — Nursing and Midwifery, Tasmanian Health Service South.</span></em></p><p class="fine-print"><em><span>Andrea Middleton is affiliated with the Centre for Education and Research — Nursing and Midwifery, Tasmanian Health Service South.</span></em></p><p class="fine-print"><em><span>Steven Campbell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What does the coronavirus look like? What kids want to know about the pandemic isn’t always what we tell them.Karen Ford, Adjunct Associate Professor, School of Nursing, University of TasmaniaAndrea Middleton, Lecturer, University of TasmaniaSteven Campbell, Professor of Clinical Redesign – Nursing, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1142282019-04-04T14:22:49Z2019-04-04T14:22:49ZScorecards can help measure health outcomes. An East Africa case study<figure><img src="https://images.theconversation.com/files/266839/original/file-20190401-177184-mb55af.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors at a hospital in Kisumu, Kenya.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Information is important for high level managers to make informed decisions. The advance of information and communication technology means that information is generated in abundance and at a fast pace. But this has led to managers facing information overload. This is particularly true in the health domain – a sector fragmented with information systems from a variety of data sources. </p>
<p>One way round the problem is to visually present the information from different sources on a single screen. This can enable data managers to monitor a comprehensive set of performance indicators at a glance and make informed decision.</p>
<p>A tool that enables this is the scorecard, or dashboard, which gives a full view of an organisation’s performance by using a “traffic light” visualisation to link short and long term goals. This concept was introduced by <a href="https://www.hbs.edu/faculty/Pages/item.aspx?num=8831">Robert Kaplan and David Norton</a> in 1996 and has since been used by managers in various sectors.</p>
<p>I conducted a <a href="https://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=8102381">study</a> over four years to understand how scorecards could be used in the East Africa Community to strengthen regional collaboration and address common health agendas. During the study a regional scorecard was developed, made up of indicators measuring health performance of partner states based on set targets.</p>
<h2>The scorecard</h2>
<p>The developed scorecard was used in the six partner states that make up the East African Community. These are Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. </p>
<p>The research was part of the larger global <a href="http://www.hisp.org/">Health Information System Program</a>. The initiative has been ongoing for the last 20 years and involves software development and country implementation of District Health Information Software in several countries in Africa, Asia, South America and Europe. I am part of the global network and have been engaged in implementing and evaluating health information systems in several of these projects in Africa. </p>
<p>The East African Community scorecard was first used to monitor maternal and child health care. </p>
<p>A set of indicators measuring countries’ maternal and child health care performance were selected in the design of the regional scorecard. Data populating the selected indicators were periodically pulled from the national level health information system. </p>
<p>For example, one indicator included in the scorecard measured the percentage of women who visit health facilities at least four times during pregnancy. This indicator was based on World Health Organisation (WHO) <a href="https://www.who.int/reproductivehealth/news/antenatal-care/en/">recommendations</a> which have since been increased to eight visits. </p>
<p>The scorecard was designed and developed by regional and national health information systems experts as well as officials responsible for maternal and child health policies in the partner states’ ministries of health. The development process entails a series of face to face meetings complimented with off-site discussions. Members from health information initiatives were also part of the implementation process.</p>
<p>The regional scorecard measured the countries’ performance by displaying a red colour where performance was off track, a yellow colour for progress but requiring more effort, and the green colour indicating the target achieved. </p>
<p>The first regional scorecard was launched on 2015 in the East African Community. The event brought together ministers in the region responsible for health, selected parliamentarians, the academia and development partners. </p>
<p>Using a colour coded approach, the scorecard managed to capture the attention of leaders from the region by quickly identifying the indicators with poor performance as well as those that needed more drive to achieve agreed targets. </p>
<p>By arranging the countries together while showing their performance, the scorecard generated a competition element among leaders. For example, while progress was observed from Rwanda and Tanzania in reducing child mortality, progress towards maternal health goals was slow across the rest of the region. </p>
<p>This awareness prompted ministers of health and parliamentarians to commit resources to areas with lower performance. </p>
<p>In addition, the leaders of the East African Community endorsed the first regional scorecard, and asked for it to be produced <a href="https://healthdata.eac.int">annually</a>.</p>
<h2>Lessons learnt</h2>
<p>A few useful lessons were learnt from the research. It showed that the scorecard was:</p>
<ul>
<li><p>An effective communication tool. By using the traffic light display, managers could track performance of several indicators. Its visualisation enabled information to be understood at a glance.</p></li>
<li><p>Useful as the basis for performance benchmarking: understanding areas that affect the success or failure of the organisation is of a paramount importance in the management of complex system like health sector. </p></li>
<li><p>A good advocacy tool. It can be used in discussions among technical and non-technical stakeholders in viewing the progress and address challenges.</p></li>
</ul>
<h2>Way forward</h2>
<p>Based on the experience in East Africa Community we believe the scorecard can be useful in creating awareness among high level managers and engaging them in a broader discussion on improving the maternal and child health care. Managers can rely on the scorecard to quickly inform them of the performance of their organisation as well as what progress is being made towards a defined set of targets.</p>
<p>We are working on a third version of the scorecard for the East Africa community to be integrated into other health programmes such as HIV and TB.</p><img src="https://counter.theconversation.com/content/114228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wilfred Senyoni does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>East African countries use a scorecard to monitor maternal and child health progress in the region.Wilfred Senyoni, PhD Candidate in Information Systems, University of OsloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/852362017-10-11T23:37:56Z2017-10-11T23:37:56ZSleeping on your back increases risks of stillbirth<figure><img src="https://images.theconversation.com/files/190192/original/file-20171013-3537-uh6o55.jpg?ixlib=rb-1.1.0&rect=15%2C101%2C5031%2C3193&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research reveals two strategies women can use to lower the risks of stillbirth: counting kicks, and sleeping on their left side. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p><a href="http://www.october15.ca/about/">Pregnancy and Infant Loss Awareness day</a> on Oct. 15, 2017 draws our attention to a bleak statistic — an estimated <a href="https://www.tommys.org/our-organisation/charity-research/pregnancy-statistics/miscarriage">one in four pregnancies end in a loss</a>. Many of these are early miscarriages. But in Canada about <a href="http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=1024515">one in 125 pregnancies end in a stillbirth</a> — that is, the death of a fetus <em>in utero</em> after 20 weeks gestation. </p>
<p>Countries such as Korea and Finland have much <a href="http://dx.doi.org/10.1016/S0140-6736(15)00837-5">lower rates of stillbirth</a>, so we know that there is more we can do to prevent it. There is research on the risk factors that increase the chances of a stillbirth. Yet many pregnancy guides do not give enough information about stillbirth, in the belief that women do not want to be frightened about pregnancy loss. </p>
<p>Information about how to prevent stillbirth needs to get into the hands of women who need it, even if it leads to an uncomfortable conversation. As a medical librarian, my job is to connect people to trusted information about their health. When dealing with a taboo topic, such as stillbirth, this is even more challenging as both health care providers and women might be afraid of increasing anxiety, rather than improving health. </p>
<p>We also want to ensure that women who have had a stillbirth in the past and may have slept on their back do not feel guilt over doing so. I know, because I myself have had a stillbirth. With the passage of time, I cannot honestly answer how I might have slept that night when my twins died, but it is still something that worries me.</p>
<p>While some risk factors are not things most pregnant women can change, there are two very simple things women can do, to lower the odds.</p>
<h2>1. Count the kicks</h2>
<p>There are <a href="https://doi.org/10.1002/14651858.CD004909.pub3">two methods</a> described in the medical literature about how to count your baby’s kicks: the Sadovsky method and the Cardiff method. In the Cardiff method, you count 10 movements and record how much time it takes for you to reach 10. In the Sadovsky method, you are asked to count how many movements you feel within a specific time frame, usually 30 minutes to two hours. In either case, the most important consideration is that you should be aware of your baby’s normal movements. </p>
<p>Any decrease in fetal movement should prompt a phone call or visit to your health care provider immediately. We don’t shame people for seeking medical advice when they have chest pains. Reduced fetal movements are similar to chest pains — a warning sign that something could be wrong. See your doctor or midwife and don’t delay or feel guilty for taking up their time! </p>
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<h2>2. Don’t sleep on your back</h2>
<p>At last month’s <a href="http://isacork2017.com/">International Stillbirth Alliance conference</a>, several researchers presented information to show that back sleeping increased the risk of stillbirth. </p>
<p>In the <a href="https://doi.org/10.1186/s12884-017-1457-7">first study</a>, researchers in New Zealand put 10 pregnant women who were otherwise healthy into MRI scanners, to see if they could see changes in blood flow when they were lying on their backs or on their left side. They found that cardiac output (how efficiently the heart pumps blood) was the same in both positions. </p>
<p>However the blood flow and diameter of the inferior vena cava were reduced when lying on their backs. This affects how blood flows back to the heart from the body. The researchers speculate that this might contribute to stillbirths in some instances. </p>
<p>The <a href="https://doi.org/10.1186/s12884-017-1457-7">second study</a>, also from New Zealand, placed 30 pregnant women in a sleep lab. They monitored their breathing and position throughout the night to see if there was a relationship between lying on their backs and measured breathing. While none of the women met the criteria for sleep apnea, they didn’t breathe in as deeply when they were lying on their backs. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"917404312971685888"}"></div></p>
<p>Lastly, <a href="https://doi.org/10.1186/s12884-017-1457-7">researchers in the UK</a> interviewed over 1000 women about their sleep practices before pregnancy, during pregnancy and the night before their stillbirth (for those who had suffered one) or the interview (for women who had not suffered one). The women who had gone to sleep on their backs while pregnant were twice as likely to have had a stillbirth then women who had gone to sleep on their left side. </p>
<p>All of this was a follow up to <a href="https://doi.org/10.1371/journal.pone.0179396">earlier research</a> which had proposed the same hypothesis, that sleeping on your back increased the risk.</p>
<h2>Women need accurate health information</h2>
<p>Delivering timely information to prevent stillbirth is important, and withholding information out of a fear you’ll frighten women is patronising at best and potentially dangerous at worst. </p>
<p>What’s more, witholding information does little in an era where most people can get online and are not always equipped to evaluate what information is useful and how to put it into context. Health care providers can do more to partner with librarians on delivering evidence-based information to their patients. This is certainly true with information about pregnancy, but also in many areas of health where the information that needs to be delivered is complex, and requires more time to be evaluated than is available to most doctors.</p>
<p>Women deserve better communication about their health and the health of their babies when pregnant. While counting kicks and sleeping on your left side aren’t a guarantee that you’ll have a safe and healthy pregnancy, they are easy, low cost ways to reduce the risk.</p><img src="https://counter.theconversation.com/content/85236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Ross-White is the author of Joy at the End of the Rainbow: A Guide to Pregnancy After a Loss</span></em></p>Research suggests that sleeping on your back can increase the chances of stillbirth. Pregnant women need better access to such vital information.Amanda Ross-White, Health Sciences Librarian, Nursing and Information Scientist, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/812382017-07-26T23:20:49Z2017-07-26T23:20:49ZWomen pregnant after a loss need better support<figure><img src="https://images.theconversation.com/files/179675/original/file-20170725-30116-1ljkche.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Much health information emphasizes the role of personal responsibility in maintaining a healthy pregnancy. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In a hospital waiting room, dozens of pregnant women and their families are waiting for their turn to be called. They can’t wait to find out the sex of the baby. They can’t wait for those first ultrasound pictures. </p>
<p>But one woman sits in a dark corner with her partner. She isn’t excited at all. The last time she was here was when she found out her baby died. And she’s terrified. </p>
<p>Unfortunately, this is a common situation. An estimated one in four pregnancies ends in a miscarriage. In Canada, about <a href="http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=1024515">one in 125 pregnancies</a> ends in a stillbirth, which is the death of a fetus in utero after 20 weeks’ gestation. </p>
<p>Women who’ve had a pregnancy loss often feel <a href="http://dx.doi.org/10.1111/1471-0528.12656">fear, anxiety and uncertainty</a> during a subsequent pregnancy, as well as joy. Key times like <a href="http://dx.doi.org/10.1080/15325020590908876">ultrasounds can be traumatic</a>. These women can be <a href="http://dx.doi.org/10.1097/01.NNR.0000263970.08878.87">frustrated by health information</a> that does not recognize their conflicting emotions. </p>
<p>As a medical librarian, my job is to connect people to trusted information about their health. Medical librarians research how people find and use health information in many contexts. So when I lost my twin sons to stillbirth at 36 weeks, I was disappointed that there was little information available for women like me — women who were pregnant again, but without having given birth to a live baby.</p>
<h2>Stillbirth as failure</h2>
<p>I conducted a research project in which <a href="https://joyattheendoftherainbow.com">I interviewed six women in depth</a> over the course of their pregnancies after loss. I wanted to know what sort of information would be helpful to them throughout the various stages of their pregnancies. How did they want to receive information about their pregnancy? What were their greatest concerns? How were they managing their emotions?</p>
<p>Most pregnancy books and websites downplay the risks of pregnancy loss. Instead, they emphasize the role of personal responsibility in maintaining a healthy pregnancy. My research found that for women who have experienced a loss, this can be both isolating and condescending. For example, the slogan to Health Canada’s website on pregnancy is <a href="http://www.phac-aspc.gc.ca/hp-gs/index-eng.php">“A Healthy Pregnancy is in Your Hands.”</a> To a woman who had a loss in her last pregnancy, it implies that it was her fault. Even the word miscarriage can suggest that it is the woman who failed to carry the pregnancy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179680/original/file-20170725-30125-hcvjn5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179680/original/file-20170725-30125-hcvjn5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179680/original/file-20170725-30125-hcvjn5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179680/original/file-20170725-30125-hcvjn5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179680/original/file-20170725-30125-hcvjn5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179680/original/file-20170725-30125-hcvjn5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179680/original/file-20170725-30125-hcvjn5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women who are pregnant after losing a child can find themselves isolated with their fears.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>While much of the information these women want is the same as other women, they want it delivered in a way that is sensitive to their past experience. An ultrasound is a joyful time to catch a glimpse of your baby, get keepsake photos and more information about the health of your baby. It is also a frightening time when a woman might experience flashbacks, or get reassurance that her baby is growing normally.</p>
<h2>Navigating pregnancy questions</h2>
<p>Women are also interested in pregnancy information that is unique to the experience of loss. Many of the women I interviewed wanted guidance on how to navigate common pregnancy questions, such as an innocent stranger in the grocery store line asking “Is this your first?” A simple question for many people, but a loaded one for a woman who is pregnant after a loss. People are often uncomfortable discussing miscarriage and stillbirth and answering that this isn’t your first can lead to further questions as people assume that you have a child at home. </p>
<p>Other sources of pregnancy information, such as prenatal classes, can also be difficult for these women. Most hospitals and health units offer these classes for new mothers, but the women I interviewed felt reluctant to attend as their past histories were not welcomed by the other women, who wanted only positive affirmations about pregnancy and giving birth. </p>
<p>While larger hospitals, like <a href="http://sunnybrook.ca/content/?page=wb-subsequent-pregnancy">Sunnybrook</a> in Toronto, have dedicated departments for women who are pregnant after a loss, this isn’t available to everyone. And women in rural or remote areas often have <a href="https://dx.doi.org/10.1097/NMC.0b013e3182057335">limited access</a> to in-person support. </p>
<p>Delivering health information that is relevant to a women’s unique issues shouldn’t be this much of a challenge. Pregnancy after a loss is common, so it’s time pregnancy guides reflected this.</p>
<p><em>Amanda Ross-White is the author of <a href="https://joyattheendoftherainbow.com/">Joy at the End of the Rainbow: A Guide to Pregnancy After a Loss</a>.</em></p><img src="https://counter.theconversation.com/content/81238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Ross-White is the author of a book on pregnancy after a loss, Joy at the End of the Rainbow: A Guide to Pregnancy After a Loss.</span></em></p>After a miscarriage or stillbirth, pregnancy can involve intense fear and anxiety for many women. More sensitive health information could help.Amanda Ross-White, Health Sciences Librarian, Nursing and Information Scientist, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/698642016-12-05T04:25:09Z2016-12-05T04:25:09ZIntroducing competition to the health sector should be treated with caution<figure><img src="https://images.theconversation.com/files/148545/original/image-20161205-25653-wjd8h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We can't say whether introducing competition to the health sector would work in the same way as other markets. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>The Productivity Commission’s study report on introducing <a href="http://www.pc.gov.au/inquiries/current/human-services/identifying-reform/report">competition into human services</a> was <a href="http://www.smh.com.au/federal-politics/political-news/hospitals-housing-and-dental-services-ripe-for-privatisation-says-productivity-commission-report-20161204-gt3llf.html">quickly labelled as proposing</a> privatisation of hospital, end-of-life and dental services.</p>
<p>This isn’t really the case. The report is actually quite cautious and not too radical. Whether the next phase of the commission’s work follows the same careful approach is yet unknown.</p>
<p>The Productivity Commission has adopted a two-stage approach; the report released today marks the end of the inquiry’s first stage. This “study report” does not make recommendations, simply “findings” based on its research and consultations. This report aims to identify priorities for the next phase of investigation.</p>
<p>What is peculiar about this report is that it is a report by a <em>Commonwealth</em> agency investigating <em>state</em> services – public hospitals, public dental services and specialist palliative care are all majority-funded by states – and providing advice which may not take into account the day-to-day service realities. </p>
<p>The report ignored primary medical care, an area where the Commonwealth has responsibility. The increasing corporatisation of general practice, and the potential for strengthening information about primary-care quality, probably should have been included. This leads one to ask what criteria were used when deciding what to cover.</p>
<h2>More information is good</h2>
<p>A theme of the report is that service responsiveness – of public hospitals, dental services and end-of-life care – would be enhanced if consumers knew more about what the services delivered in terms of outcomes (quality of care) and timeliness.</p>
<p>This finding seems pretty innocuous and obvious. Even so, the Productivity Commission put some fairly large caveats on its findings. For example, it noted health literacy – the ability to understand options and make choices about health care – is not evenly distributed, so patients with low levels of health literacy would need support to use information that may become available. </p>
<p>Patients at the end of their lives may be vulnerable to inappropriate pressure and may need to be protected.</p>
<p>There is now an immense body of literature about the value of public reporting of hospital outcomes, and the commission <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1543-y">cites a systematic review</a> which finds modest benefits from introduction of public reporting.</p>
<p>However, what is still unclear is how this improvement occurs. There is little evidence patients use the information provided. There have been <a href="http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/19105440">calls to spend more energy</a> working out what will improve care, rather than simply reporting on outcomes. </p>
<p>Notwithstanding that, contemporary best practice is to have more information about quality (and other measures) in the public domain. That is so even if this is only to stimulate hospitals and other agencies to be more aware of their own performance and thus enhance their own motivation to improve.</p>
<h2>Competition is not a panacea</h2>
<p>The terms “<a href="https://theconversation.com/is-medicare-under-threat-making-sense-of-the-privatisation-debate-61308">privatisation</a>”, “competition” and “pro-competitive” reforms have many meanings. At one end of a continuum, competition could simply mean providing more information to general practitioners to help them with referrals. Further along the continuum, one could see enhanced ability of patients to choose among public providers. A more radical approach would be to allow choice between public and private providers. </p>
<p>Competition can enhance quality in normal markets, but health markets don’t always follow the same rules. A <a href="http://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP139_market_structure_patient_choice_hospital_quality.pdf">recent report</a>, which looked at the impact of competition and consumer-choice reforms in England on quality of care for elective procedures, found quality of care for hip and knee replacement appeared to fall. But quality for coronary bypass patients was not affected (either positively or negatively).</p>
<p>This study reinforces the long-held “it depends” finding of theoretical economists: competition can have a positive impact on health-care quality, but only in some places. The report doesn’t look at whether Australia’s health-care system would be one of these places.</p>
<p>As the commission’s report notes, there are costs in implementing reforms. This is even more true if the competition reform is poorly designed or implemented. The most notable recent example of policy failure is the introduction of competition into the <a href="https://theconversation.com/privatisation-of-vocational-education-isnt-working-37788">vocational education market</a>. </p>
<p>Together, this means pro-competition policies in the health sector are no panacea, and may even cause harm.</p>
<p>The main problem with the commission’s report is the frame adopted. The commission was given a hammer by Treasurer Scott Morrison who charged it with examining “competition and user choice”. The commission started with that frame and found a whole lot of nails. </p>
<p>It was not asked how best to improve quality, for example. Starting in a different place would almost certainly have produced a different outcome.</p>
<p>Although the commission’s report adopts a cautious approach, more could have been written about the prerequisites that need to be in place before pro-competitive reforms are introduced. Heeding the <a href="https://www.accc.gov.au/media-release/privatisation-needs-smarter-regulation">Australian Competition and Consumer Commission’s warnings</a> about the need for robust regulation is one example.</p>
<p>As it is, the commission has probably done as well as could be expected from its terms of reference. It has produced a cautious report which will give some stimulus to more public reporting. It has not given its unqualified support for more competition, because if it did, it would be going well beyond any evidence.</p><img src="https://counter.theconversation.com/content/69864/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Headlines pointed to the privatisation of hospital, end-of-life and dental services, but the Productivity Commission’s report is actually a lot less radical.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.