tag:theconversation.com,2011:/us/topics/medical-advice-30257/articlesMedical advice – The Conversation2023-09-19T13:24:20Ztag:theconversation.com,2011:article/2132662023-09-19T13:24:20Z2023-09-19T13:24:20ZChatbots for medical advice: three ways to avoid misleading information<p>We expect medical professionals to give us reliable information about ourselves and potential treatments so that we can make informed decisions about which (if any) medicine or other intervention we need. If your doctor instead “bullshits” you (yes – this term has been used in <a href="https://press.princeton.edu/books/hardcover/9780691122946/on-bullshit">academic publications</a> to refer to persuasion without regard for truth, and not as a swear word) under the deception of authoritative medical advice, the decisions you make could be based on faulty evidence and may result in harm or even death. </p>
<p>Bullshitting is distinct from lying – liars do care about the truth and actively try to conceal it. Indeed bullshitting can be <a href="https://theconversation.com/trump-isnt-lying-hes-bullshitting-and-its-far-more-dangerous-71932">more dangerous</a> than an outright lie. Fortunately, of course, doctors don’t tend to bullshit – and if they did there would be, one hopes, consequences through ethics bodies or the law. But what if the misleading medical advice didn’t come from a doctor?</p>
<p>By now, most people have heard of <a href="https://theconversation.com/unlike-with-academics-and-reporters-you-cant-check-when-chatgpts-telling-the-truth-198463">ChatGPT</a>, a very powerful chatbot. A chatbot is an algorithm-powered interface that can mimic human interaction. The use of chatbots is becoming <a href="https://theconversation.com/everyones-having-a-field-day-with-chatgpt-but-nobody-knows-how-it-actually-works-196378">increasingly widespread</a>, including for <a href="https://www.scientificamerican.com/article/ai-chatbots-can-diagnose-medical-conditions-at-home-how-good-are-they/">medical advice</a>. </p>
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<a href="https://theconversation.com/chatgpts-greatest-achievement-might-just-be-its-ability-to-trick-us-into-thinking-that-its-honest-202694">ChatGPT's greatest achievement might just be its ability to trick us into thinking that it's honest</a>
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<p>In a <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2023.1254334/full">recent paper</a>, we looked at ethical perspectives on the use of chatbots for medical advice. Now, while ChatGPT, or similar platforms, might be useful and reliable for finding out the best places to see in Dakar, to learn about wildlife, or to get quick potted summaries of other topics of interest, putting your health in its hands may be playing Russian roulette: you might get lucky, but you might not. </p>
<p>This is because chatbots like ChatGPT try to persuade you <a href="https://theconversation.com/chatgpts-greatest-achievement-might-just-be-its-ability-to-trick-us-into-thinking-that-its-honest-202694">without regard for truth</a>. Its rhetoric is so persuasive that gaps in logic and facts are obscured. This, in effect, means that ChatGPT includes the generation of bullshit.</p>
<h2>The gaps</h2>
<p>The issue is that ChatGPT is not really artificial intelligence in the sense of actually recognising what you’re asking, thinking about it, checking the available evidence, and giving a justified response. Rather, it looks at the words you’re providing, predicts a response that will sound plausible and provides that response. </p>
<p>This is somewhat similar to the predictive text function you may have used on mobile phones, but much more powerful. Indeed, it can provide very persuasive bullshit: often accurate, but sometimes not. That’s fine if you get bad advice about a restaurant, but it’s very bad indeed if you’re assured that your odd-looking mole is not cancerous when it is.</p>
<p>Another way of looking at this is from the perspective of logic and rhetoric. We want our medical advice to be scientific and logical, proceeding from the evidence to personalised recommendations regarding our health. In contrast, ChatGPT wants to sound persuasive <a href="https://www.embopress.org/doi/full/10.15252/embr.202357501">even if it’s talking bullshit</a>. </p>
<p>For example, when asked to provide citations for its claims, ChatGPT often <a href="https://www.embopress.org/doi/full/10.15252/embr.202357501">makes up references</a> to literature that doesn’t exist – even though the provided text looks perfectly legitimate. Would you trust a doctor who did that?</p>
<h2>Dr ChatGPT vs Dr Google</h2>
<p>Now, you might think that Dr ChatGPT is at least better than Dr Google, which people also use to try to self-diagnose. </p>
<p>In contrast to the reams of information provided by Dr Google, chatbots like ChatGPT give concise answers very quickly. Of course, Dr Google can fall prey to misinformation too, but it does not try to sound convincing.</p>
<p>Using Google or other search engines to identify verified and trustworthy health information (for instance, from the <a href="https://www.who.int/">World Health Organization</a>) can be very beneficial for citizens. And while Google is known for capturing and recording user data, such as terms used in searches, <a href="https://theconversation.com/chatgpt-is-a-data-privacy-nightmare-if-youve-ever-posted-online-you-ought-to-be-concerned-199283">using chatbots may be worse</a>. </p>
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Read more:
<a href="https://theconversation.com/chatgpt-is-a-data-privacy-nightmare-if-youve-ever-posted-online-you-ought-to-be-concerned-199283">ChatGPT is a data privacy nightmare. If you’ve ever posted online, you ought to be concerned</a>
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<p>Beyond potentially being misleading, chatbots may record data on your medical conditions and actively request more personal information, leading to more personalised – and possibly more accurate – bullshit. Therein lies the dilemma. Providing more information to chatbots may lead to more accurate answers, but also gives away <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2023.1254334/full#B22">more personal health-related information</a>. However, not all chatbots are like ChatGPT. Some may be more specifically designed for use in medical settings, and advantages from their use may outweigh potential disadvantages.</p>
<h2>What to do</h2>
<p>So what should you do if you’re tempted to use ChatGPT for medical advice despite all this bullshit?</p>
<p>The first rule is: don’t use it. </p>
<p>But if you do, the second rule is that you should check the accuracy of the chatbot’s response – the medical advice provided may or may not be true. Dr Google can, for instance, point you in the direction of reliable sources. But, if you’re going to do that anyway, why risk receiving bullshit in the first place?</p>
<p>The third rule is to provide chatbots with information sparingly. Obviously, the more personalised data you offer, the better the medical advice you get. And it can be difficult to withhold information as most of us willingly and voluntarily give up information on mobile phones and various websites anyway. Adding to this, chatbots can also ask for more. But more data for chatbots like ChatGPT could also lead to more persuasive and even personalised inaccurate medical advice.</p>
<p>Talking bullshit and misuse of personal data is certainly not our idea of a good doctor.</p><img src="https://counter.theconversation.com/content/213266/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors 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>What should you do if you’re tempted to use ChatGPT for medical advice? For starters, don’t use it.David Martin Shaw, Bioethicist, Department of Health Ethics and Society, Maastricht University and Institute for Biomedical Ethics, University of BaselPhilip Lewis, Research associate, University of CologneThomas C. Erren, Professor, University of CologneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1651552021-09-17T12:19:35Z2021-09-17T12:19:35ZA direct recommendation from a doctor may be the final push someone needs to get vaccinated<figure><img src="https://images.theconversation.com/files/421188/original/file-20210914-23-t44jsf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2146%2C1391&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sometimes facts and statistics aren't enough to convince someone to get the COVID-19 vaccine.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/offering-patient-centred-care-that-proves-effective-royalty-free-image/1301555107">PeopleImages/E+ via Getty Images</a></span></figcaption></figure><p>Have you found yourself feeling frustrated when trying to convince a friend or family member to get vaccinated for COVID-19? Or maybe you are that friend or family member, and you’re fed up with people pushing you to get vaccinated.</p>
<p>Though the science is clear that <a href="http://dx.doi.org/10.15585/mmwr.mm7023e2">COVID-19 vaccines save lives</a>, it can be difficult to start a productive conversation about vaccination. And doctors experience the same challenge, too.</p>
<p>We are researchers at the UMass Chan Medical School who have been trying to address this challenge. One of us is a <a href="https://profiles.umassmed.edu/display/129771">critical care pulmonologist</a> who was on the front lines working in the COVID-19 intensive care unit during the darkest days of the pandemic. And one of us has <a href="https://scholar.google.com/citations?user=7NUJtB0AAAAJ&hl=en">studied patient perspectives on health and health care</a> for many years. To figure out how doctors can best talk to their patients about vaccination, we first needed to understand what patients were concerned about.</p>
<h2>Why people choose to get vaccinated (or not)</h2>
<p>In April 2020, when vaccines for COVID-19 were still undergoing testing, we <a href="https://doi.org/10.7326/M20-3569">asked 1,000 adults across the U.S.</a> about their vaccination plans, and why. Around 3 in 10 were not sure whether they would get vaccinated, and 1 in 10 planned not to get vaccinated. Both groups gave a variety of reasons for their reluctance, including concerns about vaccine safety and side effects, wanting to wait for additional information, thinking they were not personally at risk, and distrust of the government, the Centers for Disease Control and Prevention, or vaccines. </p>
<p>We then <a href="http://dx.doi.org/10.17294/2330-0698.1882">conducted another survey in January 2021</a> just as the vaccine was becoming available to the public, with a new sample of about 1,700 people. Reasons for vaccine reluctance hadn’t changed since April 2020. The most common reasons were concerns about vaccine safety, speed of vaccine development and insufficient testing, as well as a general distrust of the COVID-19 vaccines. </p>
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<p>In addition, we found that those who planned on getting vaccinated knew more about COVID-19 transmission, the potential health effects of the disease and vaccine effectiveness. They also were much more likely to rely on data and statistics when making decisions about their health than those who were hesitant about getting vaccinated.</p>
<h2>Doctors can make a difference</h2>
<p>If people who are reluctant to get vaccinated don’t rely on statistics to make health decisions, what do they rely on? </p>
<p>Turns out their doctor plays a big role. <a href="https://doi.org/10.1016/j.vaccine.2017.12.016">Several</a> <a href="https://doi.org/10.1542/peds.2017-2312">studies</a> <a href="https://doi.org/10.1016/j.vaccine.2016.01.023">have shown</a> that many people rely on their doctor’s advice in making decisions about vaccines.</p>
<p>We tested different approaches doctors could take to talk to their patients about the COVID-19 vaccine. While all of the messages included statements that the patient was eligible for a safe and effective vaccine, they differed by what the doctor said following this information.</p>
<p>We found that the most effective message was an explicit recommendation (“I recommend that you get it”) coupled with a reference to protecting others (“It’s the best way to protect the people you are close to and keep them healthy”). About 27% of those who received this message became more likely to get vaccinated.</p>
<p>In comparison, the least effective message was elective, or open-ended (“So what do you think?”) – only 13% were more likely to be vaccinated after receiving this message.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-important">The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p>
<p>When we followed up with people who were initially hesitant six months later, about 33% had since gotten vaccinated. Notably, of those who had a conversation with their doctor directly recommending vaccination, 52% had been vaccinated, compared to only 11% of those whose doctor had not recommended the vaccine.</p>
<p>Their reasons for vaccination varied. More than half cited wanting to protect others. Others expected that vaccination would be required, or were worried about getting COVID-19.</p>
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<a href="https://images.theconversation.com/files/421387/original/file-20210915-20-1kt8nmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Masked health care provider in green scrubs talking to patient." src="https://images.theconversation.com/files/421387/original/file-20210915-20-1kt8nmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/421387/original/file-20210915-20-1kt8nmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/421387/original/file-20210915-20-1kt8nmg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/421387/original/file-20210915-20-1kt8nmg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/421387/original/file-20210915-20-1kt8nmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/421387/original/file-20210915-20-1kt8nmg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/421387/original/file-20210915-20-1kt8nmg.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">How doctors talk about vaccination with their patients can influence whether they decide to get vaccinated.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-talking-to-patient-royalty-free-image/1225529688">Aekkarak Thongjiew/EyeEm via Getty Images</a></span>
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<h2>What can you do?</h2>
<p>Getting at the heart of what motivates someone can be an important step in understanding their point of view. These findings may help you have more effective conversations with your family and friends – and even your own doctor.</p>
<p>If you are vaccinated and are seeking to encourage a friend or family member who is not:</p>
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<li><p>Suggest that they talk to their doctor. The COVID-19 vaccines are <a href="https://www.cdc.gov/vaccines/covid-19/downloads/Guide-for-Jurisdictions-on-PCP-COVID-19-Vaccination.pdf">becoming available in doctors’ offices</a>, which will make it easier to get vaccinated in a familiar setting. Their doctor may also be able to provide the reassurance they need to feel good about getting the vaccine.</p></li>
<li><p>Talk about protecting others. Tell them how good it feels to play a role in reducing the spread of a potentially deadly disease.</p></li>
<li><p>Talk about protecting yourself. Tell them how freeing it is to feel safe. </p></li>
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<p>If you are not vaccinated, but are wondering whether you should be:</p>
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<li><p>Talk to your doctor. Tell your doctor what worries you about getting vaccinated. Your doctor has current, accurate information on the COVID-19 vaccines and can answer your questions. You may be able to get vaccinated during your visit. If not, your doctor can give you information on where to get vaccinated.</p></li>
<li><p>Talk to people who have been vaccinated. Many have said they were <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-in-their-own-words-six-months-later/">nervous or afraid</a> to get vaccinated, but once they received their COVID-19 shot, they felt safe and relieved.</p></li>
<li><p>Consider how you might feel in different situations. Some people don’t mind <a href="https://theconversation.com/emotion-is-a-big-part-of-how-you-assess-risk-and-why-its-so-hard-to-be-objective-about-pandemic-precautions-165917">taking chances</a> with their own health. Others can picture what it’s like to be in a hospital for weeks or be hooked up to a ventilator, and don’t want to take that risk. And almost everyone would feel terrible if they were <a href="https://www.nbcnews.com/news/us-news/i-gave-my-dad-covid-19-survivors-grapple-guilt-infecting-n1207921">responsible for someone they cared about getting very sick</a>.</p></li>
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<p>Figuring out how to have a productive conversation about COVID-19 vaccines can be difficult. Looping in your doctor is one way to close the communication gap.</p><img src="https://counter.theconversation.com/content/165155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathleen Mazor receives funding from the National Library of Medicine and the UMass Chan Medical School. </span></em></p><p class="fine-print"><em><span>Kimberly Fisher receives funding from the National Library of Medicine and the UMass Chan Medical School.</span></em></p>There are a variety of reasons why people do or don’t want to be vaccinated. Depending on how they frame their messaging around vaccination, doctors can often be the deciding factor.Kathleen Mazor, Professor of Medicine, UMass Chan Medical SchoolKimberly Fisher, Associate Professor of Pulmonology, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1516702020-12-29T14:19:57Z2020-12-29T14:19:57ZSeat belts and smoking rates show people eventually adopt healthy behaviors – but it can take time we don’t have during a pandemic<figure><img src="https://images.theconversation.com/files/376416/original/file-20201222-15-1l2l98c.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4683%2C3713&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Once upon a time, buckling up was new behavior.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/young-woman-fastening-seat-belt-news-photo/931844278">Harold M. Lambert/Archive Photos via Getty Images</a></span></figcaption></figure><p>Why do we do things that are bad for us – or not do things that are good for us – even in light of overwhelming evidence? </p>
<p>As someone with a <a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C39&q=author%3A%22Juhl+rp%22&btnG=">long career in pharmacy</a>, I have witnessed some pretty dramatic shifts in public health behavior. But I won’t sugarcoat it. It generally takes years – or even decades – of dragging people, kicking and screaming, to finally achieve new and improved societal norms.</p>
<p>This plodding time course seems to be an innate human defect that existed long before the current-day pandemic mask and social distancing conundrums. Historically, people aren’t fond of being told what to do.</p>
<h2>Notable victories</h2>
<p>Attitudes toward smoking have undergone dramatic changes over the past 50 years. Although there has been a gradual decline in smoking, from 42% of the American population in 1965 to the low teens today, there still are <a href="https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/overall-tobacco-trends">a lot of smokers in the U.S.</a> – and premature deaths due to smoking. Even <a href="https://www.doi.org/10.1371/journal.pone.0220168">health care workers fall prey</a> to this unhealthy and highly addictive habit.</p>
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<a href="https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two 1970s era older male politicians posting a sign that reads 'For your health and safety and the comfort of others, no smoking.'" src="https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=476&fit=crop&dpr=1 600w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=476&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=476&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=598&fit=crop&dpr=1 754w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=598&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=598&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">The Colorado Health Department Headquarters begins a ban on smoking in 1972.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/ban-on-smoking-begun-at-state-health-department-news-photo/161903567">David Cupp/Denver Post via Getty Images</a></span>
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<p>There was a strongly held view that smoking was a personal decision that do-gooders and the government should keep their noses out of – until the issue was framed differently by studies showing harm caused by secondhand smoke. You are welcome to do what you want to yourself, but it becomes a horse of a different color when it affects others. </p>
<p>Today, public smoking restrictions have become commonplace. But this change in societal behavior didn’t happen overnight or without painful discourse. The journey from the initial 1964 <a href="https://www.hhs.gov/sites/default/files/consequences-smoking-exec-summary.pdf">surgeon general’s report on smoking and health</a> to the 2006 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576627/">surgeon general’s report on secondhand smoke</a> to today was a fractious one.</p>
<p>Another about-face has been the adoption of seat belts. <a href="https://www.cdc.gov/transportationsafety/seatbeltbrief/index.html">Seat belts save lives.</a> And most people now use them as a result of the <a href="https://www.iihs.org/news/detail/belt-reminders-can-be-just-as-effective-as-interlocks">nagging warning alarm</a>, the marketing of automobile safety, the law and the data. </p>
<p>This change in behavior, however, <a href="https://www.cdc.gov/motorvehiclesafety/calculator/factsheet/seatbelt.html">followed a rocky road</a> over many years. In my earlier days, I can remember more than one occasion when I hopped into a friend’s car, put on my seat belt and was then chastised for having so little faith in my friend’s driving ability.</p>
<p>Seat belts were <a href="https://www.cdc.gov/motorvehiclesafety/calculator/factsheet/seatbelt.html">required to be installed</a> in new cars starting in 1964 and New York enacted the first seat belt use law in 1984. In the U.S., <a href="https://en.wikipedia.org/wiki/Seat_belt_use_rates_in_the_United_States">seat belt use rose</a> from 14% in 1983 to 90% in 2016. </p>
<h2>Continuing challenges</h2>
<p>In the medical arena, much effort has been expended in promoting healthy behaviors – diet, exercise, sleep hygiene, adherence to prescribed drugs and immunizations. Frankly, the success has been mixed. </p>
<p>Studies have suggested <a href="https://www.uspharmacist.com/article/overcoming-barriers-to-statin-adherence">many possible variables</a> associated with not following accepted medical advice: age, gender, race, education, literacy, income, insurance copays, level of physician and pharmacist care – and plain old stubbornness. But there is no single, easily addressable cause of nonadherence to healthy behaviors. </p>
<p>For example, properly prescribed cholesterol-lowering drugs called statins literally add years to patients’ lives <a href="https://www.acc.org/latest-in-cardiology/articles/2016/11/17/09/03/summarizing-the-current-state-and-evidence-on-efficacy-and-safety-of-statin-therapy">by reducing heart attacks and strokes</a>. Even in people with insurance coverage and minimal side effects, <a href="https://www.uspharmacist.com/article/overcoming-barriers-to-statin-adherence">50% of patients discontinue statin therapy</a> within one year of receiving their first prescription. </p>
<p>Vaccines and immunization offer another window into the puzzle of human behavior. <a href="https://www.statista.com/statistics/1040079/life-expectancy-united-states-all-time/">Life expectancy in the U.S. rose</a> from 40 years in 1860 to 70 years in 1960. These gains resulted largely from decreased infant and child mortality due to infectious diseases. A better understanding of infectious diseases along with scientific advances, vaccines and antibacterial drugs were the primary factors for this <a href="https://www.nationalgeographic.com/culture/2019/08/cannot-forget-world-before-vaccines/">profound increase in life expectancy</a>.</p>
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<p>Common sense alone makes the value of vaccines abundantly clear; how many people do you know who are suffering from polio or smallpox? Yet some intelligent, thoughtful friends, family and neighbors are convinced <a href="https://www.cnn.com/2020/10/22/health/anti-vaxxers-old-arguments-covid-19-wellness-partner/index.html">vaccines are not helpful and are even harmful</a>. Some believe wearing a mask is <a href="https://www.nytimes.com/2020/11/18/us/coronavirus-mask-mandate-iowa-reynolds.html">nothing more than a “feel good” placebo</a>. I believe these contrarian beliefs make better press and are therefore more frequently reported than mainstream ones, but clearly there is reason for concern.</p>
<h2>The current crisis</h2>
<p>Historically, changes in societal behavior that benefit public health occur in fits and starts – and never fast enough for the individuals who fall victim before society comes around. </p>
<p>The urgency imposed by the coronavirus has actually resulted in comparatively swift behavioral changes (<a href="https://www.cbsnews.com/news/face-mask-retail-sales-gap-etsy/">masks</a>, <a href="https://news.bloomberglaw.com/environment-and-energy/hand-sanitizer-disinfectant-demands-hit-biblical-proportions">hand-washing</a>, <a href="https://doi.org/10.1377/hlthaff.2020.00608">distancing</a>) in the U.S. – as scientists learned how the coronavirus is spread, how dangerous it can be and which groups are more susceptible. But these behavioral changes were not as complete or as fast as they should – or could – have been when judged by far better outcomes in <a href="https://www.wsj.com/articles/finland-and-norway-avoid-covid-19-lockdowns-but-keep-the-virus-at-bay-11605704407">other countries</a>. </p>
<p>I am discouraged by the battle between the scientific method and political ideology when it comes to public health. Ideology never seems to change and is therefore more comforting to some – while science evolves as new findings debunk old ideas or confirm new ones. It is clear to all who want to listen: controlling the virus and maintaining the economy is not an either/or choice – they are interdependent.</p>
<p>At the same time, I am buoyed that the tide seems to be turning. As a better understanding of treating COVID-19 has emerged and with more than one highly effective vaccine on the horizon, the “<a href="https://www.motherjones.com/2020-elections/2020/10/trump-sticks-by-his-losing-message-fauci-and-the-scientists-are-idiots/">idiot scientists</a>” are gaining ground, both in the lab and at the bedside. Even the most prominent ideologues run to the hospital to get <a href="https://www.nytimes.com/2020/10/02/health/trump-antibody-treatment.html">the best treatments science can offer</a> when the effect of their maskless behavior rears up to bite them. </p>
<p>But as history suggests, the science, no matter how great, is only the beginning of implementation in a divided population. Ultimately, both the citizenry and the economy will benefit from a shot in the arm.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/151670/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Randy P. Juhl's wife is a retiree of Pfizer Inc., which developed one of the COVID-19 vaccines authorized in the U.S.</span></em></p>Public health recommendations have always been a hard sell. Resistance to new behaviors – like the mask-wearing and social distancing advised during the COVID-19 pandemic – is part of human nature.Randy P. Juhl, Dean Emeritus and Distinguished Service Professor Emeritus of Pharmacy, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1360372020-04-22T11:56:45Z2020-04-22T11:56:45ZChronic conditions worsen coronavirus risk – here’s how to manage them amid the pandemic<figure><img src="https://images.theconversation.com/files/328975/original/file-20200420-152558-1hof1e4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2117%2C1383&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">To avoid the high risk COVID-19 poses to older adults with chronic illnesses, many doctors have shifted appointments to telemedicine. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com">BSIP/Universal Images Group via Getty Images</a></span></figcaption></figure><p>Amid the stress and confusion of coronavirus shutdowns and social distancing orders, it can seem to older patients as though everything is on pause. Clinics have postponed regular office visits. Patients worry about going to pharmacies and grocery stores. There’s even <a href="https://www.washingtonpost.com/health/patients-with-heart-attacks-strokes-and-even-appendicitis-vanish-from-hospitals/2020/04/19/9ca3ef24-7eb4-11ea-9040-68981f488eed_story.html">anecdotal evidence</a> that people with <a href="http://www.onlinejacc.org/content/accj/early/2020/04/07/j.jacc.2020.04.011.full.pdf">serious issues such as chest pain</a> are avoiding emergency rooms.</p>
<p>One important fact must not get overlooked amid this pandemic: Chronic health conditions still need attention. </p>
<p>If you had diabetes before the pandemic, you still have diabetes and should be monitoring your blood sugar levels. If you were advised to follow a low-salt diet before the pandemic to control your blood pressure, you still need to follow a low-salt diet during what my spouse calls “the duration.” If you had to check in with your doctor if your weight increased from underlying congestive heart failure, you still need to check your weight daily and call your doctor.</p>
<p>As <a href="https://theconversation.com/profiles/laurie-archbald-pannone-894205">I remind my geriatric patients</a>, taking care of chronic conditions is even more critical right now as the new coronavirus raises the risk for people with underlying medical problems.</p>
<h2>Lungs, heart and even kidneys</h2>
<p>If you have chronic medical conditions and you become infected with the coronavirus, you’ll likely face an increased risk of developing severe symptoms. </p>
<p>The Centers for Disease Control and Prevention looked at a sample of U.S. patients with COVID-19 and found that
<a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm?s_cid=mm6915e3_w#contribAff">89% of those hospitalized in March had underlying conditions</a>. The percentage rose to 94% for patients age 65 and older.</p>
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<p>COVID-19 primarily affects the lungs, and people with lung diseases, such as COPD, have less “pulmonary reserve,” which is like having a backup generator waiting to kick in if the power goes out. So, what might have been a mild infection for someone else can develop into a severe infection for someone with lung problems.</p>
<p>Beyond the lungs, doctors and scientists are starting to see signs that COVID-19 may have <a href="https://doi.org/10.1016/j.kint.2020.04.003">devastating effects on the kidneys</a> and heart. An extreme immune system response known as a <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/797584">cytokine storm</a> can damage organs, and <a href="https://doi.org/10.1111/jth.14830">mini blood clots</a> have developed in some patients. </p>
<p>High blood pressure, congestive heart failure or diabetes can also increase the risk of developing severe symptoms from COVID-19. In the <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm?s_cid=mm6915e3_w#contribAff">CDC sample</a>, 73% of older patients hospitalized with COVID-19 also had hypertension, about a third had diabetes and just over half had cardiovascular disease.</p>
<h2>How to keep seeing your doctor</h2>
<p>Managing chronic conditions amid a pandemic is not easy. It requires adjusting daily routines and dealing with new obstacles. </p>
<p>One of the challenges is medical appointments. During the pandemic, most geriatric clinics have postponed in-person visits for routine check-ups to avoid exposing patients or staff to the coronavirus. But that doesn’t mean your doctor isn’t there for you. </p>
<p>My clinic, for example, has transitioned most patient appointments to telehealth. This allows us to keep in touch with our patients and their symptoms and to adjust treatment plans in real time. </p>
<p>Online portals with “virtual waiting rooms” allow for video visits between patient and doctor. For patients who don’t have access to the internet or aren’t as comfortable with the technology, the telephone works, too. Patients can send photos of injuries. Over 90% of my clinic visits with my geriatric patients are now by telephone. We schedule time for the clinic appointment, the clinic staff registers the patient, and then I call the patient for the check-up. </p>
<p>I was in the middle of one of these visits recently when a patient asked me if I thought they should try telehealth. I was surprised by the question, and the patient was surprised by my answer – we were in the middle of a telehealth visit. I realized that the common picture of telehealth conveys a complex process, perhaps similar to calling a customer service line.</p>
<p>Telehealth is typically arranged with your own doctor – same doctor, same relationship – just a different physical connection. </p>
<h2>What about prescription refills?</h2>
<p>Even if a clinic no longer has routine patient appointments, the office is probably still staffed. Patients can call the clinic and may also be able to request medication refills online. </p>
<p>Patients should check if their insurance company will allow 90-day supplies rather the usual 30 days so they can limit trips to the pharmacy. Some pharmacies are also providing <a href="https://theconversation.com/older-americans-are-risking-coronavirus-exposure-to-get-their-medications-135899">medication delivery or curbside pickup</a> now so high-risk patients don’t have to walk inside the store. </p>
<h2>Staying on a diet</h2>
<p>Diet is often one of the toughest adjustments needed for controlling chronic medical conditions.</p>
<p>Watching what we eat can be even more challenging during a pandemic. Following a low-carb diet for diabetes, following a low-salt diet for congestive heart failure or following a low-cholesterol diet for heart disease isn’t simple when people are sitting at home with stocked pantries and unable to get to the grocery store for fresh produce. </p>
<p>To avoid snacking out of boredom, try creating a daily meal and snack schedule. </p>
<p>Staying hydrated can also help. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682932/#R1%20(PMID:%2023702406)">Hormones that tell us when we need to drink something don’t respond as well</a> as we age, so our bodies may need water rather than an unhealthy snack. </p>
<p>If getting to the grocery store is a challenge, check if the store has senior-only hours, delivery or curbside pickup. A friend, neighbor or family member might be able to go grocery shopping for you. Many people are eager to help and just need to be asked.</p>
<h2>Staying out of the hospital</h2>
<p>Even if you don’t get COVID-19, it is still critically important that you continue to manage your chronic medical conditions. </p>
<p>When chronic conditions aren’t managed, patients run a higher risk of ending up in the emergency room and hospital – places where COVID-19 patients are likely also being treated and that have <a href="https://www.washingtonpost.com/graphics/2020/investigations/coronavirus-hospitals-data/">become overburdened</a> amid the pandemic.</p>
<p>One of the best ways to help them is to take care of yourself. Stay home. Stay well. Stay connected. </p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/136037/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Archbald-Pannone 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 COVID-19 raises the risk for people with underlying medical conditions such as diabetes, high blood pressure and COPD, social distancing can make it harder to keep up diets and medication.Laurie Archbald-Pannone, Associate Professor Medicine, Geriatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/639392016-08-16T20:12:32Z2016-08-16T20:12:32ZDoctors need to be taught how to discuss their patients’ excess weight<figure><img src="https://images.theconversation.com/files/134064/original/image-20160815-15264-13be4qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors need to be able to discuss their patients' weight, but they need to be taught how to do so delicately, for the best outcomes. </span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>With <a href="http://www.aihw.gov.au/overweight-and-obesity/">80% of adults and close to one-third of children</a> expected to be overweight or obese by 2025, doctors are increasingly likely to be working with people who are overweight or obese.</p>
<p>An individual’s weight is a complex and sensitive issue, which may be related to many factors that are not only medical but social, environmental and emotional. The skills to address the issue in a way that communicates the health risks of being overweight without judgement and without inciting negative responses are not easy to acquire or universally taught. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/22450855">Health professionals repeatedly report</a> a lack of confidence in knowing how to address obesity in their patients. They report minimal, if any, training on obesity as well as limited resources for effective conversations and insufficient clinical time to be able to do this well. </p>
<p>Starting a conversation about weight requires not only empathy but awareness of strategies people can use to manage weight issues and an understanding of the range of local services available to assist. It <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2008.636/abstract">has been shown</a> that although behavioural and medical strategies can be effective, uninformed discussion in the clinic can disengage, stigmatise or shame patients, which then has negative impacts on the outcomes.</p>
<p>Many patients do expect weight-loss guidance from health professionals and the discussion can influence outcomes. In fact, having the conversation and formally diagnosing and documenting excess weight or obesity is <a href="http://www.ncbi.nlm.nih.gov/pubmed/17673060">the strongest predictor</a> of having a treatment plan and weight-loss success.</p>
<h2>Choice of language is crucial</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/23369374">Research has identified</a> the terms “fat” and “fatness” are the least preferred terms. The words “obese” and “obesity” have also been found to arouse negative responses. The <a href="https://www.nice.org.uk/guidance/ng7">National Institute of Clinical Excellence</a> in the UK suggests patients may be more receptive if the conversation is about achieving or maintaining a “healthy weight”.</p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/22777543">STOP Obesity Alliance in the US suggests</a> using “people first” language such that a person “has” obesity rather than “is” obese, similar to “having” cancer or diabetes. </p>
<p>This is part of a debate about whether obesity should be labelled as a disease rather than a risk factor. </p>
<p>Regardless of how this issue is classified, doctors and patients both require the knowledge to understand effective therapies do exist and obesity treatment is not futile. Losing 5-10% of body weight can have a significant impact on risk factors such as blood pressure and can lower the risks of later health problems such as heart disease or type 2 diabetes. </p>
<p>This sort of weight loss also often improves other factors more immediately beneficial to the patient, such as energy levels, mood and mobility.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/134065/original/image-20160815-15238-1ylxkb1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/134065/original/image-20160815-15238-1ylxkb1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/134065/original/image-20160815-15238-1ylxkb1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134065/original/image-20160815-15238-1ylxkb1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134065/original/image-20160815-15238-1ylxkb1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134065/original/image-20160815-15238-1ylxkb1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134065/original/image-20160815-15238-1ylxkb1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134065/original/image-20160815-15238-1ylxkb1.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">How a doctor discusses excess weight with the patient makes a big difference to the outcome.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>A communication style that encourages shared decision-making and helps people change their behaviour is key. The objective is not to solve the problem but to help the patient begin to believe change is possible and develop a plan about health goals. </p>
<p>Let’s take the case of a woman who presents with urinary incontinence. The woman may describe the problem of needing to wear sanitary pads because of daily leaking of urine. Factors such as obesity will worsen the problem, but the woman may not be aware of this. </p>
<p>The doctor might say:</p>
<blockquote>
<p>I hear you’re concerned about your loss of urine, is that correct? Let’s talk about that; and would it be OK to discuss your weight too, as that may be related?</p>
</blockquote>
<p>The practitioner might listen for a willingness to have further discussion and then pose a goal-orientated question: </p>
<blockquote>
<p>If, as part of our plan to help your urinary symptoms, you decide to work on getting to a healthier weight, what might be a first step?</p>
</blockquote>
<h2>Repercussions for our kids</h2>
<p>For men and women of reproductive age the conversation is potentially not just about their own health but also about that of their children. Women who have higher pre-conception weight and pregnancy weight gain are <a href="http://www.ncbi.nlm.nih.gov/pubmed/18611299">at increased risk</a> of developing diabetes and heart disease in later life and are <a href="http://www.ncbi.nlm.nih.gov/pubmed/23731445">less likely to lose weight</a> after they give birth.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/134073/original/image-20160815-15253-y6vr1c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/134073/original/image-20160815-15253-y6vr1c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134073/original/image-20160815-15253-y6vr1c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=470&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134073/original/image-20160815-15253-y6vr1c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=470&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134073/original/image-20160815-15253-y6vr1c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=470&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134073/original/image-20160815-15253-y6vr1c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=591&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134073/original/image-20160815-15253-y6vr1c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=591&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134073/original/image-20160815-15253-y6vr1c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=591&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Being a healthy weight is important for people planning to have kids.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>This vicious cycle results in larger babies that are predisposed to short-term risks as newborns, longer-term risks of increased childhood obesity and an <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984422/http://www.ncbi.nlm.nih.gov/pubmed/20562299">increased lifetime risk</a> of obesity, diabetes and heart disease. </p>
<p>Between 1985 and 1995 the rate of excess weight and obesity in childhood <a href="http://www.obesityaustralia.org/LiteratureRetrieve.aspx?ID=168776&A=SearchResult&SearchID=9345738&ObjectID=168776&ObjectType=6">increased by 50%</a> and obesity tripled in Australia. <a href="http://www.ncbi.nlm.nih.gov/pubmed/26974008">Animal studies also suggest</a> obesity in the male parent can increase the chance of their offspring developing obesity or diabetes.</p>
<p>The intergenerational nature of obesity therefore means until we address overweight and obesity in adults who are planning a pregnancy, it may be impossible to lower rates of childhood obesity. </p>
<p>The framing of the issue as a problem for patients’ own health as well as for the health of their children is even more complex. However, unless there is a greater understanding of this risk and more training of doctors in talking to patients about obesity this will be difficult to tackle.</p>
<p>Currently, many health professionals remain uncomfortable and unsure in this area of practice. Ensuring the workforce is skilled will also mean there is the ability to discuss weight when it is not the primary issue a patient presents with, but where an important conversation at a critical life stage may actually have lasting effects on patients’ health and that of their children.</p>
<hr>
<p><em>Adrienne Gordon will be online for an Author Q&A between 4 and 5pm AEST on Wednesday, 17 August, 2016. Post any questions you have in the comments below.</em></p><img src="https://counter.theconversation.com/content/63939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors 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>An individual’s weight is a complex and sensitive issue, which may be related to many factors that are not only medical but social, environmental and emotional.Adrienne Gordon, Neonatal Staff Specialist, NHMRC Early Career Research Fellow, University of SydneyKirsten Black, Associate Professor & Joint Head of Discipline Obstetrics, Gynaecology and Neonatology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.