Category Archives: General public health news

A Journey of Healthy Living

I am a Penn employee and have worked for the School of Arts and Sciences for 10 years.  I started my healthy living lifestyle about two years ago and have lost a total of 80 pounds.  I started by simply walking to work.  Since then, I have been walking to and from work every day, total of about 3 miles per day.

Kim Peurifoy, Penn Employee

Kim Peurifoy, Penn Employee

About  a year and half ago, I started running on my free time, and can now run about 3 miles straight, still pushing for the 10k though!  As a reward, I completed a few 5k races.  I also slowly changed my eating habits.  I cut out of sugar and made more healthy food choices for my family and me.  Some of the habits I changed were eating out less for lunch and packing a healthy lunch daily.  I also became more conscious about making healthier choices, with the help of the nutritionist seen here on Penn’s campus.  In addition, I am an active participant in the Penn Walking Program as well as in the Penn Moves Study.  I am also a return participant in Penn’s Be In the Know Program.

I am often asked was it hard to lose the weight? How do you stay focused? My reply is that I am on personal journey path.  It’s something that I work towards every day.

Of course, I sometimes struggle with exercising and eating right, but I am committed to staying on the path.  I do not let one bad meal or a missed exercise day lead the course of my journey.  I shake it off and get back on track.  My reward is that I enjoy my increased energy level and I want to keep it!  I am proof that it can be done!
My advice is to make your “healthy living journey” fun!  We keep an accountability calendar in my office, so my staff and I record our daily personal and group workouts on the calendar.  This practice has helped us to remain consistent with moving, and it has helped us great deal. We even participated in the Penn Wellness walk together!

Written by: Kim Peurifoy, Penn employee, as a part of Healthy Penn – My Moves, My Waylogo

Advertisements

Women’s Health in Gaborone, Botswana

Botswana UPenn office

Botswana UPenn office

The week of Thanksgiving, 2015, was warm and dry in Botswana as the season turned toward full winter that is, full summer, here in the Southern Hemisphere). I am fortunate to have this time for fieldwork experience with the Botswana-UPenn Partnership, the Fellowship in Family Planning, and the Penn Master of Public Health program, immersed in women’s health care in Gaborone, the country’s capitol city under the mentorship of Dr. Chelsea Morroni.

Botswana

Botswana

Maternal and child health, particularly cervical cancer prevention and pregnancy planning, has been a key issue here. Botswana has been strongly affected by the HIV/AIDS epidemic, with 23% of the adult population infected, including 30.4% of reproductive-age women. Human Papilloma Virus (HPV) co-infection has made cervical cancer the leading cancer among women. The Cervical Cancer Prevention Program (CCP), established by Dr. Doreen Ramogola-Masire at Princess Marina Hospital, provides excision of precancerous lesions of the cervix for women referred from one of several cervical cancer screening clinic sites in Gaborone. The Women’s Health Clinic at PMH provided care to over 1300 reproductive age women in 2014, only 10% of whom were using a World Health Organization (WHO) tier 2 or 3 (moderately effective) contraceptive method, and CCP is a well-established and widely accepted part of preventative health care in Botswana.

In fact, unintended pregnancy is estimated at 44-50% of all pregnancies in Botswana, even though the Ministry of Health provides free family planning services. A significant barrier is that family planning services are not available in many gynecology clinics, including the CCP sites; women must visit a specific FP clinic for contraception. Visits to both clinics cannot be done the same day, due to scheduling conflicts. Women who lack access to education or are from rural areas have borne the brunt of the burden of unmet contraceptive need in Botswana: although they have been able to receive care through the CCP, making the long journey to Gaborone on a separate day to obtain family planning has limited contraceptive access and service utilization.

Group from Contraceptive Training

Group from Contraceptive Training

My visit is focused on the initial steps for integration of cervical cancer prevention and family planning services. During my stay, I am working with key stakeholders who lead the CCP clinics, provide expert family planning consultation to the Ministry of Health, and direct the inpatient and outpatient OB/GYN services at Princess Marina Hospital. I am training the CCP staff on contraceptive counseling and intrauterine device (IUD) and contraceptive implant insertions, based upon the WHO’s Decision-Making Tool for Family Planning Clients and Providers.

This work will form the foundation of an upcoming clinical intervention and implementation study. The study will assess the acceptability and feasibility of incorporating family planning services into CCP care, and will measure the effectiveness of the contraceptive counseling, plus on-site IUD and implantS availability, on uptake of highly effective contraceptive methods for women seeking cervical cancer prevention who wish to delay pregnancy.

The “IUD at CCP” program will help fill the gap in contraceptive access in Botswana, by focusing on the importance dual method use (condoms for HIV prevention plus a highly effective contraceptive method for women not seeking pregnancy) at the time of cervical cancer screening. This will bring services to a setting that is convenient for the women with the highest need. Provider training in contraceptive counseling, and clinical training in IUD insertion techniques, as begun with this work, lays the groundwork for this program. A long-term, comprehensive implementation strategy including ongoing community education and garnering of public buy-in, with continuing provider trainings in shared-decision making and IUD and implant insertion techniques, will be needed for the continuing growth and success of this program.

It is my hope that I, and future public health practitioners and physicians, will be able to visit the warm, welcoming city of Gaborone in coming years, to participate the growth and witness the success of the IUD at CCP program.

Written by Elizabeth Gurney, MD, 2nd year Family Planning Fellow at the University of Pennsylvania

From Innovation to Dissemination: 2015/16 Seminar Series

2015-16-Seminar-Series-Logo

This year’s CPHI seminar series is titled “From Innovation to Dissemination”. The series builds upon the University of Pennsylvania’s annual theme for 2015/16 – The Year of Discovery that focuses on both the long-range, planned and calculated research toward an intended goal as well as the more “spontaneous and serendipitous” discoveries.
This year’s series will create a forum for cross-sector communication around innovative public health solutions. Seminars will present real world solutions to complex problems including new finance mechanisms to fund public health initiatives, the use of digital health technology, and innovative approaches to address the opioid epidemic.

Throughout each series, we aim to encourage different perspectives to add to the conversation; we hope to foster current collaborations and spark new ones; and we hope to instill the importance of always searching for new ways to improve health.

Save-the-date! Fall Semester Seminar Line-up

Seminar Kickoff Event: Voices of Health Exhibit and CPHI Overview

September 9th (Wednesday) 4:30pm – 6:00pm | Register
Claudia Cohen Hall – Terrace Room

Come and join CPHI Fellows and the public health community to learn about CPHI and the resources that we have to offer. Wine reception to follow as you stroll through a photo exhibit that documents what the domain of “health” means to the Penn community. We asked over 300 students, staff, faculty members and community residents “what words come to mind when you think about health?”. This photo exhibit documents what they said.

Moving an Innovative Idea into Action: It’s Not as Hard as You May Think
Roy Rosin, MBA
Chief Innovation Officer
Penn Medicine’s Center for Innovation

September 18th (Friday) 12:00pm – 1:30pm | Register
Claudia Cohen Hall – Terrace Room

Join us as we hear from Roy Rosin, Chief Innovation Officer from Penn Medicine’s Center for Innovation where he works with thought leaders across the health system to turn ideas into measurable impact in the areas of health outcomes, patient experience and new revenue streams. Roy will talk about practical ways to turn your innovative idea into a reality. Roy received his MBA from the Stanford Graduate School of Business and graduated with honors from Harvard College. Outside of work he serves as a board member and angel investor for venture funded startups, an advisor to Fortune 100 companies and a coach to his son’s little league baseball teams.

Digital Health Innovation
Chris Murphy, PhD
Associate Professor of Practice
Department of Computer and Information Science University of Pennsylvania
Nalaka Gooneratne, MD, MSc
Associate Professor of Medicine UPenn, Presby, & VA

October 5th (Monday) 12:00pm – 1:30pm | Register
Krishna Singh Center for Nanotechnology

Move out of your comfort zone and into the world of Digital Health Technology. Drs. Murphy and Gooneratne will each bring their own expertise and demonstrate how to leverage digital technology into practical applications to improve health outcomes. Dr. Murphy is an Associate Professor of Practice in the Department of Computer & Information Science at the University of Pennsylvania, and Director of the Masters of Computer & Information Technology program. Dr. Gooneratne is a physician specializing in sleep disorders. In addition to his research (funded by NIA, NCCAM and NHLBI), he is the Associate Program Director for the Clinical and Translational Research Center, and the mHealth service (mobile app development) within the Institute for Translational Medicine and Therapeutics (ITMAT). He is also the director of the Masters in Translational Research Entrepreneurial Science track.

A New Approach to Address Social Challenges: Impact Bonds
Jeff Liebman, PhD
Professor of Public Policy
Harvard Kennedy School of Government
Moderated by:
Ezekiel Emanuel, PhD
Vice Provost for Global Initiatives
Chair of the Department of Medical Ethics and Health Policy
The University of Pennsylvania

October: Exact Date TBD

Social Impact Bonds (SIBs), often referred to as Pay-For-Success, are a novel funding approach that combine components of results- or performance-based financing and public-private partnerships, which have been used to fund public services for many decades. With a SIB, financing is provided upfront rather than when results are attained and results are related to outcomes as opposed to outputs. To date, 44 SIBs are being utilized in developed countries to, among other social issues, provide high-quality preschool education, reduce prison recidivism, avoid foster care placement, and increase youth employment.

Dr. Liebman will walk us through the SIB model and see how we can apply it to fund public health services. Dr. Liebman, Malcolm Wiener Professor of Public Policy, studies tax and budget policy, social insurance, poverty, and income inequality. During the first two years of the Obama Administration, Liebman worked at OMB, first as Executive Associate Director and Chief Economist and then as Acting Deputy Director. From 1998 to 1999, Liebman served as Special Assistant to the President for economic policy and coordinated the Clinton Administration’s Social Security reform technical working group.

Advocacy & Influence: Innovations Addressing Homelessness
Sister Mary Scullion
President & Executive Director
Project HOME

December 8th (Tuesday) 12:00pm-1:30pm| Register
Class of ’49 Auditorium

Sister Mary Scullion, R.S.M. is a Philadelphia-based American Roman Catholic Religious Sister and activist, named by “Time” as one of the “100 Most Influential People in the World” in 2009, alongside Michelle Obama and Oprah Winfrey. Scullion has been involved in service work and advocacy for homeless and mentally ill persons since 1978. In 1989, she co-founded Project H.O.M.E., a nationally recognized organization that provides supportive housing, employment, education and health care to enable chronically homeless and low-income persons to break the cycle of homelessness and poverty in Philadelphia. Join us to hear Sister Mary’s powerful voice on political issues affecting homelessness and mentally ill persons. She will address how advocacy efforts can result in long-term sustainable policy and law changes.

Behavioral Economics: How People Process Information and Make Decisions
Kevin Volpp, MD, PhD
Director
Center for Health Incentives and Behavioral Economics, Leonard David Institute

January 12th (Tuesday) 12:00pm-1:30pm| Register
Arch 208 Auditorium, 3601 Locust Walk

Dr. Volpp is the founding Director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics (LDI CHIBE), Director of the NIH-funded Penn CMU Roybal P30 Center in Behavioral Economics and Health, Vice Chairman for Health Policy for the Department of Medical Ethics and Policy, and a Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania and Health Care Management at the Wharton School. He is a core faculty member of the Center for Health Equity Research and Promotion (CHERP) and a board certified practicing physician at the Philadelphia VA Medical Center.

The Science of Simple, Low-Cost Health and Safety Interventions
Charles Branas, PhD
Professor of Epidemiology
University of Pennsylvania

Sara Heller, PhD
Associate Professor of Criminology
University of Pennsylvania

February 25th (Thursday) 12:00pm-1:30pm| Register
Location TBD

Dr. Branas works to improve health and healthcare and is recognized for his efforts to reduce violence and enhance emergency care. Much of his work incorporates human geography and place-based change. His studies have taken him to cities and small towns across the US and other countries. Dr. Branas has served on boards and offered scientific expertise for numerous groups including the NIH, the CDC, and the National Academies in the US, as well as national scientific organizations in Canada, South Africa, New Zealand, and the Netherlands. His work has been cited by the US Supreme Court and Congress. He is a past President of the Society for Advancement of Violence and Injury Research, an elected member of the American Epidemiological Society, and affiliated faculty at the University of San Carlos in Guatemala.

Professor Heller focuses primarily on field experiments testing the effects of treatment interventions on crime, education, and other life outcomes. She is investigating the effects of cognitive behavioral therapy-based programming on juvenile crime and schooling outcomes. She is also conducting two related studies on the effects of summer jobs on youth, especially on their crime and labor market outcomes.

Innovative Practices to Address the Opioid Epidemic
Matthew Hurford, MD
Vice President of Medical Affairs
Community Care Behavioral Health Community

March 18th (Friday) 12:00pm-1:30pm| Register
Location TBD

Dr. Hurford is Vice President of Medical Affairs for Community Care Behavioral Health Organization one of the country’s largest not-for-profit behavioral health managed care organization. Headquartered in Pittsburgh, Community Care serves over 750,000 Medicaid beneficiaries across Pennsylvania by facilitating the ongoing evolution of the behavioral health system toward one that embraces the journey of healing, transformation, and empowerment.

As VP of Medical Affairs at Community Care, Dr. Hurford provides leadership in the development of new business opportunities and program development including physical health/behavioral health integration and innovative healthcare payment models.

Prior to joining Community Care, Dr. Hurford served as the Chief Medical Officer of the City of Philadelphia’s Department of Behavioral Health and Intellectual Disability Services (DBHIDS) and Community Behavioral Health (CBH), a not-for-profit behavioral health managed care organization.

Additional training and educational opportunities:

LGBT Transgender Symposium: Training for Healthcare Providers
December 10th, 8:30am-1:00pm
Biomedical Research Building

Qualitative Research Institute
January 7th – 9th (all day training)
More details coming soon!

For questions about our seminar series, please contact Elizabeth Devietti eldevi@mail.med.upenn.edu

Arrest on the Run: How a Penn MPH Student Saved a Life Using CPR

On Sunday, May 3, 2015, Kelsey Sheak, a 2015 Master of Public Health Candidate at the University of Pennsylvania, woke up and prepared to run the 10K Broad Street Run.  Shortly after starting the race, she noticed a crowd gathering around a collapsed man. Upon arriving at his side, Kelsey immediately put her CPR training into action.  Kelsey was one of the many bystanders who helped this fallen runner survive from his cardiac arrest.  Read her full story below.


 

Kelsey Sheak, 2015 MPH Candidate

Kelsey Sheak, 2015 MPH Candidate

CPHI: We heard you performed a life-saving procedure at the Broad Street Run on Sunday, May 3, 2015.

Kelsey Sheak: I did!  I was running and between miles 2 and 3 I saw a crowd of people. There was a gentleman in the center of the crowd and he was clearly having a medical emergency.  Shortly after I arrived, he lost his pulse.  Once he lost his pulse, a group of bystanders and I started administering cardiopulmonary resuscitation (CPR).  We communally performed CPR – one person would start, another person would step in, and so on.  After about ten minutes in, the Philadelphia Police Department came with an automated external defibrillator (AED). The police are trained on how to use AEDs and to provide emergency medical care. They took over for all the bystanders and the patient was shocked and taken to the hospital.  We were sent on our way and told to continue running. It was a little weird!

CPHI: Let’s back up for a minute. You are a Master of Public Health (MPH) student, but clearly you are well trained in CPR. What is your background?

KS: It’s crazy because 40,000 people ran the Broad Street Run and for me to come upon this is just mind-blowing – really serendipitous.  My background is in cardiac arrest research and education.  By profession I spend my days learning as much as I can about CPR and ways to improve it, ways to disseminate it, and ways to make survival much better.  To come across this situation where I needed to use it was crazy.

CPHI: Who were other bystanders?

KS: Most of the people that were helping the collapsed runner had medical backgrounds: nurses, a physician, and me.  The most important take-home message is that he didn’t need a medical professional; he just needed someone to recognize that he was in cardiac arrest and that he needed CPR.  Anyone who is trained can do that.  If you’re not trained in CPR, you should be!

CPHI: How was it meeting the collapsed runner the next day in the hospital?

KS: I went to the hospital after he arrested and I was able to meet his family.  They were very nice and very thankful.  I’m happy to know that he will go back to having a normal life.

CPHI: I want to take a moment to address a common misconception: many people think a heart attack is the same as a cardiac arrest. Can you help clear up this confusion?

KS: A cardiac arrest is when your heart stops and blood flow stops to the entire body.  With a heart attack, your heart doesn’t stop; rather, there is a blockage. Generally, people who have a heart attack have chest pain, they go to the hospital, and they can recover.  Cardiac arrest generally happens with little to no warning and people are generally healthy when it happens.  It can happen for a lot of different reasons and everyone’s reason is different.

CPHI: Is there a most common reason why cardiac arrest happens?

KS: There isn’t a most common reason – but there are situations that are most savable.  The gentleman at the race had a savable arrest because he had a shockable arrest.  This means that his heart was in a rhythm that a defibrillator could recognize and turn into a healthy heart rhythm.  Places like airports, casinos, and races are places where lots of cardiac arrest victims do well – there are numerous educated people around and these places are heavily watched. But there are also places where people don’t do well – like low-income neighborhoods, which are less likely to receive bystander CPR.

CPHI: After you helped save a fellow racer, did you continue running?

KS: Yes, I finished the race!


 

For more information about CPR and cardiac arrest, please visit the Penn Medicine Center for Resuscitation Science website.

Health Equity- A Dream or an Achievable Goal?

Source: Saskatoon Health Region Advancing Health Equity

Source: Saskatoon Health Region Advancing Health Equity

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”  – Dr. Martin Luther King Jr.

Nearly half a century after Dr. King’s observation, the Affordable Care Act made tremendous strides towards equality of access in health care. Equality promotes fairness, however it’s only effective if everyone starts from the same place and has the same needs.  When it comes to breaking the barriers to health care equity—we still have a long road.

Dr. David Satcher was the keynote speaker for the Perelman School of Medicine Health Equity Symposium, held at the University of Pennsylvania in January. He was the first African American Surgeon General of the United States and is the current director of The Satcher Leadership Institute at the Morehouse School of Medicine. “In order to eliminate disparities we need leaders who care enough, know enough, will do enough, and are persistent enough,” he said. He encouraged attendees to delve deeper into the realities of health inequity in America.  The symposium provided a glimpse into some of these inequities.

According to the CDC Health Disparities & Inequalities 2013 Report, Non-Hispanic Black adults are 50% more likely to die of heart disease or stroke prematurely than Caucasians.  Until recently, scant efforts in organizational quality improvement were made in health care to address racial disparities. This was evident in the health care inequities of our Veterans population.

Said Ibrahim, co-director of the U.S. Department of Veterans Affairs Center of Health Equity Research, posed the following question at the Symposium,

“How do we make sure the equality of opportunity translates to the equality of health outcomes?”

According to the Department of Veteran Affairs Health Service Research & Development Services, minority veterans are receiving less and lower quality health care, despite needing more and higher quality care (suggesting a form of “regressive” healthcare delivery).

Another population that is currently experiencing health care inequities are Asian Americans. They are currently the fastest growing minority group with a growth rate increase of 46% from 2000 to 2010.  Ironically, this group receives little attention in the statistical analyses of health and health care inequities. The labeling of the “model minority” for Asian Americans is quite paradoxical —simultaneously successful and marginal. The notion has often led to the tuning out of the hardships of prejudices, health disparities, and health care inequities, Asian Americans face.

pic 2

Although the Affordable Care Act benefited Asian Americans in increasing health care access, cultural competence and community engagement is necessary to successfully eliminate the gaps in health care equity.   A concerted effort by public health professionals on local, state, and national levels will help bridge the gap in health care access in the Asian American & Pacific Islander communities.

The LGBT community  faces health care inequity as well. Risk of psychiatric disorders, substance abuse, and suicide are elevated as a result of social stigma and discrimination, calling for a need for culturally competent medical care.

SOURCE: Center for American Progress, 2009

SOURCE: Center for American Progress, 2009

Increasing coverage promotes greater access to care but it won’t translate to equity of health outcomes. Quality improvements in health care delivery must place emphasis on social determinants of health and culturally competent care.  Our health care approach should not be one size fits all, but rather it must be modified to fit the specific needs of vulnerable populations.

Written by: Amy Rajan, RN, MSN/MPH Candidate, Class of 2016

Don’t expect a “Disneyland effect”

Alison Buttenheim, PhD, MBA, Assistant Professor in the University of Pennsylvania School of Nursing, a Senior Fellow of the Leonard Davis Institute and the Penn Center for Public Health Initiatives, and Faculty Affiliate in the LDI Center for Health Initiatives and Behavioral Economics

Alison Buttenheim, PhD, MBA, Assistant Professor in the University of Pennsylvania School of Nursing, a Senior Fellow of the Leonard Davis Institute and the Penn Center for Public Health Initiatives, and Faculty Affiliate in the LDI Center for Health Initiatives and Behavioral Economics

Senior Fellow Alison Buttenheim recently published an article for the Leonard Davis Institute of Health Economics blog. Read it below!

“So how about that Disneyland measles outbreak?”  As a researcher who studies vaccine refusal, I’ve been asked this question a lot recently. More than 50 people have come down with measles after exposure at the iconic Southern California amusement park, and nationwide measles diagnoses exceeded 90 in the month of January alone. (For the record, that’s a lot of measles cases to see in one month in the US in recent years, although 2014 was also banner year for the virus.)

Last week a colleague posed a particularly compelling question: “Do you think we’ll see a ‘Disneyland effect’?” – meaning, could this widespread outbreak produce a backlash against vaccine refusal and thereby reduce rates of vaccine exemptions, “alternative” vaccine schedules, or opting out completely of recommended childhood immunizations.

Parents less likely to refuse vaccines now?

It’s reasonable to expect a Disneyland effect. After all, there was strong evidence of a “Katie Couric effect” on colon cancer screening rates after Ms. Couric underwent an on-air colonoscopy in 2000. Similarly, an “Angelina Jolie effect” on breast cancer screening rates for women with a family history followed Ms. Jolie’s disclosure of her double mastectomy in 2013.

Several features of the Disneyland measles outbreak are also conducive to moving the needle on parents’ beliefs and decisions about childhood immunization: First,  the outbreak has high salience: news stories have run in major print and broadcast outlets almost daily, and the internet and blogosphere are packed with posts from all perspectives. If vaccine hesitancy and worries about the measles virus were just lurking in the back of your brain last month, they are top-of-mind now. The universality of Disneyland may make parents feel more vulnerable in a “this could happen to us” way—it’s no longer possible to imagine that measles outbreaks or high rates of vaccine refusal are happening in another state or another school community.

Second, the Disneyland outbreak could shift both the social norms around vaccine refusal and the framing of the importance of childhood immunization.  In recent years, people arguing against the safety, efficacy, and necessity of vaccines have created a powerful social norm that validates vaccine refusal and privileges claims about vaccine-related harms. In the Disneyland outbreak coverage, we are seeing more stories framed from the perspective of the potential harms of measles: for example, the stress and financial burden associated with quarantining an exposed infant; or the request from a father of an immune-compromised child to keep unvaccinated children out of his son’s school. This could in theory produce more “something must be done about this” sentiment that could then lead, for example, to stricter state vaccine exemption laws.

Third, this recent outbreak very simply plays on inherent present bias—our tendency as humans to heavily discount future costs and benefits of a decision or behavior while overweighting current costs and benefits. For most parents, the benefits of vaccinating are intangible (we take an action so that something doesn’t happen), probabilistic (vaccines are not 100% effective, and the chances of being exposed to measles are small), and in the future.  It’s reasonable to imagine why parents with any level of concern about vaccines might opt out. The Disneyland outbreak shifts this calculus by making the cost of not vaccinating very immediate and tangible, and might therefore lead to decreased refusal.

A prediction (and I hope I’m wrong)

Despite these prior effects and reasonable assumptions, I hereby predict no such Disneyland effect this time. While I would be delighted to be proven wrong, I think there are at least three reasons why we won’t see a lasting impact of the outbreak on exemption or refusal rates.

First, our attention span is limited. While the Disneyland outbreak is getting a lot of coverage now, this will likely last for only a few more news cycles. (Caveat to this point: If someone were to die of measles from this outbreak – which I decidedly hope does not happen – the salience and duration of the outbreak in the news cycle would both increase.)

Second, the parents whose vaccine beliefs and behaviors are most likely to be affected by this outbreak are the slightly hesitant and the undecided. We are not likely to see much shift in the more adamant, hard-core anti-vaccine folks.  In one anecdote from a news article on the outbreak, a non-vaccinating parent in Los Angeles reported that “she hadn’t even been aware of the Disneyland outbreak because she refused on principle to follow the mainstream news media. But she was in no doubt, even without reading the coverage, that ‘they have skewed the facts in favor of trying to sell people more pharmaceuticals’”.  The same facts about the outbreak that might convince a moderately hesitant parent to vaccinate will only reinforce previously-held beliefs in a strongly anti-vaccine parent.

In a terrific recent paper, Brendan Nyhan and colleagues demonstrated this effect in a study in which parents were exposed to information about the dangers of vaccine-preventable diseases and the lack of evidence for an MMR-autism link. This information actually reduced intention to vaccinate among parents with previously unfavorable views of vaccines. Similarly, images of sick children with vaccine-preventable diseases increased beliefs in an MMR-autism link. So, the people whose beliefs we would most want to change in response to the Disneyland outbreak are the least likely to be persuaded. Unfortunately, these beliefs and the vaccine-refusing behaviors that accompany them tend to cluster socially and spatially–and it is this very clustering that leads to outbreak “hot spots” where herd immunity is most compromised.

Finally, I am skeptical about a Disneyland effect because I have spent a lot of time looking for a similar effect in other recent, highly-publicized outbreaks (including a 2008 measles outbreak in San Diego, California) and have failed to find one. That doesn’t mean it won’t happen this time. I will continue to look for shifts in social norms, beliefs, and behaviors in response to vaccine-preventable disease outbreaks, and work towards developing interventions that reduce vaccine hesitancy and boost herd immunity in the population.  Let’s not let any more trips to Disneyland be ruined by Mickey Mouse science.

Why a fake article titled “Cuckoo for Cocoa Puffs?” was accepted by 17 medical journals

Coco Puffs

A Harvard scientist wanted to see exactly how easy it is to get medical research published. In some cases, $500 is pretty much all it takes.

Read through this interesting article by Elizabeth Segran about navigating through the process of medical research publication.

http://www.fastcompany.com/3041493/body-week/why-a-fake-article-cuckoo-for-cocoa-puffs-was-accepted-by-17-medical-journals