by S. Todd Stolp MD
©January 2011
One of the most palatable features of the “Law of Supply and Demand” is the intuitive notion that the value of something diminishes when you have too much of it. This phenomenon is easily illustrated by comparing the unwasteful care focused upon a crab leg at the beginning of an all-you-can-eat crab feed compared with the attention garnered by the last crab leg of the evening. However, in an era that is likely to be seen by our descendents as the “Information Age,” which began with access to newspapers and now at mid-stream is highlighted by the Internet, Facebook, Google, Yahoo, and cell phones smarter than NASA computers of yesteryear, it is worthwhile to remind ourselves that information, like crab meat, is at risk of being devalued by its shear plenty.
From the perspective of public health, the danger that we lose respect for information is no laughing matter. One of the largest underground activities of public health in this country is the collection and analysis of data relating to our health. Without this infrastructure the discovery of epidemics or the identification of risk factors that shorten life expectancy or quality of life would be delayed. By scrutinizing this data according to stringent statistical rules, the public health system wades through a sea of potential and alleged risks in order to identify those that appear to have a causal relationship to illness and select the ones for which practical mitigating measures are available. In this way, every health care and illness prevention dollar can be spent to the greatest public benefit. There is enormous responsibility inherent in this mission.
First, it is important that the analysis of data be done objectively. All of the mysterious tools available to statisticians and epidemiologists – coefficients of variance, confidence intervals, t-scores, etc… – should be applied with consistency. In accordance with a timeless scientific principle, those collecting the data should have no self-interest or pre-judgment about the conclusions of the ultimate findings, within what is humanly possible. A positive and productive recommendation cannot justify misrepresentation of the data.
Secondly, the importance of credibility cannot be overemphasized when we are talking about the role of public health in the dissemination of information. Recognizing what we do not know is equally as important as recognizing what we think we know. The list of historical examples of science doing a poor job of public education and suffering a lack of public support because of it is striking. More important, serious and unnecessary outbreaks of illness have resulted from such events. A few examples follow.
The British Medical Journal recently published a report identifying incriminating evidence that the article published in another English journal in 1998 that fueled the anti-vaccine movement was rife with distorted data, misrepresentations and frank conflicts of interest. These ethical lapses ultimately led to the revocation of the author’s license to practice medicine, but this has not prevented countless deaths resulting from cases of vaccine-preventable illnesses that may have been, at least in part, a result of this misinformation.
The ongoing debate regarding climate change is another example of science falling victim to passion and dogma on both sides of the debate. While the data is absolutely convincing that unprecedented changes in certain parameters are occurring within the historical records, the interpretation and dissemination of this information needs to follow scientific guidelines, as free from political or self-centered influence as possible.
The recent release of Healthcare Acquired Infection rates for healthcare facilities throughout California is another example. It was clear to the experts that the rates of infections due to surgical procedures at various hospitals was reported inconsistently between hospitals, under different criteria, and was largely influenced by the patient mix at various hospitals. Naturally, hospitals receiving a large number of seriously ill patients and burn victims suffered higher infection rates. Therefore, to the objections of certain consumer groups but in accordance with objective principles, this data was released by the California Department of Public Health with clear disclaimers.
The responsibility to handle information with great respect, of course, extends to all levels of the community. Whether in debates involving party politics, health reform, climate change, private agencies or public health, maintaining a sense of humility about the data we wield and showing a healthy skepticism about the data we consume is a duty and skill that deserves our attention, right down to that last crab leg.