Update 2010-01-19: I received a thoughtful note from Jane Sarasohn-Kahn at Health Populi — more thoughtful than perhaps I deserve, in light of my snarkiness — thanking me for the observation and letting me know she’s replaced the chart in her original post. I confess that I still have some trouble making the direct connection between this data point and EHR, but as a fellow believer in the potential for EHR and PHR to improve the healthcare landscape on many dimensions, I appreciate her trying to connect the dots. Original post below…

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I’ve done a bit of work related to Electronic Health Records (EHR) and Personal Health Records (PHR), and as a result, I follow several blogs that cover these issues. I’m also very interested in data visualization, good and bad. Today, these worlds collide.

I’m a believer in EHRs, but today Health Populi takes a tiny data point (from a somewhat off-kilter outfit called the National Center for Policy Analysis) and not only places it entirely out of context, but also commits a major dataviz sin: screwing around with the origin point.

In context, NCPA says that in Minnesota, for treatments of colds and sore throats in children, MinuteClinic (the largest retail-based walk-in clinic) follow evidence based-guidelines 91% of the time, versus an average of 86% of the time for all primary care clinics. A 5% difference can certainly be meaningful, although it might not be. They provide this helpful chart to illustrate the information:

NCPA's Original Chart; not great but not bad

It’s not a great chart; best practice suggests that 3D bar charts can be slightly misleading. But it’s mostly honest, and shows that the difference is effectively tiny.

For reasons passing understanding, Health Populi recreates this chart:

ZOMG! Huge difference!

And abra cadabra! The difference in conformity to guidelines now appears to be about 2.5 times greater among retail clinics, an effect achieved by setting the bottom of the chart to the 83% point.

What’s especially weird here is that this massaging of the chart doesn’t even bolster the argument the Health Populi post tries to make, which seems to result from this leap of logic: MinuteClinics show better compliance with guidelines (explicitly true) -> better adherence to guidelines equals better outcomes (probably true, but not explicitly shown by the source materials) -> MinuteClinics have adopted EHR and this must somehow be responsible for these amazing results (wait… what?).

Maybe I’m missing something, but I’m having an awfully hard time seeing how this argument hangs together, or finding any possible justification for juicing the chart like that. I’d welcome comments.

So, one of the reasons things have been so quiet around here is that I’ve been trying to finish my MPH. I’m pleased to say that this week, I delivered my capstone presentation, thus fulfilling my final requirement.

My talk was on a topic near and dear to my heart: What public health can do to better meet the rising tide of antivaccination opinion. I recorded my talk and most of the Q&A, and thought I would post it here for anyone interested.

The short version? I argue that instead of viewing the antivaccination community as monolithic, public health and healthcare institutions should instead take a spectrum approach, segmenting this community into appropriate categories that better lend themselves to engagement and intervention.

I’ll also post my references and further reading list for anyone interested. Enjoy!

Regular readers of this blog (both of you) know that I’ve devoted a few posts to public awareness campaigns, particularly related to accident prevention. You can imagine my delight then at coming across The Book of Accidents, Designed for Young Children, an indispensable guide from 1831. A sample warning:

Little children who can just reach to the top of a table, often endeavor to drink from the spout of a tea-pot; and in consequence scold their mouths and throats, and die miserable deaths in a few hours.

And in a later passage that could serve equally well as a warning against run-on sentences:

The little girl was playing about at the head of the stairs, and though frequently cautioned by her mother of the danger and carelessness of so doing, yet she heedlessly neglected the charge, and the consequence was, that one of her feet slipped off the first step, and down she came headlong, crying and bawling in the most dreadful manner, and alarming all the inmates of the house.

I wonder if this inspired Gorey’s Gashleycrumb Tinies.

(Via MeFi.)

First we had the Flu Wiki; now we have… Flu Flickr! (Via BoingBoing.)

Just a quick post to note three new public-health related blogs to the blogroll:

Angry Toxicologist, for those of you who always felt you could get interested in toxicology if only it had more of an attitude.

The Pump Handle, which focuses mostly but not exclusively on environmenal and occupational issues

Secret Ingredients, by the excellent Seattle Post-Intelligencer reporter Andrew Schneider, covering public health and worker safety.

Enjoy!

One of my new year’s resolutions was to blog more often this year. Obviously, I’ve fallen down on that one a bit. But for those of you who continue upholding new year’s resolutions to eat better, make no mistake: salad will hurt you.

(I say this as someone who’s pro-salad, although I tend to prefer my vegetables cooked.)

Read the complete Post.

This is not the announcement alluded to in the post below (that will come in a few weeks), but I’m happy to report that I’m also blogging at the newly retooled PublicHealthGames.com, a new resource sponsored by CADE. (Full disclosure part 1: CADE (and by extension the School of Public Health at UIC) is my employer. Full disclosure part 2: This blog is my own, and in no way reflects the opinions of my employer, even though I may mention them from time to time. Just thought I should say…)

While there were many reasons I didn’t post for a few weeks, I’d be lying if I didn’t confess another reason for my procrastination: every time I tried to write about this NY Times OpEd by Atul Gawande, covered so well in this Effect Measure post, I felt as though my head might explode. So instead of trying to write about it here, and working myself into another frenzy, I just leave you the links to read on your own. Breathtaking. (Maybe we DO need Squid Soap for doctors, now that we’ve been shown how wrong our other approach has been.)

Speaking of the holidays, I am now (thanks to Virginia) a proud owner of a HomeHero fire extinguisher, surely the snazziest fire extinguisher ever designed. Apparently, everyone but me has been talking about this product for months, but despite articles about it appearing in several magazines I read, I seemed to have totally missed it. So it was a funny coincidence that just a few days after receiving this thoughtful gift, I ran across this excellent piece about HomeHero in Rob Walker’s Consumed column.

Walker examines one of HomeHero’s more interesting claims, namely that its good looks will encourage owners to keep the extinguisher out where it can be seen and admired and — by extension — be closer at hand when needed in an emergency.  As Walked concedes, it’s hard to say whether or not this claim holds up. But it’s still an interesting idea that injecting good (or, at least, attractive) design into health and safety tools might enhance their effectiveness.

Speaking of that old Web 2.0 and Public Health talk, one of the main points I tried to get across was that public health has to redefine “outreach” to engage communities as they extend into online spaces or form anew in online spaces. Via Effect Measure, I give you Exhibit A:

And public health authorities need to come to grips with the potential impact YouTube, Facebook and the whole Internet-based social-networking phenomenon could have on policies like universal vaccinations, suggested the authors, researchers from the University of Toronto and York University.

Senior author Dr. Kumanan Wilson said he calls the approach “anti-vaccination 2.0″ – a play on the term Web 2.0.

“This is their new strategy for communicating,” said Wilson, an internal medicine specialist and a public health policy researcher.

“These people believe their viewpoint is not being aired in public. They believe that they are being shut out of the discourse and they want to get their viewpoint out. And this is their way of creating commercials for their viewpoints.

“And they’re putting a lot of effort into it. And other people … just from the view counts and the ratings, are coming on and wanting to find out more about these viewpoints. Their videos are being viewed and rated highly.”

…

Wilson acknowledged that in the past some vaccine advocates didn’t like to address the claims of opponents, assuming any discussion of what was seen as views from the fringe was counterproductive. But the Web 2.0 universe requires a new strategy, he suggested.

“In the past that could work, but it’s not going to work anymore. You could ignore it and not discuss it and perhaps it would eventually peter out. But now there are ways for people with these viewpoints to communicate with each other,” he said.

“These sites are now providing people with a mechanism by which they can bypass the conventional filters and get their messages out. It can be dangerous. The Internet is valueless in that respect.”

Talk about missing the forest for the trees. Memo to Dr. Wilson: These sites can provide public health with a mechanism by which we can bypass the conventional filters and get our messages out. It can be a great opportunity. The Internet is valuable in that respect.

In recent months, I’ve posted about shock images being used in HIV awareness campaigns, but our friends to the north have recently taken this approach to a whole other category of public health messages: worker safety, with a new series of ads, including the one below. (Warning: NSFW, or for the squeamish.)

Other topics include construction, warehouses, retail space, and electrocution. I don’t think OSHA could ever get away with something like this.

I’m at APHA this week, and ran across these terrific condom packages put out by the NYC Department of Health and Mental Hygiene, styled after New York subway route signage:

More info at NYDOHMH.

While the French like to use both shock and hipster imagery in their promotion of safe sex, the Indians adapt their own pop culture to this important public health task:

Boing Boing has a great write-up on EpiSurveyor, a fascinating open source epidemiological data collections software that works on mobile phones and PDAs, and uses SMS to send data to a central database, which as you might imagine, just hits so many of my buttons at once. Very nifty.

But I will take issue with one thing: The software seems to be designed with the developing world in mind, and the article mostly references examples falling into that category. But it would be a mistake to overlook applications right here in the U.S. and other industrialized nations. For example, after Hurricane Katrina, Bob Joyce and Balaji Ramadoss, two of my colleagues at other preparedness centers, collaborated to rapidly develop a PDA-based health survey tool to use at the Astrodome in Houston. Volunteers took these surveys to collect health surveillance data, and then brought them back to a central office every evening to download the data. A great idea, and a tool like EpiSurveyor would have made it even easier and faster to deploy.

After reading about the army of 10,000 marauding monkeys roaming New Dehli, I began to wonder if my peers working in the Indian equivalent of preparedness centers in India spend their time developing courses instructing officials and the public on how to deal with such threats. If they do, they might also want to link to this helpful and timely article on Slate about how to protect yourself from a menacing macaque.

It’s almost as though the editors of Governing Magazine were sitting around a table asking each other, “why hasn’t Jblawg linked to us recently? I was sure we had him with that article last month about adapting to meet the needs of Gen X and Gen Y workforces. Maybe we should do an issue with so many articles he’s interested in, he’ll have to link to us again. Something on pan-flu preparedness, and maybe another piece on communications interoperability. Let’s throw in a piece on municipal wi-fi too; he’s a sucker for that.”

Yep, I bet that’s just how it happened…

I’m all for innovative uses of technology in preparedness training, but couldn’t the producers of this virtual laser fire extinguisher accomplished the same thing by writing software for a Wii and attaching the controller to an empty extinguisher? I’m just sayin’…

In a finding that should surprise no one who writes quiz questions, the CDC recently discovered that when they release fliers to counteract false information about, for example, vaccination, readers tend to remember the false information written on the flier. This problem is well known to people who construct questions for tests and assessments, and is why questions phased “Which one of these items is not…” tend to be frowned upon.

I wondered why this finding seemed so familiar, and then I remembered this Deborah Franklin article from two years ago, which I also blogged about. The more things change…

Also in the New York Times this past Sunday was an article by Gina Kolata about statistics about differing ‘average’ numbers of sexual partners between men and women. As she points out, it is mathematically impossible for men and women to have meaningful gaps in their “average” number of sex partners. And she’s right, sort of. As this reply to Kolata by Slate’s Jordan Ellenberg points out, the problem boils down to math illiteracy and linguistics. First, one of Kolata’s examples actually refers to the median number of sex partners, rather than the mean. Secondly, the average non-academic reader of articles on this subject don’t take the word average to mean, well, “mean.” But instead, they take it to mean “typical.” As a pair, these articles provide a good jumping off point for why allegedly objective statistics can be used to make claims that don’t quite make sense or hold together on closer examination.