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Communicating Health Risk Information
Condensed from the Epidemiology Monitor, Volume Ten, Number Six, June, 1989

Following are excerpts from a talk given at a conference on ethics and epidemiology held in Birmingham in 1989 and sponsored by The Industrial Epidemiology Forum.

... the third session on the afternoon of the first day included the largest number of speakers. A colorful talk was given by Peter Sandman, a Rutgers communications expert, on the topic of communicating risk information. He described his work as alerting people to risks they are likely to ignore - and as reassuring people about risks that are overestimated. In simpler terms, scaring people and calming people down - but not at the same time!

Dr. Sandman presented several principles to keep in mind in the communicating risk information from epidemiologic studies. They are:

1)      Tell the affected group in a timely fashion what you have found.

            This responsibility is not met by putting a report in a professional journal, according to Dr. Sandman. People do not wish to be told about their risks in the mass media. He joked, "You don't want to hear you're dying on the six o'clock news!"

2)      Make sure people understand your findings and their implications.

            To accomplish this, he suggested simplifying the content of findings and cutting out jargon. All scientists hate this, he said. But either you will simplify or it will be done by the media or the public. The choice is clear.

Also, to make people understand, epidemiologists must interpret their findings for others. This is difficult because it takes epidemiologists outside of epidemiology, and many consider it none of their business. But Dr. Sandman urged epidemiologists to go beyond their field and to address the most obvious and appropriate questions which arise from the point of view of the public.

3)      Find ways to bolster credibility.

            Dr. Sandman urged epidemiologists to do things in advance of releasing results such as insulating themselves from their sponsor by the use of review boards, and obtaining the participation of the community in the study. The results will be easier to believe if the community participates in the design and implementation of the study, he said.

4)      Acknowledge uncertainty.

            If investigators do not acknowledge uncertainty, it makes them appear incredible. In any case, your peers will point out uncertainty if you do not, and you are more believable if you are the first to point this out.

5)      Apply epidemiology where it is called for and do not misapply it where it will not help.

            For example, avoid studies with low power. Avoid studies which cannot answer questions.

6)      Show respect for the public.

            In this regard, Dr. Sandman reminded the audience that people trust anecdotal data even if epidemiologists do not. "People do not like to hear that Aunt Matilda's cancer was an outlier", he said.

He also encouraged epidemiologists to draw the distinction between the statistical and social significance, and finally to respect and acknowledge the public's genuine outrage when there has been a lack of fairness or truthfulness.

Note added at press time:

A later version of this presentation has been published in full in a recent supplement to the Journal of Clinical Epidemiology Volume 44, Supplement I, 1991. This recent article adds two other recommendations about communicating health risk information:

7)      Involve people in the design, implementation, and intervention of the study, and

8)      Decide that communication is part of your job and learn the rudiments its easier than epidemiology.


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