We Must Improve Communication With the Public

Maurie Markman, MD

The scienctific community has been in some ways stunningly ineffective in clearly communicating highly relevant information about the COVID-19 virus and pandemic to the public. Several factors help explain this discouraging state of affairs, including that baseline satisfactory skills for communicating with the lay public and/or specific training in this area have not been a priority within the scientific establishment. In addition, the rapidly changing scientific evidence associated with multiple components of the pandemic may mandate frequent alterations in public health-related recommendations.

It is not difficult to appreciate how this state of affairs can lead to loss of faith in any government-produced guidelines, leading many to ask: “Do they know what they are doing?” It is much easier for critics to declare a recommendation that disrupts normal life activities (eg, wearing masks, social distancing, business lockdowns) to be without sufficient foundation than it is for the scientifically and evidence-based public health community to provide definitive objectively valid data in its support.

Perhaps one should not have been surprised, considering the status of the national public health community among many members of society, to see actions taken in direct opposition to the formal position and guidance from the CDC.¹

Further, potential associations between COVID-19 infections and serious medical events (eg, cardiac dysfunction) may remain in the realm of hypothesis or anecdote for considerable periods of time—potentially years rather than weeks or months—before it is possible to make a formal claim acceptable to the scientific, medical, and public health communities.² Such is often the nature of objectively valid clinical investigation.

Again, it should not be surprising that those making statements related to vaccine adverse effects or unsubstantiated claims for a COVID-19 therapeutic may sound more authoritative and even more knowledgeable to those in the general public than the cautious and tentative words of a spokesperson representing objective science.

One additional factor needs to be considered: the rapidly expanding role of social media. In a recent commentary in Science, authors Dominique Brossard, PhD, MS, MPS, and Dietram A. Scheufele, PhD, MA, made several thoughtful and crucial observations about the current scientific information landscape, including the following:

• “Since the early days of the internet, the scientific community has had a very spotty track record of harnessing the full potential of online communication tools to reach beyond an audience that already follows science.”
• “The same profit-driven algorithmic tools that bring science-friendly and curious followers to scientists’ Twitter feeds and YouTube channels will increasingly disconnect scientists from the audiences that they need to connect with most urgently.”
• “Social media platforms and their underlying algorithms are designed to outperform the ability of science audiences to sift through rapidly growing information streams and to capitalize on their emotional and cognitive weaknesses in doing so.”

One of the overarching problems, as noted by Holden Thorp, PhD, editor in chief of Science, is that “disagreement and outlandish statements result in more engagement,” encouraging movement away from authoritative information to leverage the algorithms used by social media companies.⁴

Although the issues highlighted here are complex, overcoming existing deficiencies will require substantial effort by the scientific community and its leadership. There are certain strategies that may help, such as national groups working closely together on a consensus before public statements are made in order to avoid the confusion that often has clouded governmental pronouncements related to the COVID-19 pandemic.

In addition, agencies developing public health guidelines should make information as simple as possible. Yes, clinical science can be messy. For example, alternative and competing treatment approaches or drugs may be available for patients, and experts may strongly disagree about optimal strategies based on the availability of high-quality data. But we need to think about the primary care physician, the specialist, or the patients who are not experts and are attempting to understand different approaches to manage even the most common clinical problems.

For example, consider the existing recommendations for cervix cancer screening in the United States. At what age should screening begin? What is the optimal test strategy? What is the effect of prior vaccination, either complete or partial?

Several national organizations, such as the American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, American Society for Colposcopy and Cervical Pathology, US Preventive Services Task Force, and the American Cancer Society, have developed their own guidelines, which, although similar, are far from identical.⁵ Is it really that difficult to come to a consensus regarding a recommendation for screening?

Imagine the very busy primary care clinician, family care physician, pediatrician, generalist obstetrician/gynecologist, or other practitioner responsible for advising patients about such a critically important individual and public health measure. Is it any surprise that results of a recent study comparing data from 2005 to 2019 demonstrated a highly disturbing decrease in the percentage of women aged 21 to 65 years who were up-todate on screening for cervical cancer?⁶

The investigators concluded this decline was not because of lack of access or prior human papillomavirus vaccination but because of “lack of knowledge and not receiving recommendations from health care professionals.”⁶ Remarkable.

Even though cervical cancer screening is one of the most successful public health measures implemented during the past 50 years, the medical, scientific, and public health communities are being told their efforts to deliver simple, clear, and vital information regarding this highly effective approach in cancer prevention is failing. This mess needs to be fixed.

References

1. Mazzei P. Contradicting federal guidance, Florida will recommend against Covid vaccines for healthy children. New York Times. March 7, 2022. Accessed April 7, 2022. nyti.ms/3E8GL05
2. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590. doi:10.1038/s41591-022-01689-3
3. Brossard D, Scheufele DA. The chronic growing pains of communicating science online. Science. 2022;375(6581):613-614. doi:10.1126/science.abo0668
4. Thorp HH. Science and social media. Science. 2022;375(6581):593. doi:10.1126/science.abo4606
5. Reynolds EE, Weinstein A, Farid H, Libman H. When and how would you screen this patient for cervical cancer? Ann Intern Med. 2022;175(2):267-275. doi:10.7326/M21-4372
6. Suk R, Hong YR, Rajan SS, Xie Z, Zhu Y, Spencer JC. Assessment of US Preventative Services Task Force guideline-concordant cervical screening rates and reasons for underscreening by age, race and ethnicity, sexual orientation, rurality, and insurance, 2005 to 2019. JAMA Netw Open. 2022;5(1):e2143582. doi.10.1001/jamanetworkopen.2021.43582