Map of life expectancy at birth from Global Education Project.

Monday, July 31, 2006

This obviously doesn't apply to you

As readers have undoubtedly noticed, the leading medical journals are starting to make more content free to non-subscribers. The cynical view -- i.e. the correct one -- is that they are hoping to mollify the critics cheaply; they still keep most of the good stuff behind the wall. Anyhow, I have to take what they'll give me so here's an essay in the new NEJM by Erin N. Marcus about illiteracy and health.

Actually she tends to conflate general illiteracy -- limited ability to read -- with health illiteracy, which may affect people who can read some kinds of materials but who have trouble with specialized medical concepts or vocabulary. As Marcus notes, according to a large scale study about 14% of U.S. adults lack even basic literacy skills. Obviously, they can't read medication labels or the informational brochures the doctor hands you.

In my own research, however, I have found that many people who are perfectly well able to read the Boston Herald or a Tom Clancy novel lack basic knowledge of biology and as a result can't communicate effectively with their physicians. Of course their doctors are utterly obvlivious to this problem.

For example, I have interviewd dozens of people with HIV. One woman, who was smart, articulate, and professionally employed, told me that she couldn't understand what "viral load" meant until somebody explained to her that it's "how many baby viruses the mother virus is having." Now she felt she understood it. Most of the people I interviewed didn't understand the concept of viral drug resistance -- they thought that it meant that their bodies would become resistant to the drugs. Out of 60 people who we interviewed for one study, exactly one understood that drug resistance resulted from Darwinian evolution, and could explain how it worked.

This information isn't just for fun, either -- it is absolutely critical for people living with HIV, so they can understand the importance of strict adherence to medication regimens and avoiding re-infection or re-transmission of the virus, even with partners who are already infected. As a matter of fact, I wonder whether all of my readers feel comfortable that they fully understand all of these concepts. Should I explain them here?

How many people understand the basic design of the eurkaryotic cell -- or even know that there is such a thing? How many people really comprehend what DNA is or why it is important? Without this knowledge, you can't understand cancer, for example. So let me add that to the poll -- are there readers out there who aren't completely sure they know what eukaryote means?

I find myself in a minority, but it really offends me that many health care providers and health educators try to jury rig a solution to this problem by talking to patients in metaphors. For example, one man told me that his doctor had told him to think of the virus as "enemy soldiers" and his meds as "our soldiers." We have to keep as many soldiers in the field as the enemy or the enemy will gain territory. Actually, military metaphors are very popular in medicine.

These metaphors are misleading and patronizing, as far as I'm concerned. People deserve to have access to scientifically accurate information. We need to work harder to get it to them. Anybody who can find his or her way to the doctor's office is capable of understanding basic ideas of biology, they've just never had them explained properly. And the place to begin, obviously, is by teaching biology in school, and that means teaching evolution. Evolution, in the era of drug resistant pathogens, is life and death to us all. Actually, it is our life. It's our essence. Denying children knowledge of evolution is child abuse.

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