An ill-judged campaign; an argument for EBP?

An Atlanta billboard campaign designed to draw attention to chilhood obesity has backfired rather badly for the Stong4Life advocacy group:

The campaign has drawn strong criticism for stigmatizing overweight children rather than attempting to address the issue through more positive means. We could draw some interesting parallels here between the medical professions fondness for coercive and negative role modeling to educate (of which it has a long tradition), but more interesting is the relationship of this case to evidence based practice (EBP).

If we consider that EBP is represented by the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (Sackett et. al, 1996), then we can clearly see the scientific evidence supports the case that childhood obesity is bad for children’s health. It results in obesity and increases the risks significantly of many other childhood illnesses.

However, the evidence in EBP is not just medical, it represents the collection, interpretation, and integration of valid, applied empirical experience from research-derived, clinician-observed and patient-reported evidence. The aim being that the best available evidence, cost-effectiveness, practical patient circumstances and preferences are all considered in care decisions to maximize the quality of care we deliver. This is a tall order, but the EBP is clearly focused on patient preferences and needs as well as medical evidence. This seems to be something that the Strong4Life group did not consider, as there is a lot of evidence that this type of sterotyping can be counterproductive. Media stereotypes are a fact of life, especially in the advertising and entertainment industries, which need as wide an audience as possible to quickly understand information. Stereotypes give audiences a quick, common understanding of a person or group of people but stereotypes are frequently problematic. They can reduce a wide range of differences in people to simplistic categorizations: transform assumptions about particular groups of people into “realities”: be used to justify the position of those in power: perpetuate social prejudice and inequality, and as seems to be clear from this case often the groups being stereotyped have little to say about how they are represented.

Opponents to the advertisments have noted there are many studies that suggest the perception that obesity is mainly a matter of personal responsibility as opposed to understanding the complexity of the phenomenon, and this can increase negative stereotypes about overweight people.The evidence here would seem to suggest this is not an approach that is going to prove helpful to obese children.

There are clearly other ways to do this.

In the UK in the 1980’s we had a (rather abstract) HIV/AIDS campaign that used giant stone slabs (or tombstones) as a visual icon. The government funded campaign sent leaflets to every household in the UK and new diagnoses of HIV,dropped by a third in three years. Admittedly this was not just due to the campaign, but there was a clear decision taken from marketing and media experts to avoid negative human images that could lead to sterotypical messages, and use alternative graphical formats and focus on outcomes the disease itself rather than the individuals afflicted by it. The actual effectiveness of this approach compared to others is debatable, but clearly it resulted in a growth in public awareness of HIV/AIDS, and it avoided stereotyping those affected by the disease.

This is just one example of effective health media campaigns, but it seems that often the drive to apply knowledge from medical science overlooks the broader psycho-social factors in actually delivering the message.

Jamie Oliver’s Food Revolution program that attempted to get healthier eating into US high schools is an excellent example of a positive program focused on children’s diets that did not stigmatize the kids, but also highlighted some of the complex socio-cultural and political aspects of childhood obesity.

So, from the science perspective where did the strong4life program go wrong? Does it represent a good application of EBP, or a bad one. I would suggest this ill-judged campaign missed the EBP boat by quite some way. Do let us know if you agree, and we would love to hear of other examples of other negative stereotyping you may have seen in public health campaigns, that represent a misguided use of scientific evidence in the media.



Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal, 312(7023), 71-72.









Football, Racism and Science

So, what’s been the big news stories in the UK this week ? The Eurozone crisis? The Afghan War? The cold weather? No, the two major news stories dominating the media in all its forms have concerned a resignation and a refused handshake.

The resignation was that of the England football manager (for those who may be reading this in North America, that’s the national team Soccer coach). So newsworthy was this event that even the Prime Minister, David Cameron, felt the need to pontificate on it. Mind you, I suppose that’s the modern trend. There was a time when Prime Ministers only spoke about really important stuff, since Tony Blair they’ve tended to throw themselves in front of cameras to give their (well rehearsed) views on all sorts of stuff, from soap opera plots to, well, the England football team.

The act of resignation and the wave of speculation over the successor rather over shadowed the reason why he went. It was precipitated by the Football Association (the body that controls the English game) removing the captaincy from the incumbent, John Terry. This was due to the fact that Terry had been recorded by numerous live TV camera’s racially abusing another player during a league match and the police deciding to prosecute him (racial abuse is illegal in the UK).

The refused handshake was another football story. This involved two of the biggest clubs in the English game, namely Manchester United and Liverpool F.C. (world brands really – I don’t think I’ve ever been to any country in the world without seeing a kid in ‘Man U’ shirt….well, except perhaps North American ones)

The Liverpool player Louis Suarez had just returned after a long suspension for racially abusing the Man U player, Patrice Evra and by desperate coincidence his second match back was against Man U and of course Patrice Evra. At the start of football matches all the players shake hands and despite Evra offering his, Suarez ignored it and walked past.

Both of these episodes have revealed an undercurrent of racism in football that more serious commentators in the UK have linked to that which still, despite all attempts, exists in our wider society.

Now at this point, you may be wondering what this has to do with a blog about science. Well, it’s just that I think that we as scientist have really failed to confront and expose racism for the myth that it undoubtedly is.

In the book ‘African Exodus’ Chris Stringer and Robin McKie briefly review the genetic evidence pertaining to our evolution, not only do they point out that genetically we are all Africans, but also one of the defining features of the human genome is its startling lack of variation between individuals. We are incredibly similar. They point out that there is more genetic variation in one group of mountain gorillas than in the entire human global population. Very few genes control our physical variability; in fact skin colour is controlled by 12 (out of 30,000 or something like that? Bernie will put me right on that.)

I’m actually (and strangely) quite proud that in science we don’t even recognise the term ‘race’, it is a sociological idiom, not a scientific one. Of course, our past in the scientific community has been less considered and yes, the field of eugenics did much to encourage the myth of differences and the allied and bogus ideas of genetic superiority and inferiority. Yet, as genetics has come of age it is perhaps one of the few areas of modern science that has downgraded its expectations, but one of the most important findings in my view has been the almost species defining characteristic of genetic uniformity.

Now Bernie told me to keep it short this week. So here it is. I realise that racism has complex, multi-layered origins that don’t simply start and stop with Biology. However, I do think that as scientist we could do much more to combat racism, especially in challenging the often-offensive ‘low level background’ pseudo-science that seems to encourage it.

After all despite what’s said on football pitches and elsewhere, the simple fact is that we are all equal under a microscope.


3D Printing and experimental surgery?

Not  that this is a technical blog, but it is interesting to note some of the new technologies that are arising and how the media reports them.. However, like many of these stories involving high-tech new devices and surgery, there seems a tendency to present them more from the “wow look at this” angle rather than a balanced evaluation of the outcomes. Very scant details of the clinical case and results are discussed in the news item and the developers note  “there are still big biological and chemical issues to be solved.”

Interesting, yes, a good example of media science reporting, well you decide.