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The scent of sickness: 5 questions answered about using dogs – and mice and ferrets – to detect disease
Could medical detection animals smell coronavirus?
14 January, 2021
Leon Neal/Getty Images
As COVID-19 continues to spread worldwide, scientists are analyzing new ways to track it.
<p> One promising approach is <a href="https://doi.org/10.1038/d41586-020-03149-9" target="_blank">training dogs to detect people who are infected</a> by smelling samples of human urine or sweat. Research scientist Glen Golden, who has trained dogs and ferrets to detect avian flu in birds, explains why certain animals are well suited to sniff out sickness.</p><h2>1. Which species have a nose for disease?</h2><p>Some animals have highly developed senses of smell. They include rodents; dogs and their wild relatives, like wolves and coyotes; and <a href="https://www.britannica.com/topic/list-of-mustelids-2058294" target="_blank">mustelids</a> – carnivorous mammals such as weasels, otters and ferrets. These species' brains have three or more times more functional olfactory receptor neurons – nerve cells that respond to odors – than species with less keen smelling abilities, including humans and other primates. </p><p>These neurons are responsible for detecting and identifying volatile olfactory compounds that send meaningful signals, like smoke from a fire or the aroma of fresh meat. A substance is volatile if it changes readily from liquid to gas at low temperatures, like the acetone that gives nail polish remover its fruity smell. Once it vaporizes, it can spread rapidly through the air.</p><p>When one of these animals detects a meaningful odor, the chemical signal is translated into messages and transported throughout its brain. The messages go simultaneously to the olfactory cortex, which is responsible for identifying, localizing and remembering odor, and to other brain regions responsible for decision-making and emotion. So these animals can detect many chemical signals over great distances and can make rapid and accurate mental associations about them. </p>
<h2>2. How do researchers choose a target scent?</h2><p>In most studies that have used dogs to detect cancer, the dogs have identified physical samples, such as skin, urine or breath, from patients who either have been diagnosed with cancer or have <a href="https://doi.org/10.1016/j.applanim.2004.04.008" target="_blank" rel="noopener noreferrer">undiagnosed cancer at an early stage</a>. Scientists don't know what odor cue the dogs use or whether it varies by type of cancer.</p><p>The U.S. Department of Agriculture's <a href="https://www.aphis.usda.gov/aphis/ourfocus/wildlifedamage/programs/nwrc" target="_blank" rel="noopener noreferrer">National Wildlife Research Center</a> in Colorado and the <a href="https://monell.org/" target="_blank" rel="noopener noreferrer">Monell Chemical Senses Center</a> in Pennsylvania have trained mice to detect <a href="https://doi.org/10.1371/journal.pone.0075411" target="_blank" rel="noopener noreferrer">avian influenza in fecal samples from infected ducks</a>. Bird flu is hard to detect in wild flocks, and it <a href="https://www.cdc.gov/flu/avianflu/avian-in-humans.htm" target="_blank" rel="noopener noreferrer">can spread to humans</a>, so this work is designed to help wildlife biologists monitor for outbreaks.</p><p>The Kimball lab at Monell taught the mice to get a reward when they smelled a confirmed positive sample from an infected animal. For example, mice would get a drink of water when they traveled down the arm of a Y-shaped maze that contained feces from a duck infected with avian influenza virus.</p><p>By chemically analyzing the fecal samples, researchers found that the concentration of volatile chemical compounds in them changed when a duck became infected with bird flu. So they inferred that this altered smell profile was what the mice recognized.</p><iframe src="https://www.youtube.com/embed/0UxLt3yugUA?wmode=transparent&start=0"></iframe><p>Members of the mustelid family, such as ferrets, badgers and otters, have highly developed senses of smell. Here a wolverine sniffs out frozen meat buried deep in the snow.</p><p>Building on that work, we've trained ferrets and dogs to detect avian influenza in fowl, such as wild ducks and domestic chickens, in a collaborative study between Colorado State University and the National Wildlife Research Center that is currently under review for publication.</p><p>With ferrets, we started by training them to alert, or signal that they had detected the target odor, by scratching on a box that contained high ratios of those volatile compounds and to ignore boxes that contained low ratios. Next we showed the ferrets fecal samples from both infected and noninfected ducks, and the ferrets immediately began alerting to the box containing the fecal sample from an infected duck.</p><p>This approach is similar to the way that dogs are trained to detect known volatile odors in explosives or illegal drugs. Sometimes, though, we have to let the detector animal determine the odor profile that it will respond to.</p>
<h2>3. Can animals be trained to detect more than one target?</h2><p>Yes. To avoid confusion about what a trained animal is detecting, we can teach it a different behavioral response for each target odor.</p><p>For example, the dogs in the U.S. Department of Agriculture's <a href="https://www.aphis.usda.gov/aphis/ourfocus/wildlifedamage/programs/nwrc/sa_spotlight/sniffing+out+disease" target="_blank" rel="noopener noreferrer">Wildlife Services Canine Disease Detection Program</a> respond with an aggressive alert, such as scratching, when they detect a sample from a duck infected with bird flu. When they detect a sample from a white-tailed deer infected by the prion that causes <a href="https://www.cdc.gov/prions/cwd/index.html" target="_blank" rel="noopener noreferrer">chronic wasting disease</a>, they respond with a passive alert such as sitting down.</p><p>Research at the University of Auburn has shown that dogs can remember and respond to <a href="https://doi.org/10.1007/s10071-020-01362-7" target="_blank" rel="noopener noreferrer">72 odors during an odor memory task</a>. The only limitation is how many ways a dog can communicate about different odor cues.</p>
<h2>4. What kinds of factors can complicate this process?</h2><p>First, any organization that trains animals to detect disease needs the right type of laboratory and equipment. Depending on the disease, that could include personal protection equipment and air filtering.</p><p>Another concern is whether the pathogen might infect the detection animals. If that's a risk, researchers may need to inactivate the samples before they expose the animals. Then they need to see whether that process has altered the volatiles that they are teaching the animals to associate with infection.</p><p>Finally, handlers have to think about how to reinforce the desired response from detection animals in the field. If they are working in a population of mostly noninfected people – for example, in an airport – and an animal doesn't get a chance to earn a reward, it may lose interest and stop working. We look for animals that have a strong drive to work without stopping, but working for a long time without reward can be challenging for even the most motivated animal.</p>
<h2>5. Why not build a machine that can do this?</h2><p>Right now we don't have devices that are as sensitive as animals with well-developed senses of smell. For example, a dog's sense of smell is <a href="https://doi.org/10.1016/j.applanim.2005.07.009" target="_blank" rel="noopener noreferrer">at least 1,000 times more sensitive than any mechanical device</a>. This could explain why dogs have detected cancer in tissue samples that have been <a href="https://doi.org/10.1016/j.applanim.2004.04.008" target="_blank" rel="noopener noreferrer">medically cleared as not cancerous</a></p><p>We also know that ferrets can detect avian flu infection in fecal samples before and after laboratory analysis shows that the virus has stopped shedding. This suggests that for some pathogens, there may be changes in volatiles in individuals who are infected but are asymptomatic.</p><p>As scientists learn more about how mammals' sense of smell works, they'll have a better chance of creating devices that are as sensitive and reliable in sniffing out disease.<img src="https://counter.theconversation.com/content/151832/count.gif?distributor=republish-lightbox-basic" alt="The Conversation"></p><p><a href="https://theconversation.com/profiles/glen-j-golden-1186384" target="_blank">Glen J. Golden</a>, Research Scientist/Scholar I, <em><a href="https://theconversation.com/institutions/colorado-state-university-1267" target="_blank" rel="noopener noreferrer">Colorado State University</a></em></p><p>This article is republished from <a href="https://theconversation.com/" target="_blank" rel="noopener noreferrer">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-scent-of-sickness-5-questions-answered-about-using-dogs-and-mice-and-ferrets-to-detect-disease-151832" target="_blank" rel="noopener noreferrer">original article</a>.</p>
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How New York's largest hospital system is predicting COVID-19 spikes
Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
14 January, 2021
Credit: Getty Images
Sponsored by Northwell Health
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
<p>One of the most devastating aspects of the COVID-19 pandemic has been unpredictability. The nation's health systems—especially those in hard-hit areas like New York City—have had to adapt to sudden surges of COVID-19 cases, all while dealing with limited resources, existing patients, and a novel virus that's still not fully understood.</p><p>But what if health systems were able to forecast COVID-19 hospitalizations two weeks before they occur? Northwell Health, the largest health care system in New York state, recently deployed a predictive tool that does just that.</p><p>Northwell Health's <a href="https://www.northwell.edu/northwell-website-patterns-predict-covid-19-cases" target="_blank">surveillance dashboard</a> is able to predict COVID-19 hospitalizations by using insights from machine learning. In March, Northwell Health's Customer Insights Group developed an algorithm that's been mining data from online traffic to the Northwell.edu website, which has received more than 20 million hits since March.<strong></strong></p><p>The algorithm collects data through 15 different indicators, each of which reflects the online behavior of the website's visitors. For example, the tool analyzes metrics such as the length of time users spend on certain pages, searches for emergency department wait times, and specific symptoms users search for. Combined, this information translates into something like the "public mood" of the website on any given day.</p>
<blockquote>Since Northwell Health began using the predictive tool in September, it's predicted COVID-19 hospitalizations with an accuracy of about 80 percent.</blockquote>
<p>To understand how this mood relates to future COVID-19 cases, Northwell Health began comparing its data with a timeline of COVID-19 hospitalizations across 23 hospitals and nearly 800 outpatient facilities and in the metro New York area. This enabled the Customer Insights Group to see patterns of online activity that precede future increases or decreases in hospitalizations.</p><p>Since Northwell Health began using the predictive tool in September, it's predicted COVID-19 hospitalizations with an accuracy of about 80 percent.</p><p>"This is really the first tool that I've been exposed to that gives me a sort of guestimate of what two weeks from now may look like," said Dr. <a href="https://www.northwell.edu/find-care/find-a-doctor/emergency-medicine/dr-eric-scott-cruzen-md-mba-11346068" target="_blank" rel="noopener noreferrer">Eric Cruzen, </a>chief medical informatics officer of Northwell's emergency medicine services and chair of the emergency department at Lenox Health Greenwich Village in Manhattan.</p><p>"Even if the data can provide an idea of whether to expect an increase, decrease, or stasis, that's valuable. Because every day we're working to estimate what tomorrow's going to bring. Any tool that's going to shed light on that is a good tool in my book."</p>
The value of forecasting
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health
<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>Making machine-learning tools openly accessible
<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>
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7 expert perspectives on what COVID-19 means for the planet
At the height of the first wave, many people took heart from the drop in air pollution resulting from global lockdowns.
27 December, 2020
DENIS LOVROVIC/AFP via Getty Images
Experts agree that the legacy of the COVID-19 pandemic will be with us for years, even after the immediate threat has passed.
<p>The way we live may have changed, perhaps for ever, but what about the impact on our planet? Here are 7 perspectives on what's happening – and what we can do about it.</p><h3>1. COVID-19 may have cut air pollution but we haven't beaten climate change</h3><p>At the height of the pandemic, many people took heart from the drop in air pollution resulting from global lockdowns. The reduction in economic activity took us back to <a href="https://www.weforum.org/agenda/2020/05/enviroment-coronavirus-covid19-pandemic-emissions-co2-pollution/" rel="noopener noreferrer" target="_blank">daily levels last seen in 2006</a>. But <a href="https://www.esrl.noaa.gov/gmd/ccgg/trends/mlo.html" rel="noopener noreferrer" target="_blank">concentrations of CO2 in the Earth's atmosphere are still rising</a>.</p><p>Larissa Basso, a postdoctoral fellow at Stockholm University, says <a href="https://www.weforum.org/agenda/2020/05/why-a-17-emissions-drop-does-not-mean-we-are-addressing-climate-change/" rel="noopener noreferrer" target="_blank">that's because CO2 molecules can persist in the atmosphere for up to 200 years</a>. And, regardless, she says the drop in emissions will only be temporary unless we address the root causes by changing the way we live.</p><p>The International Energy Agency has called for <a href="https://www.weforum.org/agenda/2020/06/sustainable-green-recovery-economy-boost-coronavirus/" rel="noopener noreferrer" target="_blank">a global investment of $1 trillion</a> to accelerate the move to zero-carbon energy. Its plan would create 9 million jobs a year, reduce emissions by 4.5 billion tonnes globally and deliver a sustainable recovery.</p>
<h3>2. The food waste problem has been made worse</h3><p><a href="https://www.weforum.org/agenda/2020/06/covid-19-food-waste-mountains-environment/" target="_blank" rel="noopener noreferrer">Mountains of food have been thrown away</a> because the pandemic has closed restaurants, shops and takeaway food outlets. And, with much of the waste dumped in landfills, methane levels could rise as a result.</p><p><a href="https://www.sciencedirect.com/science/article/abs/pii/030626199190021O#:~:text=On%20a%20molecule%2Dfor%2Dmolecule,18%25%2C%20during%20the%201980s." target="_blank" rel="noopener noreferrer">Methane is 20 times more potent than CO2 as a greenhouse gas</a> and is thought to have been responsible for approaching a fifth of historic global warming. It makes up at least half of all emissions from landfills.</p><p>The <a href="https://www.weforum.org/great-reset/about" target="_blank" rel="noopener noreferrer">World Economic Forum initiative 'The Great Reset'</a> calls for urgent action to manage the consequences of the COVID-19 crisis, including food waste at a time of rising global poverty. "We must invest in the future and transform our food systems to build a more inclusive and sustainable world," the Food and Agriculture Organization of the United Nations <a href="https://twitter.com/FAO/status/1271747397002067968?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1271747397002067968%7Ctwgr%5Eshare_3&ref_url=https%3A%2F%2Fwww.weforum.org%2Fagenda%2F2020%2F06%2Fcovid-19-food-waste-mountains-environment%2F" target="_blank" rel="noopener noreferrer">said recently</a>.</p>
<h3>3. Single-use plastics are on the rise too</h3><p>Plastic has played a vital role in keeping us safe and treating people suffering from COVID-19 – think masks and plastic cups. But some experts say it's being used so much that we are <a href="https://www.weforum.org/agenda/2020/07/plastic-waste-management-covid19-ppe/" target="_blank" rel="noopener noreferrer">storing up a plastics crisis for the future</a>.</p><p>The pandemic threatens to <a href="https://www.weforum.org/agenda/2020/07/plastic-waste-management-covid19-ppe/" target="_blank" rel="noopener noreferrer">stall or even reverse progress to reduce global plastic waste</a>, says Jacob Duer, President and CEO, Alliance to End Plastic Waste. In the UK, illegal dumping of trash has risen 300% during the crisis.</p><p>In Thailand, the Environment Institute blames soaring home food deliveries for <a href="http://thainews.prd.go.th/en/news/detail/TCATG200418155259223" target="_blank" rel="noopener noreferrer">increasing levels of plastic waste from about 1,500 tonnes a day to about 6,000 tonnes</a>. Duer urges companies and governments to work together to reduce plastic use and improve waste management.</p>
<h3>4. Millions more people will be driven into poverty</h3><p>The World Bank says as many as <a href="https://www.weforum.org/agenda/2020/06/world-bank-coronavirus-covid19-extreme-poverty/" target="_blank" rel="noopener noreferrer">100 million extra people could be pushed into extreme poverty by the COVID-19 pandemic</a> and its impact on the global economy. That's 100 million people forced to <a href="https://www.worldbank.org/en/topic/poverty/overview" target="_blank" rel="noopener noreferrer">live on less than $1.90 a day</a>.</p><p>Shrinking global GDP risks reversing <a href="https://www.worldbank.org/en/topic/poverty/overview" target="_blank" rel="noopener noreferrer">recent progress in reducing the numbers of the world's poorest people</a>. A total of <a href="https://www.oxfam.org/en/press-releases/half-billion-people-could-be-pushed-poverty-coronavirus-warns-oxfam#:~:text=The%20economic%20fallout%20from%20the,developing%20countries%2C%20said%20Oxfam%20today.&text=The%20immediate%20cancellation%20of%20US,country%20debt%20payments%20in%202020." target="_blank" rel="noopener noreferrer">half a billion people could be pushed into poverty by COVID-19</a>, according to Oxfam.</p><p>Of the <a href="https://www.weforum.org/agenda/2020/06/world-bank-coronavirus-covid19-extreme-poverty/" target="_blank" rel="noopener noreferrer">176 million people the World Bank expects to be pushed into poverty</a> with an income below $3.20 a day, two-thirds are in South Asia. Only a robust global recovery will reverse this trend, it says.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk5ODI0Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2MzAwMzY0Nn0.Dl71cPH2OHbze1cC4A3r4RBGV44-cCE7zkgLpANd4vc/img.jpg?width=980" id="c263d" class="rm-shortcode" data-rm-shortcode-id="ec8d5e61d5a3e3648756c967245f1ae8" data-rm-shortcode-name="rebelmouse-image" alt="Coronavirus pushes half a billion people into poverty" data-width="1200" data-height="1200" />
Source: Oxfam
<h3>5. Immunization has been set back by the pandemic</h3><p>While the world has been focused on fighting coronavirus, deadly diseases have not gone away. But <a href="https://www.weforum.org/agenda/2020/07/immunization-disruption-covid-19/" target="_blank">efforts to combat them by immunization have taken a back seat</a> to combatting COVID-19, and the results could be serious unless inoculations pick up the pace.</p><p><a href="https://data.unicef.org/resources/immunization-coverage-are-we-losing-ground/" target="_blank" rel="noopener noreferrer">UNICEF estimates that 80 million children under the age of one could go unvaccinated</a> due to the disruption of immunization programmes. "Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health," <a href="https://www.who.int/news-room/detail/22-05-2020-at-least-80-million-children-under-one-at-risk-of-diseases-such-as-diphtheria-measles-and-polio-as-covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef" target="_blank" rel="noopener noreferrer">says Dr Tedros Adhanom Ghebreyesus, World Health Organization Director-General</a>.</p><p>"Disruption to immunization programmes from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles," he adds. <a href="https://data.unicef.org/resources/immunization-coverage-are-we-losing-ground/" target="_blank" rel="noopener noreferrer">UNICEF agrees</a>: "As we recover from COVID-19, our aim should not be to just make up lost ground, but to break through the long stagnation that has held us back for the last decade."</p><h3>6. 'Building back better' must put the environment and fairness first</h3><p>IKEA may be best known around the word for its flat-pack furniture. But <a href="https://www.weforum.org/agenda/2020/06/five-pathways-to-a-better-future-after-covid-19/" target="_blank" rel="noopener noreferrer">Per Heggenes, CEO of the IKEA Foundation</a>, wants us all to collectively work to build something bigger – a better world for future generations.</p><p><a href="https://www.weforum.org/agenda/2020/06/five-pathways-to-a-better-future-after-covid-19/" target="_blank" rel="noopener noreferrer">Writing for the World Economic Forum</a>, Heggenes set out a five-point programme for a fairer and more sustainable post-COVID world: protect the planet; renewable energy for all; a changed relationship to food; dignified work and entrepreneurship; and leave no one behind.</p><p>"Challenging situations can bring out the best in people. Solidarity, unprecedented collaboration and new ways of thinking can help us emerge stronger and smarter from this pandemic," Heggenes says.</p>
<h3>7. Looking after the environment could help prevent future pandemics</h3><p>Protecting nature is <a href="https://www.weforum.org/agenda/2020/05/scientists-pandemics-coronavirus-nature-covid19-health/" target="_blank" rel="noopener noreferrer">the key to avoiding future pandemics</a>, scientists believe. Writing in a guest article for the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, four leading biodiversity experts lay the blame for the current crisis at the door of humanity.</p><p>Warning that 1.7 million viruses, known to infect humans, exist in mammals and water birds, they say deforestation, intensive farming, mining and development, coupled with the exploitation of wild species have created a "perfect storm" for the spillover of diseases from wildlife to people.</p><p>But if we are the problem we can also be the solution. "We can build back better and emerge from the current crisis stronger and more resilient than ever – but to do so means choosing policies and actions that protect nature – so that nature can help to protect us," they say.</p><p>Reprinted with permission of the <a target="_blank" href="https://www.weforum.org/" rel="noopener noreferrer">World Economic Forum</a>. Read the <a target="_blank" href="https://www.weforum.org/agenda/2020/09/experts-on-what-covid19-means-for-planet/" rel="noopener noreferrer">original article</a>.</p>
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Telehealth will save lives—for as long as it has funding
The federal government and private insurers greatly increased Americans' telehealth access during the pandemic. Will these changes be permanent?
23 December, 2020
During COVID-19, most U.S. health care organizations managed to massively increase their virtual consultations, keeping patients and doctors safe.
Credit: Adobe Stock
- When telehealth visits began skyrocketing after the pandemic began, hospitals had to increase their number of virtual appointments by magnitudes. Most did it seamlessly.
- Big Think spoke to Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, about this transition and how it benefited patients.
- Telehealth has proven its value during the pandemic, but it might stop evolving unless the federal government redesigns the regulatory framework so that insurers cover it and patients can afford it.
<p>When COVID-19 began <a href="https://www.northwell.edu/news/insights/how-covid-19-came-to-the-us-then-hit-new-york-hard" target="_blank" rel="noopener noreferrer">spreading across the U.S.</a> in early 2020, the nation's telehealth infrastructure entered a trial by fire.</p><p>It was paramount for hospitals to minimize in-person care—not only to limit the spread of the virus, but also to ensure hospitals wouldn't become overwhelmed, like they had in Italy. That's a key reason why, in March, Medicare and most private insurers sought to increase access to telehealth by relaxing restrictions, waiving fees, and reimbursing practitioners for virtual visits at the same rate as in-person visits.</p><p>Soon after the establishment of these temporary measures, telehealth visits skyrocketed. A <a href="https://www.hhs.gov/about/news/2020/07/28/hhs-issues-new-report-highlighting-dramatic-trends-in-medicare-beneficiary-telehealth-utilization-amid-covid-19.html" target="_blank" rel="noopener noreferrer">report</a> from the U.S. Department of Health and Human Services found, for example, that about 43 percent of primary care visits were conducted through telehealth in April, compared to just 0.1 percent in February.</p><p>How did that transition go? Despite having just weeks to prepare, most U.S. health care organizations managed to massively increase their virtual caseload with astounding seamlessness. Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, was one of the thousands of health care professionals who witnessed the transition.</p><p>"We went from the proverbial 'zero to 60' over a matter of weeks, and provided good care with very high degrees of patient satisfaction," Doerfler said.</p><p>Prior to the pandemic, Northwell Health—the largest hospital system in New York—was conducting about 150 telehealth visits per month between 20 to 40 physicians. But in May alone, Northwell had conducted approximately 65,000 visits with roughly 8,000 health care professionals across the health system.</p><p>Doerfler cited an example of a single mother whose young child had chronic illnesses, including respiratory problems, which made in-person visits especially dangerous during the pandemic. The pediatrician was able to evaluate the child, speak to the mother through a telehealth translation service, and provide the family with the necessary steps to keep the child healthy. The mother was happy to avoid having to take her child on public transportation to visit a hospital in person and still receive the care she needed.</p>
<blockquote>Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab.</blockquote>
<p>Clinicians at Northwell have used telehealth to adapt to the pandemic in many ways, from sending phlebotomists to elderly patients' homes after virtual visits, to connecting new mothers with lactation specialists via secure, encrypted telehealth channels.</p><p>"There are all sorts of examples throughout health care where this technology, and the willingness of patients and clinicians to embrace it, allowed for care of the type of issues that are normally done face-to-face," Doerfler said.</p><p>Telehealth programs that existed before the pandemic also helped to keep both patients and hospital staff safe by minimizing in-person visits. For example, Northwell's TelePsychiatry Department connects people in crisis, who might typically go to the emergency department, with a behavioral health specialist in about 45 minutes, any time of day or week. That is a considerable improvement since emergency department staffing typically does not include psychiatrists or other specialists who can help someone experiencing a behavioral health emergency.</p><p>The success of telehealth during the pandemic begs the question: Why hasn't US health care already embraced virtual care?</p>
What are the obstacles facing telehealth?
<p>One of the biggest obstacles to widespread adoption of telehealth has been a lack of national legislation providing financial incentive for health centers to adopt it.</p><p>States laws vary on how practitioners are paid for telehealth visits. In some states, laws require insurance providers to cover telehealth visits at parity—at the same rate as in-person visits. But in states without parity laws, there's little incentive for health care organizations to invest in telehealth infrastructure and training.</p><p>Access is also a major obstacle. The Centers for Medicare and Medicaid Services (CMS) generally reimburse practitioners for telehealth visits only when patients live in "designated rural underserved areas."</p><p>But not all underserved areas are in small, remote places. After all, a single parent living in Brooklyn, New York, might also have trouble accessing quality health care.</p><p>"Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab," Doerfler said. "So access is almost certainly going to be improved by the greater availability of telehealth in that direct-to-patient, in-their-home-or-office, setting."</p><p>Lack of internet access is also a problem. A <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768771?appId=scweb" target="_blank" rel="noopener noreferrer">paper</a> published by the JAMA Network in August found that 41 percent of Medicare beneficiaries don't have a computer at home with access to high-speed internet, and roughly the same number don't have a smartphone with an unlimited data plan.</p>What is the future of telehealth?
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDU1NTU1Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NjA1MjkxMH0.1UuR6tky1k58rOeE9Vcgt8bUfhA2vut6yaCAXik1MEY/img.jpg?width=980" id="9f55b" class="rm-shortcode" data-rm-shortcode-id="4549f30a0347a85c7145690870cf742c" data-rm-shortcode-name="rebelmouse-image" alt="Caucasian female doctor delivering telemedicine consultation to a patient" data-width="5600" data-height="3150" />Credit: Daniilvolkov via AdobeStock
<p>Lawmakers in both parties and health care professionals have indicated a desire to make permanent some of the regulatory changes to telehealth enacted during the pandemic. That's key, because without the financial incentives to continue expanding telehealth, health care providers may revert to the pre-pandemic approach.</p><p>"One issue, which is important for health care and non-health-care folks to know, is that telehealth will continue to expand dramatically as long as there's funding and reimbursement for it," said Michael Dowling, Northwell's president and CEO. "If the insurance companies and government decide, 'We don't want to pay for telehealth going forward or virtual visits,' then it's going to slow down. If there is no delivery system, no health care system, hospital, or doctor is going to continue to expand telehealth if they don't get reimbursed for it."</p><p>Yet some of the nation's biggest insurers have already stopped waiving telehealth deductibles and copays for some customers, even though there's no clear end in sight for the pandemic.</p><p>The long-term solution, Doerfler said, is for CMS to start paying for telehealth services, a<a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a>t parity, up and down the chain, and passing federal legislation that requires <a href="https://www.siia.org/i4a/pages/Index.cfm?pageID=4546#:~:text=What%20is%20a%20self%2Dinsured%20health%20plan%3F&text=A%20self%2Dinsured%20group%20health,care%20benefits%20to%20its%20employees." target="_blank">self-insured health care plans</a> to pay for telehealth services as they would in-person visits.</p><p>Telehealth is proven to work for urgent care, primary care and some specialty care, and it clearly expands access to behavioral health care, according to Doerfler. "Some have said that costs of providing telehealth are lower than face-to-face care, but most of the costs are unchanged, and new ones are added with technology requirements. When the patient receives a very specific service there are billing codes used to define that service. If the service is less, the code represents that. If the service is the same, the code will represent that and needs to be paid at parity."</p><p>Doerfler added that, while telehealth can't replace all traditional health care services, it should be "<a href="https://www.northwell.edu/news/insights/how-to-have-an-effective-telehealth-visit" target="_blank">in the toolbox</a>" for patients and physicians.</p><p>"In the modern world, where this type of technology is being used for all sorts of personal and business uses, excluding something as personal as your care between you and your doctor from fitting into that modern paradigm makes no sense," Doerfler said.</p>
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People in these countries think their government did a good job of dealing with the pandemic
Spoiler: Most people actually approved of their government's approach.
22 December, 2020
Photo by Matthew Waring on Unsplash
Coronavirus
How well did your country respond to the pandemic?
<p>It's a subjective question, the answers to which are reflected in new research recording the diversity of opinion around the world.</p><p>Spoiler alert: globally, more people approved of their own country's response than disapproved.</p><p>A Pew Research Center survey of more than 14,000 adults across 14 advanced economies in Europe, Asia, North America and Australia, found <a href="https://www.pewresearch.org/global/2020/08/27/most-approve-of-national-response-to-covid-19-in-14-advanced-economies/" target="_blank">73% thought their own country had done a good job of tackling the coronavirus outbreak</a>.</p><h3>It's a matter of trust</h3><p>Respondents' attitude to their own country's pandemic response – and its impact on national unity – were linked to feelings of trust in others, the survey found.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk4Nzc2NS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2MDQ4NTY2OH0.7aCNwI30_-qmgMOu854flTXuD1eh_iBAkO2zDlKPzS8/img.jpg?width=980" id="8d49e" class="rm-shortcode" data-rm-shortcode-id="a8db10a752157ee0a82c50dfe6a1eb90" data-rm-shortcode-name="rebelmouse-image" alt="With the exception of the UK and the US, countries believed they handled the pandemic well." data-width="462" data-height="852" />
Image: Pew Research Center
<p>Denmark recorded the highest government response approval rating of the countries surveyed (95%), followed closely by Australia.</p><p>Support for their government's actions was also shown in countries like South Korea and Canada, along with European nations like Germany, the Netherlands, Italy and Sweden, where more than two-thirds of respondents approved.</p><p>But a different picture emerged in the US and UK, where delayed action to combat COVID-19 received less emphatic support. More than half of those polled in each country said they thought the pandemic had been handled poorly.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk4Nzc2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNjYxMjA0Mn0.ZyQK6F1fJ1Z5ZtBQLWnwUECKRpopoZzXmPyyG-WETi4/img.jpg?width=980" id="6f92f" class="rm-shortcode" data-rm-shortcode-id="a9e2479f24a45ee19f9cb80c3e2742e2" data-rm-shortcode-name="rebelmouse-image" alt="Americans stand out in their belief that they're more divided as a result of the pandemic." data-width="421" data-height="820" />
Image: Pew Research Center
<h3>Divided or united?</h3><p>Opinions were also split on whether the pandemic had increased the sense of national unity.<br><br>Again, Denmark proved to have the most optimistic outlook with 72% of respondents believing the country more united following the virus outbreak. In Canada, Sweden, South Korea and Australia, over half of respondents believed their country was more united.<br><br>Despite approving of their country's response to the pandemic, in European nations like Spain, Belgium, Italy and the Netherlands, a majority of people thought their country was more divided post-lockdown.<br><br>In the US, in an era of divisive politics and with no coordinated response to the pandemic in place, more than three-quarters of respondents believed their country was now more divided than before the pandemic.</p><p>The perceived strength of national unity is linked to trust in others, the report found. As a general principle, people who thought others couldn't be trusted were more likely to see divisions in their own country.<br><br>National divisions were most pronounced in France, where almost two-thirds of respondents who think people can't be trusted also see the country as more divided than before the pandemic.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk4NzgwNC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2MzU4NDYwOH0._oLZklchjnz5tVF5q9NSiTrcBgHTG5frZGAcgU1wtW0/img.jpg?width=980" id="e0f0b" class="rm-shortcode" data-rm-shortcode-id="c8134181a7a12218b9e6ae3bd37a9573" data-rm-shortcode-name="rebelmouse-image" alt="Prevailing view that more international cooperation would have reduced coronavirus cases." data-width="369" data-height="826" />
Image: Pew Research Center
<h3>The role of international cooperation</h3><p>But did this perceived drop in national cohesion prevent countries seeking international help to combat the spread of the virus? And would cross-border cooperation have resulted in fewer cases?<br><br>For the majority of respondents, the answer was yes.<br><br>Across the 14 countries surveyed, 59% of respondents believed greater international cooperation would have reduced the number of coronavirus cases in their own country. In Europe, this average increases to 62%, with seven of the nine countries surveyed expressing belief in the benefits of international cooperation, which was strongest in countries like Belgium, the UK and Spain.</p><p>Outside of Europe, support for international cooperation was also notable in the US (58%) and South Korea (59%), according to the report.</p><p>In Denmark, however, 78% of people thought international cooperation would not have reduced the number of cases. A majority of people in Australia, Germany, Canada and Japan also held little store in international cooperation to tackle the pandemic.<br><br>The World Bank, in collaboration with the World Economic Forum and other stakeholders, held a virtual roundtable to devise an action plan <a href="https://www.worldbank.org/en/news/statement/2020/04/21/the-world-bank-wef-gsma-and-itu-mobilized-in-the-fight-against-covid-19" target="_blank">to facilitate international cooperations and communications to better tackle the pandemic</a>.</p><p>International <a href="https://www.chathamhouse.org/expert/comment/hurdles-developing-covid-19-vaccine-why-international-cooperation-needed" target="_blank" rel="noopener noreferrer">cooperation is a key element of producing an effective vaccine at scale</a> to protect the global population against COVID-19, according to Chatham House. By working together, researchers, business leaders, policy-makers and other stakeholders can more quickly overcome scientific, regulatory and market challenges to developing and distributing a vaccine.</p><p>Reprinted with permission of the <a target="_blank" href="https://www.weforum.org/" rel="noopener noreferrer">World Economic Forum</a>. Read the <a target="_blank" href="https://www.weforum.org/agenda/2020/09/covid-19-survey-trust-unity-cooperation/" rel="noopener noreferrer">original article</a>.</p>
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5 facts about positive affect for 2021
After the unrelenting negativity of 2020, we may need a refresher on the benefits of a positive affect.
21 December, 2020
Credit: Antonioguillem / Adobe Stock
Personal Growth
<ul class="ee-ul"></ul>
<p><a target="_blank" rel="noopener noreferrer">The </a><a href="https://bigthink.com/politics-current-affairs/top-google-searches-2020" target="_self">year 2020</a> was an unrelenting nightmare of negative stimuli. The coronavirus hit early and, in coastal cities like Seattle and New York, hit hard. Daily news reports tallied <a href="https://covid.cdc.gov/covid-data-tracker/#cases_casesper100klast7days" target="_blank" rel="noopener noreferrer">a death toll</a> that today accounts for more American lives lost to coronavirus than <a href="https://www.va.gov/opa/publications/factsheets/fs_americas_wars.pdf" target="_blank" rel="noopener noreferrer">battles in World War II</a>. <a href="https://bigthink.com/coronavirus/job-seekers-coronavirus" target="_self">Unemployment</a> reached <a href="https://www.latimes.com/politics/story/2020-05-08/jobs-report-labor-market-shock" target="_blank" rel="noopener noreferrer">unprecedented levels</a> just as schools rushed to implement <a href="https://bigthink.com/personal-growth/remote-education" target="_self">remote-learning contingencies</a>. Then there were the violent displays of racial inequality, the revelations of America's <a href="https://bigthink.com/Northwell-Health/health-disparities-coronavirus" target="_self">devastating health gaps</a>, and <a href="https://www.scientificamerican.com/article/a-running-list-of-record-breaking-natural-disasters-in-2020/" target="_blank" rel="noopener noreferrer">widespread disasters</a> that hit with devastating force. Oh, and it was an election year, a time customarily reserved for bickering and the revocation of goodwill.</p><p>Many of us know that 2021 won't bring miraculous change, like a hard reboot of America's fractured systems and growing cultural distrust. But with New Year's quickly approaching, we also can't help but revel in its symbolism, a fresh start to a new (hopefully better) year.</p><p>After the fusillade of negativity that was 2020, though, we may need some help rerouting our mental circuitry toward positivity. Here are five helpful reminders of the value of sporting a positive outlook backed by science—and not self-help quackery.</p>
1. Positivity correlates with better health
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="67cab64f293633035f0c699f71a5d426"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/vyJ_hhninDw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>It's difficult to say whether a positive outlook nurtures health, success, and life satisfaction or if people who are healthy, successful, and satisfied maintain a positive outlook for, well, obvious reasons. While establishing a causal relationship has been difficult, research does suggest that happiness, extraversion, and optimism—the traits of a <a href="https://www.verywellmind.com/positive-affect-and-stress-3144628#:~:text=%22Positive%20affect%22%20refers%20to%20one's,negativity%20in%20relationships%20and%20surroundings" target="_blank" rel="noopener noreferrer">positive affect</a>—influence beneficial life outcomes as much as it is a byproduct.</p><p>A longitudinal study published in <a href="https://journals.sagepub.com/doi/10.1177/0956797620953883" target="_blank" rel="noopener noreferrer">Psychological Science</a> found that enthusiastic, cheerful people experienced less memory decline with age. The researchers tested nearly 1,000 middle-aged and senior U.S. adults and found a strong association between having a positive affect and a stronger performance on the memory test.</p><p>As study authors Claudia Haase and Emily Hittner, an associate professor and a Ph.D. graduate at Northwestern University, respectively, <a href="https://www.psychologicalscience.org/news/releases/2020-oct-positive-outlook-memory.html" target="_blank">said in a release</a>: "Our findings showed that memory declined with age. However, individuals with higher levels of positive affect had a less steep memory decline over the course of almost a decade."</p><p>Preliminary research looking at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122271/" target="_blank" rel="noopener noreferrer">the broaden-and-build theory</a> suggests that a positive affect not only helps people cope with stress but makes them more psychologically resilient to future stressors. And <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-power-of-positive-thinking" target="_blank" rel="noopener noreferrer">studies have found</a> that a positive outlook boosts immune responses while reducing the likelihood of heart attacks or other coronary problems. (Though, again, it is unclear in the literature whether positive people make healthier choices or if the positive affect influences these boons).</p>2. Positivity is contagious
<p>The <a href="https://www.psychologytoday.com/us/blog/high-octane-women/201210/emotions-are-contagious-choose-your-company-wisely" target="_blank" rel="noopener noreferrer">emotional contagion phenomenon</a> describes the tendency for us to acquire the emotions of the people around us. Hanging out with happy, enthusiastic people, researchers have discovered, makes us happier and more enthusiastic ourselves, leading to windfalls such as less stress and increased energy. Of course, the phenomenon works in the opposite direction, too. Our minds can become the harbors of others' misery. </p><p>"Just as some diseases are contagious, we're found that many emotions can pulse through social networks," sociologist Nicholas Christakis told <a href="https://hms.harvard.edu/magazine/science-emotion/contagion-happiness" target="_blank" rel="noopener noreferrer">Harvard Medicine in an interview</a>. Unlike a real disease, however, emotions don't have to be transmitted through contact. They can infect our minds through social networks and even online.</p><p><a href="https://www.sciencedaily.com/releases/2007/10/071004135757.htm" target="_blank" rel="noopener noreferrer">A study out of the University of Chicago</a> found that researchers could alter people's opinions of a product by simply revealing peer evaluations. Sharing the negative opinions of others turned previously positive opinions sour and entrenched the already negative ones. </p><p>As Christakis added later in the interview, "Rather than asking how we can get happier, we should be asking how we can increase happiness all around us. When you make positive changes in your life, those effects ripple out from you and you can find yourself surrounded by the very thing you fostered."</p>3. Social connections support positivity
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="d5c6236f760ae82fc9ed12daecff4847"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/OAsTZGwc3Kw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>If emotions are contagious, then it stands to reason that positive social connections support personal positivity. And that's exactly what the research shows. </p><p>In 2019, the American Psychological Association published <a href="https://doi.apa.org/fulltext/2019-55803-001.html" target="_blank" rel="noopener noreferrer">a meta-analysis</a> surveying two decades of longitudinal research. All told, the report analyzed more than 47,000 participants across 52 studies looking at the effect social relationships had on self-esteem. The researchers found that social relationships, social support, and social acceptance helped develop positive self-esteem throughout people's lives.</p><p>"For the first time, we have a systematic answer to a key question in the field of self-esteem research: Whether and to what extent a person's social relationships influence his or her self-esteem development, and vice versa, and at what ages," Michelle A. Harris, study author and psychologist at the University of Texas, Austin, <a href="https://www.sciencedaily.com/releases/2019/09/190926092416.htm" target="_blank" rel="noopener noreferrer">said in a release</a>. "The reciprocal link between self-esteem and social relationships implies that the effects of a positive feedback loop accumulate over time and could be substantial as people go through life." Harris added that the effect did not differ significantly across the studies analyzed, suggesting a robust finding.</p>4. We have a bias toward positive language
<p><a href="https://www.sciencedaily.com/releases/2015/02/150209161143.htm" target="_blank" rel="noopener noreferrer">Researchers at the University of Vermont</a> wanted to test the Pollyanna Hypothesis, the idea that there is a universal human tendency to—feel free to whistle along—look on the bright side of life. </p><p>To test it, they asked the native speakers of ten different languages to rate individual words on a 9-point scale. Nine equaled broad-smiley face, while one was for deep-frowny face. For example, among English speakers, "laugher" rated a happy 8.5, "the" a neutral 4.98, and "terrorist" a depressing 1.3. The researchers then gathered a data set containing billions of words from 24 sources in those languages, from books to tweets, websites to music lyrics, and, of course, news stories.</p><p><a href="https://www.pnas.org/content/112/8/2389" target="_blank" rel="noopener noreferrer">An analysis of the data</a> showed that humans typically use language to imbue a, in the researcher's words, "usage-invariant positivity bias." Every one of their 24 sources rated above the neutral score of five across all ten languages. Though it's certainly not true of all songs or novels—no amount of data massaging could turn "<a href="https://en.wikipedia.org/wiki/The_Road" target="_blank" rel="noopener noreferrer" style="">The Road</a>" into anything other than a bummer—the researchers found that overall humanity "use[s] more happy words than sad words." Counterintuitive as it sounds, Twitter really is a gathering of the Pollyannas.</p>5. Positivity is not a self-fulfilling prophecy
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="adc4ace82b7a0f39e0c2ba4fd07f8201"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/-xA5xgAqj1I?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Do these findings mean we should give ourselves over to the cult of positivity come 2021? Should we ignore every one of life's difficulties, view every rain cloud as a cotton-candy-laced fantasy, and use positive thinking to ween away our every foible until we become new-age Übermenschs? Absolutely not. Without realism to serve as ballast, positivity can become a flight of fancy that drifts us over dangerous territories.</p><p><a href="https://journals.sagepub.com/doi/10.1177/0146167220934577" target="_blank">One study</a> compared people's financial expectations in life with their ultimate outcomes over 18 years. They found that participants who set realistic expectations based on accurate assessments of their situations had higher well-being than those who set unrealistic expectations based on overly positive attitudes. Crucially, realists had a higher well-being score than pessimists, too.</p><p>"I think for many people, research that shows you don't have to spend your days striving to think positively might come as a relief. We see that being realistic about your future and making sound decisions based on evidence can bring a sense of well-being, without having to immerse yourself in relentless positivity," Chris Dawson, study author and associate professor of business economics at Bath University, said <a href="https://www.sciencedaily.com/releases/2020/07/200707113230.htm" target="_blank" rel="noopener noreferrer">in a release</a>.</p><p>Positivity must also be measured against a realistic accounting of our emotions. Sometimes, life just sucks. It isn't fair. We lose the people we love, our hard work goes under-appreciated, and we struggle to traverse the paths that others seem to bypass. To just think positively and assume everything will be fine is what psychologist Susan David calls the "tyranny of positivity." Rather than ignore these parts of our life, David suggests that we should accept them.</p><p>"Difficult experiences are part of life. They are part of life's contract with the world. They're part of our contract with the world simply by virtue of being here," David told <a href="https://bigthink.com/videos/susan-david-on-our-unhealthy-obsession-with-happiness" target="_self">Big Think during an interview</a>. "It is really important that as human beings, we develop our capacity to deal with our thoughts and emotions in a way that isn't a struggle, in a way that embraces them and is with them and is able to learn from them."</p><p>Positive realists don't ignore life's hardships and challenges, nor do they let the negativity bias worsen such struggles. They approach both rationally and with measured expectations. When remembering a year or period in their lives, they may also choose to treasure its positive qualities. And after a year like 2020, we can all be forgiven if, in 2021, we err on the bright(er) side of life. </p>
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How to have a constructive conversation with vaccine skeptics
Jonathan Berman wants us to have better dialogues.
21 December, 2020
Photo: AntonioDiaz / Adobe Stock
Coronavirus
- In his book, "Anti-vaxxers," science educator Jonathan Berman aims to foster better conversations about vaccines.
- While the anti-vax movement in America has grown, more Americans now say they'll get a COVID-19 vaccine.
- In this Big Think interview, Berman explains why he's offering an ear to the anti-vax movement.
<p>As two COVID-19 vaccines roll out in America, <a href="https://www.pewresearch.org/science/2020/12/03/intent-to-get-a-covid-19-vaccine-rises-to-60-as-confidence-in-research-and-development-process-increases/" target="_blank">Pew Research reported</a> a rare glimmer of hope in the ongoing saga of vaccine disinformation: the number of citizens willing to get a vaccine increased to 60 percent. The trend is moving in the right direction, course-correcting anti-vaccination rhetoric that led to the <a href="https://www.who.int/news/item/12-11-2020-worldwide-measles-deaths-climb-50-from-2016-to-2019-claiming-over-207-500-lives-in-2019" target="_blank">first increase in measles cases</a> (and the highest number of measles deaths) in the modern era.</p><p>While we have <a href="https://bigthink.com/politics-current-affairs/anti-vaxx" target="_self">fabricated research</a> by disbarred doctor Andrew Wakefield to thank for this trend, anti-vaccination efforts are tethered to the first vaccinations. As with seemingly every topic, vaccines are a wedge issue, with a fervent cohort of anti-vaxxers going so far as to be "<a href="https://www.latimes.com/politics/la-pol-sac-skelton-california-measles-vaccines-20190509-story.html" target="_blank">single-issue voters</a>."</p><p>Jonathan Berman, an assistant professor in the Department of Basic Sciences at NYITCOM-Arkansas, grew tired of seeing all of the "dunking on anti-vaxxers." As with many science advocates, he grew skeptical of the anti-vaxx movement while studying for his degree in the aughts. Though he agreed with Richard Dawkins and Christopher Hitchens, he recognized them as bullies. Berman wanted to grapple with the underlying reasons for opposing vaccination rather than just write them off. </p><p>Those reasons, which comprise a chapter of his recent book, "<a href="https://mitpress.mit.edu/books/anti-vaxxers" target="_blank" rel="noopener noreferrer">Anti-vaxxers: How to Challenge a Misinformed Movement</a>" (MIT Press), include issues of social class, race, individual liberties, individual and collective rights, distrust of authority, and changing ideas about health and medicine. Instead of exhibiting knee-jerk reactions, he wants to offer compassion and empathy while expressing critical thinking when analyzing the science of vaccines. As Berman recently explained of anti-vaxxers, </p><p style="margin-left: 20px;">"They're making a risk evaluation just like we're making a risk evaluation. They're doing it in a less reasonable and healthy way and arriving at the wrong decision. That doesn't mean that we have to call them stupid or act like they're foolish. It means we can have a conversation with them. Hopefully, that's a more productive way to go about it."</p>
Conspirituality 31 interview: Jonathan Berman
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="731bc6f3fa27b262f0e6cae7f8fb4bdd"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/O-JyLRihIhE?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>As he wrote the book before the pandemic hit, Berman is a bit dismayed (though not surprised) by the growth of the anti-vaccine movement. He noticed a convergence point this year: anti-mask and anti-lockdown proponents (as well as QAnon devotees) learned a set of tactics from the longstanding anti-vax movement, while anti-vaxxers took the energy of "personal liberty" and "bodily sovereignty" being expressed by those groups.</p><p>There have been a number of anti-vax leaders whose star has risen this year: Mikki Willis has surged since the release of his <a href="https://bigthink.com/coronavirus/the-plandemic" target="_self">Plandemic</a> film; Del Bigtree, whose show "The Highwire" is in large part <a href="https://www.washingtonpost.com/national/health-science/meet-the-new-york-couple-donating-millions-to-the-anti-vax-movement/2019/06/18/9d791bcc-8e28-11e9-b08e-cfd89bd36d4e_story.html" target="_blank">funded by hedge fund managers</a>, is growing more influential; and gynecologist Christiane Northrup, who has used her <a href="https://conspirituality.net/transmissions/dear-dr-northrup/" target="_blank" rel="noopener noreferrer">social media platforms</a> to promote QAnon-related and anti-vax sentiments, is also seeing a rise in followers. As Berman writes, celebrities are not the best sources of information, and their intentions might not be as benevolent as they seem. </p><p style="margin-left: 20px;">"There's a degree of grift in what they're doing. They're collecting donations from their audience of anti-vaccine people they've built up."</p><p>Science sometimes suffers from lack of celebrity. Paul A. Offit will never be Neil deGrasse Tyson or Bill Nye. While a select few science educators break through, vaccination advocates are unlikely to achieve that level of star power. Berman, one of the founders of the "March for Science" movement—a rare mainstream moment of science advocacy in the Trump era—knows the difficulty of spreading the gospel of sound scientific methods.</p><span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="9f04e562d75f55e2fbafb81bbe4daad0"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/tPMCoD1p-x8?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Navigating the tricky terrain of vaccines is difficult. Thankfully, Berman's excellent book offers hope. Twenty-two concise chapters pack a lot of punch: the history of both vaccines and the anti-vax movement; dangerous ploys by grifters; the science of vaccines; and a chapter on vaccine ingredients, like adjuvants. </p><p>While Berman is pro-vaccine, he believes Pfizer and Moderna <a href="https://bigthink.com/coronavirus/astrazeneca-vaccine" target="_blank">deserve scrutiny</a>. Commentary from outside organizations and researchers should be offered. That said, while pharmaceutical companies certainly have a track record of corporate greed, vaccines only account for 2 percent of profits—hardly cash cows like <a href="https://bigthink.com/21st-century-spirituality/opioids-dont-treat-depression-yet-people-turn-to-them-anyway" target="_self">painkillers</a> and <a href="https://bigthink.com/mind-brain/depression-universal-basic-income" target="_self">antidepressants</a>. </p><p>Berman laughs off the occasional criticism that he's a paid shill. "I'm still on the negative on the book—just because of caffeine purchases while I was writing it."</p><p>Disinformation abounds in the modern era. Posts about the dangers of thimerasol and aluminum persist even though <a href="https://www.nytimes.com/interactive/2020/12/17/technology/pfizer-vaccine-microchip.html" target="_blank" rel="noopener noreferrer">neither are in the Pfizer vaccine</a>. Berman advocates for pushing back against misinformation with better data. </p><p style="margin-left: 20px;">"The coronavirus vaccine—these are very simple formulations. There's salt, RNA, and a lipid to help the RNA cross cell membranes. If someone says there's aluminum in that, you can say, 'not in this one.' And if someone says there's mercury in that, you can say, 'not in this one.'"</p><p>He knows the challenges that lie ahead. Still, as Pew shows, more Americans understand the role that vaccines play in reaching a post-pandemic world. Berman concludes our talk on what you might say is a hopeful note. </p><p style="margin-left: 20px;">"We're not going to get everyone on board. We just need to get enough people on board."</p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His new book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
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