Effect Measure

YouTube and public health

YouTube is a phenomenon. We’ve gotten so used to it (and its user generated content cousins) sometimes we don’t realize how potent it is. Potent and in the hands of all sorts of people. Creative, crazy, evil, well meaning, ordinary, boring . . . you get the idea. And getting ideas is another thing people get from YouTube. Sometimes the ideas are good. Sometimes not:

It may be better known as the place to go to watch a drunken David Hasselhoff eating a hamburger, but the video website YouTube has also become a popular and effective soapbox for people who believe vaccinations are harmful, a new scientific review reveals.

And public health authorities need to come to grips with the potential impact YouTube, Facebook and the whole Internet-based social-networking phenomenon could have on policies like universal vaccinations, suggested the authors, researchers from the University of Toronto and York University. (Helen Branswell, Canadian Press)

Unfiltered access to information, even when that information is bad, misleading or outright false, is a hallmark of the internet and YouTube provides it in a form that is unusually powerful, video. The public health community has been slow on the uptake. I talk a lot about internet communication with my colleagues and my students and, with some notable exceptions, there is disinterest or indifference, sometimes even hostility. So the field has been clear for those for whom the conventional wisdom of public health isn’t so wise. No sense complaining about it. It’s a new world.

For the record, I’m pro-vaccination (as my recent measles post should show). I got a flu shot and so did my 6 month old grandson. That doesn’t mean I think all vaccines are unproblematic all the time. That wouldn’t be reasonable, nor would it be reasonable to think adverse reactions won’t occur when tens or hundreds of millions people are vaccinated.

But consider the alternatives. We don’t have the plethora of childhood diseases common in my own youth, diseases that took tens of thousands of young lives a year. On a YouTube video an anecdote or even a genuine rare reaction has an immediacy with no immediate counterpart in a world where the diseases the vaccine prevented are absent.

It’s a new world. And we in public health need to start living in all parts of it.


  1. #1 DemFromCT
    December 6, 2007

    That includes Second Life, and at least being aware of the social networks. it can be awkward to foray there (to see just how awkward, I’m being interviewed tonight on SL).

    I have to agree with the reveres here. There’s no way to avoid the impact of new media.

  2. #2 DemFromCT
    December 6, 2007

    PS Doesn’t mean I won’t make a fool of myself, but you gotta try.

  3. #3 junebug
    December 6, 2007

    YouTube and public health, eh? Like this?)

    (May not be safe for work, but as awful as it is, it’s public-health relevant)

    This is about what I think of when I think of public health attempts to align itself with with a YouTube present. Oddly enough, it’s exactly the sort of clumsy, unintentional self-parody that the vast majority of PSAs and public health promotion has looked like in the past.

    That said, the ridiculousness of it all may shock and horrify, but it just may do the job.

  4. #4 anon.yyz
    December 6, 2007

    For the record, I am also pro-vaccine, subject to full disclosure of risks and informed consent, even though I have concerns about the lack of safety information of adjuvants.


    During a crisis such as the onset of a pandemic, there may be a temptation to shut down social networking sites. However, it may create more suspcion and mistrust than confidence. Compliance may therefore be reduced, not increased.

    In ‘normal’ times, public health seems to think ‘marketing’ or ‘social marketing’ is the answer. Messages are carefully crafted to elicit emotional responses without educating the public. I don’t think this is going to work any more in the new world of Internet access where any one can be a publisher of truths or misinformation, where officials have to compete with individuals who have the upper hand in eliciting emotional responses since individual have no accountabilities and can ‘take it to the limit’.

    Instead of ‘marketing’, think ‘education’.


    Instead of ‘messaging’, publish ‘metrics’.


  5. #5 revere
    December 6, 2007

    junebug: LOL. Loved it. So that’s what this is all about!

  6. #6 marquer
    December 6, 2007

    As with HIV denialism, I am inclined not so much as
    to attempt to suppress it, but to even contemplate
    its active subsidization.

    The world is groaning beneath the collective mass of
    humanity. Most of whom are bone stupid. Things which
    have a disproportionately lethal effect upon the dumb
    are not to be dismissed out of hand.

    I caught a news piece about a Southern California
    yuppie mother whose precious darling, whom she had
    carefully protected from any nasty immunizations,
    had then contracted mumps to lethal effect.

    “No one told me you can die from mumps!” she sobbed.

    Correction. None of the pseudoscientists and magical
    thinkers that she actively sought out for advice had
    told her that. There were plenty of reputable medical
    authorities who would have warned her correctly of the
    risks. She deliberately opted to ignore them.

    I regret that this woman’s child had to depart our
    vale of tears at an early age because her mother was
    an idiot, but, let us be blunt, intelligence has a
    substantial inherited component, and it’s for the
    best in the long run that this person’s genes did
    not propagate.

    I’m sure there were people in remote human history
    who thought that smearing their bodies with a coat
    of plant dye would protect them in an encounter with
    a bear. None of those folks were ancestors of mine or
    of yours, for what should be obvious reasons, and I
    for one do not find that notion distressing.

  7. #7 paiwan
    December 6, 2007

    Following your logic, the intelligent couples now produce less babies, some even exempted from this duty, what do you say about this intelligence?
    The principle of nature is the survived gene from poor environment will have better chance of evolution.
    But I had followed your code, my children have all been vaccinated so far.

  8. #8 Rebecca Van Hout
    December 6, 2007

    All of my kids were vaccinated. My two middle sons are on the autism spectrum, and my oldest, and only daughter had gross motor delays. My youngest son was vaccinated after they took out the thermerisol. He is totally normal. I will never know if vaccines contributed to their neurological issues. However I do know that not vaccinating despite the chance of adverse reactions wasn’t an option I could live with.

    I was taught by my grandmother that vaccinations save children’s lives. Her daughter (my aunt) was saved by a Dr who did a tracheotomy after she stopped breathing when she came down with pertussis. There wasn’t a vaccine then, and my mother never learned how to swim because her mom wouldn’t let them go to the public pool because of polio. A lot of parents today do not understand the danger. They have always lived with vaccines. The younger ones have never even had chicken pox!

    I knew that Infectious diseases were a bigger threat to my children’s safety than the risk of an adverse reaction. It only made sense to me that if the vaccines caused an adverse reaction the real thing would probably kill my kids. You’d be amazed though at the thoughtless people who think I got what I deserved because I “fell” for the establishment’s mandate to vaccinate!

    Hopefully we can figure out the reasons some get the adverse reactions and either opt out those few children, or re-design the vaccine if that is a contributing factor. I hope in the future no one has to live with the kind of second guessing I did. I don’t blame myself now, but there was a time I felt I might have damaged my children by vaccinating and that is extremely painful to deal with as a parent. For the record I still vaccinate my kids, even the ones on the autism spectrum.

  9. #9 isles
    December 6, 2007

    Rebecca, I admire your levelheadedness, when so many other people in your situation are howling from rooftops about how the vaccines stole their babies. Now that there is such extensive evidence against the proposition that vaccines could be linked with autism or other NDD’s, I hope you’ve been entirely free of those nagging worries that maybe you could have done something differently.

  10. #10 paiwan
    December 6, 2007

    Rebecca & Isles

    Good sharing. Thanks so much.

  11. #11 Linda MacDonald Glenn
    December 7, 2007

    Yeah, this is one way to undermine evidence-based medicine, at least in the public’s mind, unfortunately.

  12. #12 Grace RN
    December 7, 2007

    As an actively working nurse for 36 years and mother of three, I have always been ‘pro-vaccine’. That said, I have a nephew who is autistic, so I have seen both sides of the coin. My husband’s uncle had polio, as did a friend of mine in grammar school.

    Have any of the ‘anti-vaccine’ parents ever seen someone with measles pneumonia? They can gasp for breath for days, their chest xrays progressively looking like someone has spilled “White-out” on them. They may required prolonged venilation, a tracheostomy and positive airway pressure, which can causes the lungs to collapse and the need for chest tubes to be placed. Who wants to watch that? Anyone interested in signing up for that?

    As a kid in the early ’60’s, I stood in a very long line outside a public school with my entire family waiting patiently for a pink sugar cube of polio vaccine. I made sure my kids got all their shots, and measles boosters. I have been vaccinated against typhoid, hepatitis B, and would get in line in a heartbeat for the existing H5N1 vaccine. My daughter is a vet tech and can immunized against rabies if she wishes.

    If these ‘intelligent’ parents want to exemp their kids I feel sorry for the kids-but not for all the other innocent victims who get exposed and can suffer greatly-ie immunosuppresed cancer patients, etc.

    If they want to risk killing off their kids rather than take the rare risk of autism-fine. But let them serve time in an ICU watching people struggle to live because of a decision someone else made for them. Who advocates for those patients?

  13. #13 Grace RN
    December 7, 2007

    ..oh yes..my great-grandmother lost 7 of her 11 children within 2 years-all due to diptheria, which is now preventable.

    7 of 11. think about that.

  14. #14 Eliene
    December 13, 2007

    There are 2 ways to look at communicating science to the public.

    1. Make a piece of science storytelling and post it and hopefully the world will come, or
    2. Go to where the people are and make something that looks like what they want and see what of your topic sticks.

    EIther way, many feature films and TV sitcoms are made about uncool people trying to be cool, as Junebug and DemfromCT allude to.

    Painful moments on YouTube or other places where scientists can post their amateur video: Who cares about pimples, wild hair, spinach in the teeth, hairs dancing out of your nose? It is the Science That Counts.

    Well, it might to a couple dozen people. But if you are trying to effect public health in a more meaningful way, then real media professionals have to be involved. Producers, marketers, evaluators, the works. I left bench research for science policy because I realized that policies are very important. I left policy work because I realized that great policies can only go so far if the public is unaware or unengaged. Disclosure: I am one of those media professionals with grants from the National Science Foundation to reach Americans through commercial media, like ABC News and YouTube, etc.

    It is one of my pet peeves that universities, hospitals, and government agencies look at public engagement in public health as a public relations issue and not a real education issue, for which there already exists a discipline – informal science education. Scientists and policy-makers need help in communicating to the public not only when pandemics arise – which is a public relations issue – but also for chronic issues – like vaccines. PSA’s are rarely effective. Even the most memorable – like “This is your brain on drugs” rarely change behavior. But short videos like Fraggle Rock really worked to teach millions of Americans the preamble to the Constitution.

    YouTube is here to stay. Smart or stupid, people will view things on it. I hope that public health institutions will consider how to game the system and get good stuff in front of people to the same extent that people with bad agendas do.