Talks@12: Oral Health Facts Matter

[email protected]: Oral Health Facts Matter

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Good afternoon. We want to thank all of
you who are here with us today in the auditorium. Welcome all of our
livestream viewers who are watching from
home throughout the world. We’re all thrilled to have
Dr. Brittany Seymour and Dr. Alessandro Villa talk with us
today about dental medicine and internet communications. I think it’s going to be a
really fascinating topic. And I also would like
to welcome Dean Donoff. Thank you for joining us. Dr. Donoff is the
Dean of Harvard School of Dental Medicine. For those livestream
viewers who would like to submit a question,
please submit your questions on our Facebook
comments section. If you’re watching on YouTube,
you can submit your question through YouTube. And you may also ask us a
question through our Twitter account. So whether we’re talking about
oral health or a patient’s overall health, the
growing popularity of the internet and
social media outlets has put a wealth of
information at our fingertips. As you well know, a
single post on Facebook can just shoot around
the world in seconds. And sometimes that
information is accurate and sometimes it is not. Also, health information is one
of the most frequently searched topics on Google,
and Google search is a broad swath of content,
and it’s all unfiltered. So sometimes you’ll have
access to peer-reviewed data, and often you’ll get
information to data that lacks documentation. So what do we do about this? How do we sift through
fact from myth? Today’s speakers from
the Harvard School of Dental Medicine
will share their views and focus on
misperceptions that can be a contagion on the internet. They’re going to give
us a number of examples, and in particular, they’ll
touch on water fluoridation and vaccinations. Dr. Brittany Seymour is
an Assistant Professor of Oral Health Policy and
Epidemiology at the Harvard School of Dental Medicine. She was an inaugural
Global Health Institute Fellow, a Harvard Medical School
Fellow in Medical Education, and is a Faculty Associate
at the Harvard Berkman Klein Center for Internet & Society. Dr. Alessandro Villa
is an instructor in Oral Medicine at Harvard
School of Dental Medicine. He is also an Associate
Surgeon in the division of Oral Medicine and
Dentistry at Brigham and Women’s Hospital. He holds a Master’s
of Public Health and a Certificate
in Oral Medicine from Harvard School of
Dental Medicine and Brigham and Women’s Hospital. I’d like to thank
Heather Denny for helping us arrange this Talk at 12. And I want you to join me please
in welcoming today’s guests. Thank you. [APPLAUSE] I’m going to probably
walk around a bit. You can hear me OK? OK, thank you so much
for the introduction and for coming today. I’m looking forward
to the discussion. And I’m going to start us
with a quiz because I teach, and this is what I do. So you don’t get off easy. How many pieces
of content do you think get shared each day on
Facebook, if you had to guess? [INAUDIBLE] billions
[INAUDIBLE].. Yeah, some high number. So about 700– and
this isn’t just– this isn’t what’s posted,
but what’s posted and shared with others– about
700,000 pieces of content, including health information
and health-related information. How many tweets a day
do you think go out? [INAUDIBLE] Close. About 500 million
tweets in a day. And per minute, how much new
content is uploaded to YouTube? Per minute. So 100 hours of YouTube content
per minute gets uploaded. And how often do you think a new
blog is created and launched? 30 seconds. Every 30 seconds. It’s actually every
half second, it’s estimated, that there’s
a new blog out there. So when you think about how
much information is circulating at any given moment, the
opportunity for our patients and our communities to encounter
misinformation is pretty good. And there’s no way
we can possibly keep track of all of this
misinformation that’s circulating when it comes to our
patients’ health and the health of our communities. So what do we do? Well, it’s definitely
been an interesting time. The time of fake news, the
time of alternative facts. The Word of the Year
in 2016 was post-truth, which is relating to or
denoting circumstances in which objective facts are
less influential than appeals to emotion and personal beliefs. Now, there have been
questions raised. Is this a war on science? It’s been concerning. And those of us in public
health and medicine recognize that the idea of
misinformation or fake news is nothing new to us. It might be new and
more mainstream. There’s an awareness, I
think, a growing awareness. But for us, especially
with the lessons we’ve learned with vaccinations,
misinformation is nothing new. So we think about the 10 great
public health achievements. Vaccines is up
there at number one. Does anybody
recognize this study? Yeah. Do you recognize it? [INAUDIBLE] OK. So you see studies popping
up in kind of, as you said, anti-vaccine groups or
vaccine-hesitant networks. So this is the original
Wakefield studies. I see you nodding,
and what was that? [INAUDIBLE] retracted later. Yes. It was retracted. Yes, he lost his license. But nonetheless,
we saw recently one of the largest outbreaks
of measles in the US in nearly a generation. A lot of that was traced
back to families opting out based on personal
belief exemptions in vaccinating their
children because of the concern of the link– as we know, is not
justified by evidence– but the concern of a link
between vaccines and autism. Families opted out. They didn’t vaccinate
their children. Traced it back to Disneyland,
and we saw an outbreak in the US. And so misinformation
is causing real harm. It’s making kids sick. Most of the
hospitalizations were infants who were too young to
be vaccinated during that US outbreak. So it’s a real problem. And, you know, we see
celebrities, and new voices, and new influencers continuing
to kind of perpetuate these myths and this
misinformation in very unhealthy ways. And now, the concerns about
vaccines over the years have ballooned. It’s not just autism. It’s all kinds of other
concerns now that the CDC is addressing directly
on their website that advocacy groups
and parents are asking about on a regular basis. And despite a lot
of counter efforts and publishing of new
evidence to dispel these myths and concerns, we see this
effort to really kind of put this misinformation to rest. Largely ineffective. And why is that? Well, I’m going to talk to
you about another example. It hasn’t been quite
as widely publicized, but it’s a regular in my
daily life in dentistry. So dental cavities, the most
prevalent disease in the world. And the most well-studied and
most highly population-based intervention for
preventing cavities is community water fluoridation,
also a public health great. And does anybody recognize
this study, by chance? So we saw something very
similar in the community water fluoridation groups where
another study was published. It’s recommended based on the
review of a series of studies a couple years ago. Most of those studies
were done in China. And in this study,
based on that review, recommended that
fluoride be named a neurodevelopmental
toxin for children. Now, this was widely contested. There were additional
followup articles saying they didn’t feel that
those claims were necessarily backed by the data. But nonetheless, within 24 hours
of the release of that study, this is what happened
over the weekend. Thousands and thousands
of views and shares with the headline that we’re
poisoning children’s brains, that we’re putting the
next generation in danger using one of the most
proven public health interventions to date. This is a huge problem. And now we see advocacy
groups, and bloggers, and all kinds of
anti-fluoridation groups popping up, advocating to
cease water fluoridation in their communities
and naming this study as justification for that. Now, the study
noted limitations. A lot of them were
done outside the US in naturally high occurring
fluoride rates in the water that, in fact, we don’t even
really have here in the US. The authors stated
themselves that findings from their studies could not
be extrapolated and applied to community water
fluoridation here. But nonetheless,
we continue to see this cited as direct
reasons why communities want to end fluoridation
here in the United States. And just like with
vaccinations, our counterefforts have not been as effective
as we’d like to see. And so we’re really
trying to figure out why. Why is that, when our efforts
to bring more evidence, better evidence, to correct
this information are not working the way we
would like to see that happen? So this brings me
to our research. Media Cloud is a joint project
between the Berkman Klein Center for Internet
Society and MIT’S Center for Civic Media, the Media Lab. And essentially, we mapped the
internet around a given topic. So we have a platform. It’s open source. And a lot of what
we’re doing is building it to be very user
friendly so others can do this kind of work. But we can enter,
and look at a topic, and look at how it’s
being talked about online. Who’s talking about it,
and what are they saying? And what can we learn from
that to better understand why our counter
information efforts are not as effective as we’d hope? So here, you can see this is
the Community Water Fluoridation Information Network
on the internet. This is what it
looks like visually. So that is the
NCBI website where abstracts for NIH funded and
related research are published, where you can go and
read these abstracts. That’s where the original
study lives online. So we thought we would learn
about this information network and see what information
spread looks like. So there’s the day that
that study was published, before it took off
across mainstream media as the government’s
poisoning children. And we see that it got picked
up by an anti-fluoridation advocacy group who linked to
the abstract and referenced new research shows that it’s
a neurotoxin, that fluoride’s a neurotoxin. But they alter their narrative. They link to the abstract to
show they’re using science, and yet the limitations
of the study are not acknowledged, the
broader context of literature, and how that study
does or does not contribute to the
growing evidence that we have is not mentioned. And a new narrative is
created around this study. Then we see a popular YouTuber,
not in the health field, not in public health,
not in science, but has a large following on
YouTube, and has a family, and cares about issues
that impact her family. Picks up on not the study
itself, but the advocacy group talking about the study. So the narrative moves forward. But the evidence starts to
shift with that moving narrative as information starts moving. And this blogger starts
spreading concerning messages to all her viewers. Video bloggers do– And then we see a newspaper
in Texas picks it up, because at the time
we did this map, Dallas, Texas was
looking to vote on whether to end water
fluoridation for the city or not. And so, there was a
lot of online activity around the Texas discussion. And so, we picked up a
newspaper, a pretty well-known newspaper in that
region, who linked back to these advocacy groups. They linked to some of the
science, to the CDC’S page, but then, in an effort to be
fair, and balanced, and show both sides, started linking. And the narrative
continued to travel that fluoride is a poison
for children’s brains, despite the evidence not really
supporting that narrative. And then before we know
it, a small local newspaper picks up on the story. And we see communities
voting to end water fluoridation, all leading
back to unsubstantiated claims directly linked to how
misinformation spreads. Very similar to
the vaccine story. Similar patterns. And so what do we do about this? So we noticed when we
mapped out this network that this particular
narrative kind of clustered in one part of the map. So we see that it’s all kind
of down here in this lower right-hand corner,
meaning those who were linking to this narrative,
based on its use of language and how people are talking
about fluoridation, all kind of clustered. And so we did the same
thing with vaccinations. We mapped out the Vaccine
Information Network. And you can see by
their color coding, we saw the same
clustering behavior. And these sources are
tending to link to each other because they’re
sharing language, they’re sharing sentiment
around the topics at hand. So they’re linking to
each other more often than to other sources. So we thought, this is
almost like the behaviors we see in social networks, right? But this is the World Wide Web. But we’re still seeing this
clustering social behavior happening. And in fact, one of our
most striking findings from our vaccination study is
that we saw this pink cluster. That’s where most of us are. That’s the health and
science community. That’s where the
discussion around evidence in the body of work
really was happening. You see CDC in there. And so we thought, is that kind
of an isolated public health medicine network within the
broader information network? And that might explain
why it’s hard to post counterevidence to scary
headlines like this. The HPV vaccine is a silent
epidemic of medical violence. That’s pretty scary. And this might explain
why our counterefforts are largely ineffective. Are we just talking
to ourselves? And we did several studies. We’ve now done over
150 case studies. And we see this clustering
behavior almost every single time. And almost every
single time, we find kind of an isolated public
health and medicine community within the larger network. So our suspicion is we’re really
good at talking to each other and linking to ourselves, but
getting these messages out to the broader
information network has been trickier
than we even realized. So our question is
how do we break out of these echo chambers
and effectively reach broader audiences? And I think we’re
dealing with a phenomenon that we’re kind of
naming social proof. Social proof is nothing
new, but thinking about it in terms of science
communication could be. And what is social proof? Well, lots of people
are sharing this. People you like share it. Your own peers share it. You share it. And before we know it, fluoride
damages children’s brains. Vaccines cause autism. No science required. No scientific proof needed. The social proof
is enough, right? And so what do we
do when we have such value in the
scientific evidence, but it’s social proof that
seems to really move messages? And that’s where we’re thinking
about new communication strategies, moving from
broadcast diffusion, where we work really hard on
our evidence-based, very well-vetted, drafted
and redrafted messages, and broadcast them to
the World Wide Web. Or, we start thinking
about social diffusion, where we rely on the sharing
momentum of social networks, which means we need to appeal
to the norms and values of all these various
clusters that we’re identifying on the web, not
just our own public health community where we all
speak the same language. So we’re really rethinking
health communication, science communication in public health. And we’re moving
from how can we get our evidence-based
information out to our target audiences,
which is the question that we ask every day when it comes to
communicating evidence, right? But we’re starting to think
maybe we need to be asking, how can we get our
audiences to share our evidence-based information? And that is an entirely
different communication strategy than broadcast
communication. Relying on sharing
momentum really requires us to take more of
a social network approach to health communication. And so we’re starting to
play with various approaches and continuing to explore
ways for additional research. And we’ve nicknamed
this exploratory stage the iCARE approach, where
the core of what we’re doing is really appealing
to the identity of these various networks. And how they identify
is going to be different depending on each cluster
in these networks. We work on building connections. Oh, you have concerns
for your child. I’m a mother, too. I understand that. We work on anecdotes,
telling stories. We request more information. Why did that particular
blog resonate? Was it from your neighbor,
and you trust that person? And the evidence. As we know, evidence
speaks volumes, if that’s a shared value
with our audiences. But for some, it’s more about
building trust and having connections. So really, what I’ve talked
about today is nothing new. The idea of storytelling
to communicate science is not a new approach. But we’re able to map out
these online communities and visualize this in ways
that we haven’t before. And it’s really
opening the door for us to become innovative and
creative in how we communicate science with our
audiences, especially when it comes to combating
myths and misinformation. So I’m going to hand it
over now to my colleague, and he’s going to dive into a
more specific example and some of his approaches. Thank you. [APPLAUSE] Thank you so much for this
wonderful presentation. And I’m going to discuss
more about HPV vaccinations. And why am I talking
about HPV vaccination? We saw from Brittany
that the number one cause of where we have the most
misinformation in any health care topic is
exactly vaccination. And HPV is a topic
that is dear to me. And when we look at the
numbers related to HPV, we know that HPV
is the most common sexually transmitted
infection in this country. If you look at the
numbers carefully, every year in the United
States, about 27,000 of cancers are caused by persistent
HPV infection. And if we translate this
number in how many minutes, we see that one
person every minute can be diagnosed with an HPV
positive cancer in the United States. And let’s look at
this table carefully. When we see the different
types of cancers that are caused by HPV, we
see that about 91% of cancers of the cervical area are caused
by persistent human papilloma virus infection. The same numbers, we see them in
anal cancer and rectal cancer. And when we look
at the oropharynx– I’m a dentist by training,
so I’m very, very interested in this topic– we
see that about 70% of oropharyngeal cancers are
now caused by an HPV infection. So I took some times
and look at the media. And I was googling about HPV. And if you google
HPV, you’ll see that there are about 27
million results on Google. And if you narrow down
this search on HPV and dentists’ role, you’ll
see that there are about 1 million results on this topic. So it’s a huge, huge
topic right now. And the HPV vaccine was
initially approved by the FDA in 2006. And there was growing interest
in the media since then. We know that in
2013, for example, Michael Douglas, the actor,
was diagnosed with an HPV positive oropharyngeal cancer. It was in the news. It was everywhere. It was on CNN. It was on TIME Magazine. There was a huge discussion
about oral sex and oral HPV infections. And in the past year,
there has been also growing interest in the media
about specifically oral HPV infections and the role
of HPV vaccination. So I want to go into
some practical examples. So if you google HPV and HPV
vaccination specifically, you see that there is a lot of
good evidence-based information about the vaccine. But we also have false
information and lots of questions about
HPV vaccination. Let’s see a couple of them. The first one is that
the vaccine was not properly tested. And there are no
proven information and data that HPV
vaccination can prevent HPV-associated cancers. And this is everywhere. When you google HPV vaccination,
you’ll see it everywhere. But the truth is that
before the approval of the vaccine in 2006, there
was a large clinical trial, multi-center, with more than
20,000 women enrolled which proved the efficacy
of HPV vaccination in preventing HPV-related
cervical infections. Let’s look at the second myth
that we can find in the media. The HPV vaccine causes
more serious side effects than any other vaccine. And again, this is not true. We see that in the
United States since 2006, 80 million doses of
vaccine were delivered. And yet, the adverse
reactions were the usual that we’ve seen also
for other vaccinations. So again, it’s a
myth against a fact. And specifically,
in this country, there are multiple organizations
and associations that monitor the vaccine safety. These are the same for
any vaccine that is available in the United States. We have the Vaccine Adverse
Event Reporting System. And all of them have some sort
of collaboration or association with the Center for
Disease Control in Atlanta and also the FDA. So the common side
effects that we see with HPV vaccinations are
exactly the same that we see with other approved vaccine. And usually, they are erythema
in the site of injection. Patients may develop
a little bit of fever in the first 48 hours,
sometimes nausea, but it’s relatively safe. And then our safety data, I
included some of the references here. And we have huge, huge data on
the safety for the HPV vaccine. And the benefits definitely
outweigh the risk, in this case,
because this vaccine has been proven to be
effective in preventing cervical cancers, vaginal
cancer, and vulvar cancers. It has potential also to
prevent oropharyngeal cancers and penile cancer in men. So just to refresh
your memory, I want to go over the
HPV dosing schedule. The CDC recommends two doses for
children, both boys and girls, before their 15th birthday. And the dose is given
at 6 to 12 months apart. In cases where patients are
immunocompromised, again, under the age of
15, the vaccines should be given in three doses
series, one at month zero, after one or two months,
and then after six months. Things are a little
bit different if patients are
over the age of 15 and under the age of 26,
where the CDC recommends, again, three doses,
one at month zero, one after one or two months,
and the final dose after six months. So just to give you a
little bit of summary, the HPV vaccination is
nowadays recommended for all children,
boys and girls, starting at the age of nine. The ideal window
is age 11 to 12, but it’s also available
up to the age of 26. And we are lucky enough
here in Massachusetts to have this vaccine
available for free. The CDC has the best
information on HPV vaccination. So if we need to advise
one of our patients or the parents of
our patients, we should direct them
to the CDC portal. Because the CDC has
information not only for health care providers, very
specific information for patients and the parents. And they’re really
simple, easy to read, and they are updated
typically every six months. So if we want to look at the
efficacy of this vaccination, it will take years
to see late outcomes. And we are starting to see
this regarding cervical cancer. It will take a little bit
longer for oropharyngeal cancers because the vaccine was
initially approved for girls and then was approved
for boys later on. And we know that oropharyngeal
cancer is mostly prevalent and seen in boys. So we’ll see late outcomes
for HPV-related oropharyngeal cancers in a few years from now. But we nowadays know
that early outcomes, we start to see these
from the HPV vaccination. And we see that HPV vaccine
is effective in prevention of HPV-related warts and also in
the oral and vaginal prevalence of HPV infections. So we are starting
to see already some good data about the
efficacy of the HPV vaccine. Let’s look at this
graph for a second. Here, we see the vaccination
coverage in the United States from 2006 up to 2016. And we see that about
90% of adolescents received at least
one dose of Tdap or one dose of the
meningococcus vaccine. If we look down here
at the HPV vaccination, we see the rates of vaccination
are way, way lower, almost half of what we see in Tdap. And this is telling
us two things. One is that we’re
not doing a good job in providing correct information
on HPV as health care providers. And the second thing that
this graph is telling us is that the majority of patients
are seeing a health care provider, so much
so that 90% are receiving at least one vaccine. And this is good
news because it means that we need to reach out to
these health care providers and provide good information
about the HPV vaccination. So what are the
reasons why parents won’t initiate an HPV vaccine? Most of the reasons
are listed here. Some of them think that their
children are not sexually active. Some of them have
safety concern. We talked about
misinformation in the media about the HPV vaccination. And then still, in a
good 15% of the cases, it’s because it’s not
recommended by the health care provider. So we really need to focus
on health care providers in doing a better job in
promoting HPV vaccination. And if you look at
the value that parents place on the vaccine
from a scale 0 to 10, we see that all the vaccines
available, including the HPV vaccine, has a good
value for the parents. So again, why is it that the
number of people vaccinated are still so low, when our
parents put the same value of a meningitis vaccine? Let’s look at the
clinician estimations. So in this study from
a group of Texas, they asked clinicians,
what do you think is the value for certain
vaccine types of the parents of your patients? And they guessed pretty much
OK for meningitis, hepatitis, and pertussis vaccination. But if we look at
the HPV vaccination, they thought that parents
were not putting enough value on HPV vaccination. Which is not true, because we
saw from the previous slide that the value that the
parents put on HPV vaccination is exactly the same as
for the other vaccines. So, same way, same day. What does it mean? Whenever we want to
promote a vaccine or there is an
immunization program, we need to promote the
vaccine, HPV vaccination, the same way that we
promote other vaccines, and the same day. I want to focus one
second on this slide. The word today, it’s
really, really important because whenever a health care
provider promotes or initiate the vaccination in
one of their patients, they start and do that the same
day that they see the patient. The same thing should be
done for an HPV vaccination. So the HPV vaccine
should be sandwiched in between the meningitis
vaccine and the pertussis vaccine. And again, the focus here
is the prevention of cancer. So we should be able
to talk directly to our patients and the
parents of our patients about the potential of
preventing certain cancer. And we know that it does prevent
cervical and vulvar cancer. So this is another
example that can be used in providing good
information to our patients. We are all familiar
with the helmet. When we go biking, we
all wear the helmet. And so, should we wear the
helmet before we go biking or before our children
go for a ride? Should we wear it while
we are riding the bike, or should we wait for
an accident and then we’re going to start
wearing the helmet? The same thing should be
done with the vaccination. Are we going to vaccine our
children before the exposure, after the exposure, or
during the exposure? And parents really
understand this well. The same example that we could
use would be the seat belt. It’s the same thing. Should we put on our seat belt
before turning on the car, after we leave the car,
after we leave the driveway, or after we have an accident? It’s the same story. So I’m a dentist by training. And so what is our role? Why are we talking
about vaccination? Why are we talking
about misinformation? And this is because we talked
about HPV specifically today. We said that about 70% of
the oropharyngeal cancers are caused by an HPV infection. And if you look at the
numbers of estimated cases of oral and oropharyngeal
cancers this year, these numbers were released a
few weeks ago by the American Cancer Society, we see
that about 51,000 new cases of oral and oropharyngeal
cancer will occur this year in the United States. And this is a
pretty high number. And oropharyngeal
cancers represent 4% of all the cancers in
the United States among men. And we saw that HPV cancer
rates are rising about 31,500 per every year. Oropharyngeal cancer
rates are becoming higher than cervical cancer rates. And we have a tool
that has the potential to prevent these cancers. And patients visit the
dentist more frequently than primary care physicians. So we really have the
potential to provide good information to
both our patients and the parents of
our little ones. This is just to show
you a few clinical cases of HPV-related disease in
the head and neck area. We see on the top
right a classic sign of oropharyngeal cancer,
a lump in the throat. There is a role also for
potentially malignant disorders, just a
small subset, but we know that some leukoplakias can
be caused by an HPV infection. And then HPV can
cause common warts, same that we see on the skin. We can see the same
disease in the mouth. Here, we have some cases of
HPV-related benign conditions. We have a squamous
papilloma, verruca vulgaris, and condyloma acuminatum. So all of these are caused
by persistent HPV infections. A recent paper
was just published on the Journal of the
American Dental Association where they show that some
dentists discussed about HPV already and the association
with oropharyngeal cancer and most of the oral
health care providers performing oral
cancer screening. So if we educate our oral
health care providers about HPV and HPV
vaccination, we may have the potential to
reach out to more patients and then prevent this
deadly condition. So we talked about the
increasing in the interest of HPV in the media. This is just one of
the examples that just came out a few days ago. It was published
on the Daily Mail where they show that dentists
may soon start asking about your sex life, about HPV. And this is another one that
came out again a few days ago, on January 20,
where they say that your next dental appointment
could come with an STD and throat cancer rise. But I wanted to show you
this practical example. I’m going to show you
exactly what was written in this article, because again,
we saw that misinformation is there. And we need to be
able to recognize what is good information
and what is bad information. So what they mentioned in
this paper, which is available online, is that by
2030, there will be more patients with mild
cancers due to HPV compared to cervical cancer. Is this true, or
is this not true? It’s not true, and the
reason is because it’s not mouth cancer that it’s raising,
but it’s oropharyngeal cancer. Let’s look at another sentence. You’ve got to be careful
what you talk about. Talking to a 20-year-old
about safe sex would probably not be
the smartest thing to do. Is this information correct? Is this the right approach to
talk about HPV in a patient? It’s not 100% correct. Let’s look at another sentence. Every dentist should be
screening patients, not only for oral cancer, but for HPV. And this is true. And most of the dentists
already perform an oral cancer screening, but they should
also start talking about HPV. And they can talk
about sign and symptoms about HPV and vaccination. So what does it mean? I want to conclude with
some reflection points, starting specifically
from this article that I found online
a few days ago. Was this misinformation, or
was this correct information? Was it good information
or bad information? And in a way, this
was misinformation because what
they’re stating here is that HPV causes oral cancer. Whereas we know that it causes
less than 5% of oral cancer, but more than 70% of
oropharyngeal cancer, which is different. But this misinformation
didn’t lead to a bad outcome. What was the final
goal of this paper? The final goal was
to increase awareness among dentists about
HPV and make sure that dentists and oral health
care providers in general provide a good oral
screening exam. So again, was this paper
focused on oral cancer or was on oropharyngeal cancer? It was on both. Again, this is just
a small example to show you that there
is a lot of information out there that we need to be
careful about what’s out there. And we need to be
able also to direct our patients and the
parents of our patients, if we want to talk about
HPV, to the right and correct information. And finally, if the bad
information is out there, us as health care providers,
we need to guide our patients and fill in the gaps to
make sure they receive the correct information. So with this one,
I want to conclude. I know I left some
questions open. This is where I’m from. I’m from Italy, so I like
always to show the place where I was born. And we are going to be happy
to answer any questions. [APPLAUSE] Should we just take a
minute more then, or– [INAUDIBLE] Hi. He’s going to start. Beautiful lecture
from both of you. I was particularly impressed
by the map of information that you actually
were able to gather, because I think that’s
exactly where we have to act. As an example, in Italy right
now, there is elections coming. And there is a
political party who is advocating
against the vaccines. And they found that the most
effective way to actually fight that is to prevent
rather than actually going on the social media
and saying, you know, the vaccine works. You’re wrong. You’ll never be able to change
the opinion of those people. They will never
change their mind. On the social media,
it’s clearly evident. They reply. They say, you’re
wrong, I’m right. But the right way to do it is
exactly what you are doing, I think. Because if you identify
the map, and you can intercept the
message, preventing, then you may not change
the mind of people that are already
convinced, but you prevent those that are going to
change, eventually, their mind. So I really think that
that’s the way to go. I mean, what do you think? Thank you for the comment. Can you all hear me? Think so. OK. My mic slipped down. So you said a couple things
that we’ve actually identified, that corrective information
is largely ineffective. And the research in the
vaccinations example has backed that up. And in fact,
corrective information tends to make people hold on
to those beliefs even stronger. So going out and saying, you’re
wrong, here’s the evidence, is largely counterproductive. And data has shown that. We’re starting to figure out
a little bit more about why. So I actually think
you’re right on. And thanks for saying that
you think we’re right on, too. I’ll just add, the
way we are starting to think about the internet
is one large dinner party where there are
multiple, different peer groups sitting at tables. And if you think about entering
a room where there’s a dinner party going on, and
you hear conversations about topics that are
interesting to you, and you go in and start– like your slide with the
adolescent vaccination rates, and you bring in this
beautiful data graph that we all love and
drool over, right? Beautiful data graphics
are our favorite thing in public health. But you go to a
dinner party, and you sit down where there are
people that are already friends having a
conversation and bring your data, that’s weird. Like, that would
be very strange. It’s not socially acceptable
to go and insert yourself into a conversation
with strangers in real life at a dinner party. And we think the internet
functions like that. It’s a very social
environment where people are– they end up in those
clusters, not by accident, but because they share
these social values, and end up there through
connections and people they already know. And so we, on the internet,
come with our counterinformation and our pretty graphs
and say, you’re wrong, and sit at
the table uninvited. We’re rejected. That’s a total social
norm violation. So we’re kind of
working on that theory now and thinking about
the dinner party example. If we want to sit down at the
table, we need to be invited. And in order to invited, we
need to make connections, we need to share some
values with folks, and then get invited
to sit down and be part of the conversation. And that’s a very
social behavior. It’s something that’s
quite different than our usual approach. So I think I agree with you. Yeah, so I have a question
here from Facebook. Is the adult male population
eligible for the HPV vaccine? So the HPV vaccine
is recommended until the age of 26. And the reason why is
that because by that time, patients or
individuals in general maybe have already
infected with HPV. HPV is– and I’m
going to answer also another question they
were asking about, how does one develop
HPV infection? So HPV infection is usually– I’m talking about oral
HPV infection– is usually through oral sex, but it’s
through skin-to-skin contact, so from the genital
area to the oral cavity. And the second
reason why it’s not recommended in the
adult population is because, again, it’s
not a therapeutic vaccine. It’s a preventative
vaccine, so it prevents from developing new infection. And the second reason why
it’s not right now recommended in the adult population is that
because the immune response, the antibody response that
we see to the HPV vaccine in the adult population
is not as good as the one that we see in
children, which is true for the majority of the
vaccine that are available nowadays. But things may change. There are some recent
data, actually, that show that it may have also
therapeutic effect on new HPV infections. But only a couple of papers came
out, so it’s too early to say. Thank you for a beautiful
talk, both of you. Dr. Landrigan is a
classmate of mine, that first paper you showed. And he told me recently–
he was up here– that he doesn’t
believe that anymore. So how do you get
that message out, particularly since the
bulletin of the school, TH Chan School of Public
Health, had also a similar anti-fluoridation
article that was rescinded? Big problem. The other issue– I’ll put on
my medical, dental integration hat. Physicians can give
dental injections. If dentists could
give HPV vaccinations, we’d be in better shape. Which one should
we go after first? [LAUGHTER] Hoo. So, you made my week. That’s great to hear that
there’s been a shifting perspective from an author. I think we– as we’re often
authors of publications, it’s humbling to
say, I was wrong. I think the more
comfortable we get as researchers in acknowledging
that and being more transparent with the broader public
about when we’re wrong could assist in opening
the conversation and making it feel more like
a social two-way street, which is the way people use
the internet today. It’s a very
bidirectional medium. And by acknowledging,
being wrong is not a bad thing in research, it
just strengthens our work. It allows us to continue to nail
down, drill down where the best evidence truly is. And that’s a part of
the scientific process. So authors being transparent
about shifting opinions, even of their own work,
I think could really assist in bringing people
into the conversation. But it’s difficult.
As we’ve seen, once the information’s
out there, it’s really difficult
to bring it back in. If he was willing to kind of
create a story around this and talk about his
experience as a person– You know, I
published this thing, and it had these
unintended consequences, and I’ve actually revised my
own views, and here I am today. That’s a powerful story that
could resonate with people. And where it becomes not just
about the data, which again, is what we love, but also
about the story of information, and how it shifts, and how
we use it in our communities. [INAUDIBLE] Yeah, the second part. I have a suggestion
together with a question that come after that, a
little bit of different topic. The suggestion is, since
a lot of the information is scientific basis of this
kind of hysterical movement is from the science,
why not request that NIH funded researchers
submit a lay summary the way we do for grants? And so you could
go, and you could get into that NIH website. And you may see the abstract. Maybe you see a pop-up
window that’ll tell you in simple terms what it means. Don’t let someone else say that. That was a simple thing. So a word like “vaccinate” if
you want a network, to avoid the spread of the information. So that’s a simple solution
to essentially avoiding manipulation and biases
in the way it’s presented. The other aspect
of this is there’s a flip side to
the story, though. The social media could be used
to detect negative outcomes, if you want, unexpected,
from some intervention. You would think,
OK, well, fluoride doesn’t cover [INAUDIBLE],, but
a new drug or a new vaccine may come and cause side effect. And because there’s
a social media, we may not have to wait until we
see something like thalidomide or what the COX-2 inhibitor
cause, tens of thousands of cardiovascular event. And yet, there is no evidence
for the positive side of the social media. So we see hysteria
and wrong information. We don’t see evidence
that the social media has helped in actually eliminating. You know, not every
intervention is successful. And we don’t see
the positive side. And I was going to
ask you, why is that? Why isn’t there? I mean, you could
have– if you want– the negative side is
hysteria, unjustified. The positive side, maybe, yes,
we do find earlier than we did. We don’t have to wait for
tens of thousands of people to die or suffer a side effect. And we don’t see that. Why is it? Yeah, that’s a good question. I think there’s a
classic example with flu, and that Twitter
can actually end up helping to predict outbreaks. And some of that research,
I believe, came out in HMS. And I do– I’m not
directly working on that, but there are
members of our team who are very interested,
looking at how can we utilize social media for
these positive reasons to help us kind of
crowdsource data in ways that were
never possible before. So I think that
you’re onto something. And there are people
very interested in that. That’s difficult to do. Maybe I am a pessimist. I still want to
know, but I’m not sure social media is a
place for that to happen. I don’t know. This is relatively new. I mean, social media’s new. When you look at the
history of medicine, and vaccinations,
and public health, we have decades and even
centuries of information. Social media is a
decade, a little older. That’s brand new. So there’s a lot of questions
that we still have to answer. But there’s a whole body of
work underway with, I think, a lot of potential
positive answers. You want to ask
another question? Can I go now? OK, sure. I have two questions. One, I’m seeing from a various
group of a very strong blog of anti-vaccine, which also
works with the fluoridation, and HPV, others. So I moved here from
upstate New York. And a few of my friends there,
they’re currently preventing. It’s like a more– the thing, we are
thinking and talking. No, they are in work. They are preventing their
kids from getting those HPV vaccination, plus even
they’re a very strong advocate for anti-vaccine, getting
vaccine for the pregnancy, they’re losing pregnancy. So those are all misinformation
is rapidly spreading. And it’s not– I think something needs
to do about it to get– Otherwise, all those diseases
like polio and others might come back again. This is one question. And the second one,
if I am in a blog, is there any site or anything
we can bring up and then show that this is nothing? Because there is a strong
anti-vaccine group, but there is no advocate
for vaccine group because this is normal. Is there anywhere? Because there is no
writing and no publication, here is the basis work, because
this is normal, it works. So there is nothing
you can counter them with any publication,
because the news is when it doesn’t work. But there is no news that the
vaccine works or vaccine is not harmful. So this is one thing. And another, I’m not a
anti-vaccine or something, so is the adult
normal immune system person does need to have
flu vaccine every year? Doesn’t you think that
they’re getting everybody– the flu vaccine is
bringing this flu back, virus more and more mutated,
and bringing it stronger? There’s my second question. Thanks. I’m not a flu vaccine expert. I just study what people
say about it online, so I’m not sure about that. Did you have any
comments about that? Not on the flu vaccine, either. Yeah. But I can tell you for the
first part of the question– and maybe you can integrate
as well– but at least here in New England, we
are working together with the Department of Public
Health, primary care physician, pediatricians, and
dentists to make sure that they are trained on how
to deliver the message related specifically on HPV vaccination. And we have these
questions all the time because parents typically read
blogs, they read the news, and they see this
misinformation. But it’s proven that if you
talk about these HPV vaccines starting for cancer
prevention standpoint– I gave you the example
of the sandwich in between two other vaccine. This is very effective. And typically, then,
the parents say yes to the vaccine on the same day. So I think that
we need to start– and again, I’m speaking
about the HPV vaccination– but I think that we
need to start small with the people that
can provide the vaccine. We know from the data
that 90% of the patients do go to either the
dentist or the health care provider, the primary
care or the pediatrician. So we have the occasion really
to work with the parents and to give them the right
information about the vaccine. On the other hand,
there are lots of bad information
about the HPV vaccine, but there are also
good information. So I showed you a
couple of examples of CNN, the Daily Mail. And right now, specifically
this past year, there has been a huge
promotion regarding immunization programs on HPV
also from media in general. So, yes, there are
bad information, but there are also good
information that are easily accessible to the public. But I don’t know if you
wanted to add anything. Well, you brought up
a lot of good points, but I think one challenge
that we do have, especially when we
talk about prevention, is a nonevent is a success. And how do you make a
story out of a nonevent? I walked out the door
today, and nothing happened. Yes! That’s really boring if you’re
trying to make headlines. So that’s– yeah, I think
that is a challenge. How do we create a story
when nothing happens? I’m not sure I would
agree with you that it’s a nonevent, in the sense that
you could be in the defensive and say it’s a nonevent. But you could also,
in the social media, say, well, cervical cancer
is the ninth or eighth cancer in women in this country. And it’s the first or
second in countries that normally have that. That’s an event. That is. And so people forget. So, there’s an issue of
sensational information. It’s really [INAUDIBLE] get
these vaccines can cause brain damage or [INAUDIBLE]. That’s exciting, right? Yeah. And the excitement is
not you take a vaccine and you won’t have brain damage. That’s not that exciting. But what is exciting, though,
is that the rate of cancer is 5%, whereas with
a vaccine is not. So to you, that’s very exciting. That’s data. That’s why we have a peak circle
with all our case studies. So I’ll push back again. I agree with you. There’s a way we need to make
that feel personal, though, because– this is the other challenge
with social media– with population-based
interventions, we talk in data, and statistics,
and population numbers. Social media is
hyper-personalized. I get on my Facebook page,
and they know the outfit I bought my daughter last week. And they’re like,
look, you might like these shoes to go with it. And it’s creepy almost how
these platforms know exactly, not what all of us like,
but what I personally like, to the T, to the
color, to the size. So when we bring data
into the discussion, I think on these
platforms, we need to get creative in how
to hyper-personalize that statistic
that you just said. Not why it matters to the group
and to the country rather than that country, but why
it matters to you. And that’s what motivates
people to then share that, because they feel compelled. It resonated with that person. And that’s, I think,
the challenge. So I completely agree
with you, but that’s why, on these platforms, we have
access to millions of people. But everyone’s on there
because it provides them an experience that’s all
about them and just for them. Any one experience
is going to be different than any
other experience. We have another
question up here. Yeah. Thinking back to the early
slides that you showed, I think you had listed a number
of great accomplishments. And if I remember right, you
had automobile fatalities also listed up there. And we know that
the breakthrough with lowering mortality
from automobile accidents happened at the point that
it stopped being optional. Seat belts became mandatory. Airbags became mandatory. And probably in
the future, we’ll see things like self-driving
collision prevention becoming mandatory. So my question– I
think you already know– is what do you think
of the nuclear option with some legislature to
make vaccines mandatory? That’s a good question. Yeah. We can all weigh in on that one. And that’s where prevention
and policy intersect. This is exactly why we
have these conversations and why policy is key to
public health successes. All of those successes
were directly linked to policies in place
to help them get there. And then you look at what
California went through after the measles outbreak. They now have– they’ve
eliminated personal belief exemptions. So I think that there’s
some thinking there is what’s the role of policy? This is about established base. I can tell you that about four
or five years ago, the town of Yarmouth had a
anti-fluoridation campaign, and they were voting on it. And all the deans of the
dental schools in Boston were asked to write letters
to the board of selectmen, and we did. And Julio Frenk was the Dean
of the School of Public Health. He did, and Jeff [INAUDIBLE]
signed the letter, et cetera, et cetera. Didn’t work. What they didn’t realize– even though they were
told most of their water came from Otis, the Air Force
base, which is fluoridated. They chose not to take
on the Armed Services. [LAUGHTER] [INTERPOSING VOICES] Just want to thank both of you. Thank you. [APPLAUSE]

1 thought on “[email protected]: Oral Health Facts Matter”

  1. I am a data nerd – I also pay attention to agendas and cognitive bias. 

    First – to conflate fluoridation and vaccination is inappropriate. They are different science and should be examined in terms of the data, not from the assumption that those policies are absolute goods and the job of the 'professionals' is to manipulate political and public opinion to accept these medical interventions. 

    Second – although more polite than most, this presentation presents the opponents of fluoridation and the vaccine hesitant as 'less than' which is consistent with the dismiss the ethics, deny the science and denigrate the opposition approach that fuels both the pro-F and pro-Vax campaigns.

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