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May 9, 2005

Just in Case Versus Just in Time

I had a very interesting discussion this week with Julie Gerberding, director of the Centers for Disease Control & Prevention, at our semi-annual board meeting of the CDC Foundation. We were talking about the experience of Toronto during the SARS epidemic and about the incredible coverage of the recent study from the University of California indicating that moderately overweight people have lower mortality rates than those who are just at goal weight.

In Toronto, at the peak of the epidemic, there were 30,000 people who were infected with SARS. They voluntarily agreed to a quarantine, in effect staying at home to prevent the spread of the disease. Why did this work so well? The key to acceptance, according to public health experts, was communication, constant and credible and consistent. Just as important was the understanding of the consequences of non-compliance. Canadians had seen the rapid spread of the disease through Hong Kong and Southern China on live broadcasts on CBC and CNN. Some had family members who died--the email traffic brought the risks home in a very personal way. There was also a very close cooperation between public and private sectors, with the aim of getting Toronto off of the WHO warning list to reinvigorate tourism and enable business as usual.

Let us contrast this communications scenario with the current confusion on obesity. There have been three major studies in the past decade from the CDC and Harvard (1990, 2000, 2001) indicating that obesity reduces life expectancy and is the number two cause of death after tobacco, A single study of questionable methodological integrity finds that moderately overweight people may live longer. The global media, eager to contradict prevailing wisdom and keen to provoke controversy, jumps on the study. The CDC, overwhelmed by a mistaken release of anthrax samples, is unable to respond in the first news cycle. So the prevailing wisdom at my house, as touted by my teenage daughters, is that their father is proven totally wrong in his insistence on family fitness and proper diet, that I should grow a gut and enjoy life.

For those of us in the PR field there are some important conclusions from the SARS and obesity situations. We cannot make any assumptions about prevailing wisdom, even in the case of obesity, with serious academic studies showing a correlation with early mortality, diabetes, and heart disease. A single report has given incredible momentum to those who would deny the truth. We need to adopt the precautionary principle, offering continual new grist for the media mill with credible studies and easily accessible spokespeople who can counter spurious findings. We need government institutions such as CDC to be able to multi-task or to delegate to other arms of the public sector. Just in time may work in manufacturing but just in case is a far better way to proceed in the PR business.

Richard

Posted by Edelman at May 9, 2005 8:16 AM | Bookmark and Share

Comments

Is there also another important difference between Obesity and SARS - namely the immediacy of the negative impact - i.e. SARS = you get, your family gets sick and people can die, in just a few weeks.

vs.

Obesity = over time you gain a pound here and pound there until years later you realize you have a problem and it is lurching slowly into the realm of serious problems - probably alongside your family who likely have gained weight with you as well.

My point, that obesity like global warming, are issues of long duration. People generally in the abstract sense they may be problems but they do not have an immediate and rapid feedback loop.

In contrast floods, Tsunami's, earthquakes, SARS etc are rapidfire, immediate, and relatively easily understood. Good or bad people will react to immediate problems (often by overreacting but clear, calm, specific and trustworthy communications will help, along with specific tangible steps people can take - such as a voluntary quarantine etc.

The challenge I see, admittedly as a non-PR professional, is how we as a society communicate around longterm, complex, hard to render as soundbites stories - global warming, obesity, social security and entitlement funding over 50 year windows, where to allocate long term, basic science research - etc.

It could also be similar to the challenge a corporation has in communicating steps taken for long term success, which may have short term negative impacts (shifting reinvestment, selling off historically important divisions such as IBM's recent sale of their PC business, etc). Clearly if you look at the financial markets IBM is still not fully recovered from some negative impacts of that sale and other related announcements.

Good topic to consider and think about.

Shannon

Posted by: Shannon Clark at May 9, 2005 2:39 PM


Richard,

As a PR practitioner who is a bit on the heavy side I must admit that every time I've heard you talk about the obesity topic I've secretly hoped that somehow you would be proven wrong. And when that report came out I thought of you and smiled. But while I found it amusing I did not make a trip to the donut shop. Instead I remembered one of the core principles of journalism - dog bites man is not news, man bites dog is news. An overweight person actually living longer, as proven by a study, is man bites dog. In the 24-second media news cycle we live in the dog needs to bite back faster and faster, and as you point out that did not happen here. As public relations practitioners it is our role to facilitate the biting (whether through the CDC or another organization). But in this case I think both sides are a bit guilty of over promoting or "wagging the dog." The media and the public have been so inundated with the obesity message that any "credible" study that said being a little overweight wasn't going to kill you would be welcomed like water in a desert - even it was only a mirage. The "think thin" movement clearly needs to clarify the facts, but they must be careful that in doing so they are not overly aggressive in their message. If they are they may be seen as chicken littles. And in a fat America some people like to eat their chickens - even the little ones.

Posted by: Ken Kerrigan at May 10, 2005 10:29 AM


Ken, the biggest problem for CDC was staff available in managing multiple crises But as further point there should have been a group of MDs on standby This obesity doesn't matter story was inevitable at some point CDC could have knocked it on its head in the early rounds before it got traction Thanks for writing I am in Seoul with my office

Posted by: Richard Edelman at May 10, 2005 5:14 PM


Richard: The main issue I have with the obesity alarmists is the obessessive focus on body fat as a sign of ill health. Anyone who has had a thin relative get seriously ill knows that too little body fat can quickly become a problem if they have health problems. And the over-emphasis on dieting as a way to lose weight may be making lots of money for companies, but it's not serving their customers well in the long term.

Eat healthy food several times a day. Get regular exercise. Get regular sleep. Anything more complicated than that, and I get suspicious of the message and the messenger.

Posted by: Eric Eggertson at May 12, 2005 1:46 PM


Eric,
Sorry so long in getting back to you
Was in Asia and just back
Clearly you have a point I think my dad now 85 is too thin and this makes him vulnerable to upper respiratory illness and anything else
Thanks for writing
Richard

Posted by: Richard Edelman at May 23, 2005 1:07 PM


"A single study of questionable methodological integrity finds that moderately overweight people may live longer."

Hmm. That study was put out by CDC itself! Using CDC's own data! And was coauthored by people from NIH! And went through review and clearance at CDC and at NIH, who both approved the methods used. It says so right in the article. Julie Gerberding is talking out of both sides of her mouth on this.

Also there are many many studies that show that slight overweight is asociated with slightly reduced risk of deaths. It's not a 'single study'. Read the article! It sounds like Julie Gerberding has never read it!

Posted by: Carolyn at June 5, 2005 9:50 PM


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