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Protecting the Soul of a (Fairly) New Discipline, Health Communication

Dear colleagues and friends

I urgently need some input on how to proceed. I recently tried to get a letter to the editor published in a major international scientific journal but was refused with the simple - and on the surface, reasonable - argument that the journal does not carry a Letters to the Editor section.

My letter critiqued a conflict of interest (COI) I perceive on the part of the editor of the said journal, who is simultaneously employed by one of the huge multinational pharmaceutical companies. I have received no comment on this issue from the editor or from the managing editor about this, nor do I expect to.

However, this topic seems to me to be far too important for me simply to accept this letter of rejection. To paraphrase, it is actually about protecting the soul of a (fairly) new discipline, health communication. Hence, I am seeking avenues to publish this letter elsewhere, perhaps on this forum. But before I do this, I thought perhaps I might ask for advice on this issue.

Without getting too long-winded - the underlying issue seems to me to be the current operating and accepted but to me questionable definition of health communication itself (dealing as it does with effecting behaviour change, arguably a paternalistic, patronizing and self-serving definition devised by health and allied professionals to justify campaigns whereby they - OK, we - attempt to affect behaviour changes in OTHER people, for all the right reasons, of course, but still....). My point is that if such a definition allows for the editor of a journal to simultaneously work for a multinational drug company (which, yes, is very much involved in behaviour change, notably getting people to purchase their products), then there is something terribly wrong with the very definition itself.

True communication - whether on health or anything else - surely has nothing intrinsically to do with changing other people's behaviour but rather with a respectful exchange of ideas, which may or may not lead to those and other consequences.

I would welcome any thoughts on this general issue of the nature of health communication as well on the issue of conflict of interest, and how to proceed in this case.


David Finer

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Hi again

Looking more closely at some different definitions of health communication, I see that they do not all explicitly mention behaviour change, although most of them do include "influencing people", which seems to confirm the point I tried to make earlier.

Here are a few I have found.

’… a key strategy to inform the public about health concerns and to maintain important health issues on the public agenda. ’

‘… an approach which attempts to change a set of behaviors in a large-scale target audience regarding a specific problem in a predefined period of time’.

(Elayne Clift & Vicki Freimuth, Journal of Health Education, vol. 26, no. 2, 1995).

‘…the art and technique of informing, influencing, and motivating individuals, institutions, and large public audiences about important health issues based on sound scientific and ethical considerations.’
(Emerson-Tufts Program in Health Communication)

‘…the study and use of communication strategies to inform and influence individual and community decisions that enhance health.’ (CDC)

‘…the art and technique of informing, influencing and motivating individual, institutional, and public audiences about important health issues.’ (Ratzan, 1994)

David Finer
It is not just Health communication that is an attempt to influence or modify the behavior of others, it is practically the goal of language itself! A baby's first cry is an attempt to modify the behavior of its parents, and I would say almost half of what my 4 year old daughter tells me right now is intended to modify my behavior (mostly in the direction of providing more chocolate.) The constant barrage of advertising is also trying to sway our behavior. Some speech is purely informative or purely for entertainment value as well.
I think that that the average person off the street actually understands this and will make their own decisions. The ability of health care professionals to alter this behavior is pretty minimal. How long has the medical establishment been telling Americans to lose weight? How much do they weigh now?
For these reasons I just can't get that worried about paternalism in health communication.
However, the information presented does need to be accurate and conflicts of interest can interfere with the the dissemination of accurate information. Health communication should present the best of current knowledge, not a biased view.
Maybe another publication would pick up your letter. That would quite likely get people's attention.

Sanjay Magavi
I certainly get your point about the chocolate, Sanjay, being a serious chocaholic myself. Of course you are right in pointing out that one of the main functionis of language, and yes, of communication is to influence or persuade others. It is an important part of why I am writing these words right now. My point was just that it seemed self-serving to define health communication (and by inference, other kinds of communication) in a way which only privileges certain types of communication by certain parties, and thus excludes lots of others. Which I would argue that most of the above definitions in fact do. What about all the informal situations in which we as individuals communicate around health-related issues with friends, workmates, on the bus, at the clinic? What about communication initiated by grassroots advocacy groups, perhaps targeting decision-makers relating to health matters? These and other situations would arguably not meet the above criteria for h.c. But perhaps I am being too academic.
More concretely - and I may be stepping on a few toes here - I simply felt that working for a drug company was incompatible with "true" h.c. in the public interest (not that I don't see all the virtues of medicines, don't get me wrong). And hence, that working as the editor of a scientific journal of h.c. and a drug company was a clear conflict of interest. Of course, I could expound on my view in this regard, but I won't unless this discussion continues.And yes, now I am starting to qualify the term h.c. myself ("true", "public interest"), so maybe I too am guilty of defining the term h.c. to suit my particular views and objectives.

Anyhow, thanks for the response and for the piece of advice, which I will follow.

David Finer
I love Sanjay's idea to publish the letter in another publication and at the same time get quite upset by this lack of transparency in organisations, particularly in regards to health. I don't think a person's (possibly) conflicting involvements would preclude them from holding such a position (we all have some bias), I do however think it is only fair that there is: 1. some disclosure on the part of the editor so that people may make an informed choice as to possible motivations behind communications, and 2. a vehicle for information sharing so that readers have the opportunity to question (and interact) where issues are of concern for them, for example if they suspected that funders via the editor may be determining inappropriate inclusion/exclusion of information. Not having a "Letters to the Editor" section only highlights the lack of integrity or willingness to engage. Imagine if a journal was so transparent that readers could view the queue of submitted articles, witness rejections, edits, comments and so on, right the way through to the finished publication. Now *that* would be something. I often find much more information in the process rather than the end result... wish there were more organisations willing to open themselves up to real peer review :)



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