Why not be blunt and tell it how it is??

27 Jul

Yesterday I came across a facebook friend’s post that read:

saw the inside of a AAA today. it was disturbing. smoking should be illegal.

So, for those not familiar with medical abbreviations, AAA stands for abdominal aortic aneurysm.  Smoking, amongst many other things, can contribute to causing an AAA because it damages your blood vessels, which leads to gross, cholesterol and calcified plague sticking to the walls of the vessels and weakening them.  Weakened and damaged blood vessels can become dilated (aneurysm), and if they become too dilated, they can rupture, which often kills.

What’s your point about this and the facebook status, you ask?  I’m getting there…..

So, so, so many chronic diseases (diabetes, heart disease, strokes) are often caused or contributed to by lifestyle choices, which include diet and smoking.  The effects of these choices, though, don’t manifest until later in life, and once they do, they are extremely costly to our healthcare system and debilitating to the person.

So why do people still smoke and eat poorly?  With no immediate effect, I guess there’s no strong incentive.  But part of the problem, I feel, is that people don’t really grasp how horrible the effects of their actions are, and I think there needs to be more blunt, disturbing public health campaigns.  Show people pictures of what their vessels will look like!  Don’t just tell them they may get cancer, tell them what it feels like to deal with cancer.

**Like, ok, you’re told:  if I smoke I’m at increased risk of lung cancer.

But what does that really mean??

Translation (of what lung cancer means):   You will develop a huge mass in your lung, that will devour surrounding surrounding airways, leading to collapsed lung and trouble breathing.  It will erode into vessels and cause you to cough and spit up blood.  It will produce fluid that will surround and fill your lung and make you feel like you’re drowning.  Then, it will move onto other parts of your body …. it will cause severe pain as it gnaws away at your bones.  If it gets into your brain, your ability to think clearly will be affected.  You may end up with a stroke/brain hemorrhage…

A picture of a big lung mass invading into this person’s pulmonary artery and airway. Picture taken from statdx.

Picture of a big lytic lesion in this person’s pelvis, which is from a metastatic cancer eating away at the bone.


**Here’s another example:  If I eat lots of sugary, high processed foods, I’m at risk of diabetes.

Translation of “diabetes”:  My vessels will become severely damaged everywhere in my body.  I may lose circulation to my feet, which can lead to ugly, infected open wounds that never heal and may eventually lead to an amputation.  The vessels in my eyes may become affected, and I’ll lose my ability to see well.   The vessels in my heart, my coronary arteries, will become more susceptible to plaque and I may end up with heart attack, which will then lead me to a damaged heart (congestive heart failure, or CHF).  With CHF, I’ll have trouble breathing when walking just a few blocks.

**Want a third example?  Lets address melanoma.  If I go out in the sun often without sunscreen or go to tanning beds, I’m at increased risk of skin cancer.

Translation of “cancer”:  I will develop a tiny, dark mark on my skin that may look innocent at first, but once it grows deeper, it will become an out of control monster, invading every single organ in the body….eyes, brain, stomach, spine, etc.  I will go through rounds of chemotherapy, which basically is a poison to the body….in an effort to kill my malignant cells, the chemotherapy will also kill many of my good cells, causing me to lose my hair, vomit, and leave me weakened.     Before I die my young death, I will be pale, bald, and cachectic looking.  Hardly worth the tan.

A PET scan of someone with metastatic melanoma. Every dark spot represents foci of cancer.


Just read this girl’s story, who succumbed to melanoma at 26:

So, I know this all might sound a bit dramatic, but it IS dramatic.  Cancer is horrible.  I hate it.  I hate it SO much, and I hate the pain it causes people and their families, regardless of the cause of the cancer.  I wish I could destroy it, for it is such an evil illness.

I also hate the struggle people must go through who have had strokes.  I’ve experience it with my own family.  My grandmother, who smoked for the majority of her life, didn’t end up with lung cancer, but suffered a massive stroke.  

Not every illness is a direct cause of certain actions…most are multifactorial, and for those that all related to stigmatized behaviors, there are tons of more unhealthy habits that people “get away with” because they aren’t stigmatized by society.  However, for those habits that have been proven to increase your risk of certain health conditions, I just wish we could get more education to people about the potential repercussions of their actions.  If you’re going to educate them about what they’re at risk for, I believe you have to define what it really means and not sugar coat it or use medical terms that don’t relay the severity of what the disease/health condition entails.  Being blunt may not work for everyone, but it works for me, and so it may work for others, and so I think it should be used in addition to other educational methods that promote healthy behavior.

9 Responses to “Why not be blunt and tell it how it is??”

  1. justgngr July 27, 2012 at 10:53 am #

    so while I agree with you that sugar coating things is not the best route (direct words from my mouth this morning to a colleague)… there is ample behavioral health literature and evidence to show that fear and shame tactics are often not effective. I too find that hard to believe, but eventually people tune out or think “that wont happen to me”.

    • Julia July 27, 2012 at 4:26 pm #

      I don’t have much knowledge in public health, I guess I just know that fear motivates me and how affected I am by seeing everyday how cancer and diet can destroy the body. It scares the crap out of me.

      • justgngr July 28, 2012 at 11:04 am #

        that makes two of us!

  2. runningthewindycity July 27, 2012 at 1:38 pm #

    I agree with the above comment. There is definitely a “it won’t happen to me” complex that seperates the action from the consequences and most people who participate in high risk behaviors can’t fathom every having cancer or a chronic disease. I think the facts ARE scary but that scare tactics won’t work. We need better health education from all angles and now just the typical school health classes. We need media campaigns etc.

    *Remember the TRUTH campaign? It’s credited with decreasing smoking in the teen age group.

    • Julia July 27, 2012 at 4:33 pm #

      I guess I don’t really have much knowledge in public health. I guess all I know is that I am personally motivated by fear and deeply affected by what I see every day in regards to the effects of cancer and diet on the body. I agree that better health education, particularly targeted at middle school age kids, from all angles is needed. I think scare/blunt tactics SHOULD be one of those angles, amongst others, because it may affect at least some people like it affects me. Of course, people respond to information in different ways, which is why I totally agree about the hit it from all angles (at a young age).

  3. Losing Lindy July 28, 2012 at 8:51 pm #


  4. Bob Smothers August 20, 2012 at 8:59 am #

    hello, i was on a “pump positivity into the internet via “wefeelfine.org” ” kick and that is how i found your blog. now please understand i am trying to be kind and understanding, but i dont think you realize how you are coming off.

    “So why do people still smoke and eat poorly? With no immediate effect, I guess there’s no strong incentive. But part of the problem, I feel, is that people don’t really grasp how horrible the effects of their actions are, and I think there needs to be more blunt, disturbing public health campaigns. Show people pictures of what their vessels will look like! Don’t just tell them they may get cancer, tell them what it feels like to deal with cancer.

    **Like, ok, you’re told: if I smoke I’m at increased risk of lung cancer.

    But what does that really mean??

    Translation: You will develop…”

    you are using logical fallacy to make cancer the by product of smoking. No strong incentive? …that kind of takes peoples ability to make choices and live there life the way they want, out of the picture. doesn’t it? if feels like you overlook the benefits (at the very least the perceived benefits)

    also i don’t mean to be needlessly cruel or pessimistic, but there is only so much room and resources on this planet to accommodate.

    to get away from personal politics and global populations whatevers (ethics i suppose) lets bring it back to your style. “if i smoke i’m at increased risk of lung cancer” turns into “you will develop” (and of course i am not going to say cigs are a healthy way to relax with the family) but it seems that, in response to the farce that took place at the hands of “big tobacco” with there academy for the research blah blah blah… people started thinking it was OK to start using lies and half lies and lies you get them to tell themselves. to prove points. such as… second hand smoke. either blame it on, we dont study it hard enough, or we dont have a great test to show that second hand is a “first rate killer.” but either way you slice it, you cannot statistically verify that it was the people being around smokers that did it. whats his face (the former pitsburg stealor) is (or was, he might have passed) convinced that it was his steroid use that led to his cancer (AND HELL MAYBE IT WAS…)however comma but, there are hundreds of other guys who are “juicing” “all the time” and they manage to live cancer free lives.

    …maybe i smoke, and maybe every single puff is another microscopic layer building up in my tumor err um lung. but two things i feel you are overlooking… I like to smoke (i am addicted to the oral fixation of some form of smoke (or vapor) being in and around my face) and maybe i want to get taken out MORE by something as quick and awful as a lung issue at 50 or 60. than i want to wait for the (sometimes) agonizingly slow and horrific proses of your organs shutting down one by one at 80 or 90.

    isnt that what you are saying… Society isn’t doing enough to educate people.
    so it needs to be “more blunt, disturbing public health campaigns.” you mean like the ones with all the people giving helpful tips about using there new trake tubes… yeah the ones that make EVERY SINGLE LAST PERSON ON THIS PLANET… who has a trake tube because of some genetic defect, or past trauma, or hell, ANYTHING OTHER THAN SMOKING. feel like garbage… because that campaign is making fun, and we all know it. …or the adds that have some freaked meth head… or the adds that glorify booze? or the adds that promise they can make my dork bigger… all the other adds full of lies, half truths, and lies one tells oneself.

    …i do apologize, i started to get judgie and mean. but the point i build towards is this. the smart people will know to avoid things, without a multimillion dollar ad campaign reminding them. and the less fortunate …will continue to be less fortunate.

    seatbelts… lets take it away from the health thing that we are both clearly passionate about. click it or ticket. a huge national campaign, i’ve seen bumper stickers, i’ve seen road signs, i have seen flashing amber letters proclaim it, and i have seen them before my movie starts in the theaters… but i truely have a difficult time believing that if a person is too stupid to figure out the benefits of wearing one, the ramifications of not. and furthermore obstinate to the placard thing that lights up and chimes when your not wearing it… then what hope do we have of even one of those people being reminded “hey, you know that thing that is obvious and against the law…. well its obvious and against the law” and they respond with… hot damn your right, what a fool i have been… (not even getting into how wrong it is to try and legislate personal choice.)

    what about carpul tunnel, and the video game generation. why not the hoards of fat children we create, why not the armys of no good degenerate f**ks that call themselves parents, but really just disguise the fact that they are still children themselves. what about women who let themselves get pushed around by overbearing over dominant douche nozzles.

    ….no your right though… we need to amp the already wasteful and ineffectual campaigns that are ALREADY in place up …with some violence, and some gore. …more disturbing, i know… lets run an ad that shows the god awful act of DYING because of it (smoking)… big pulpy blood clots coughed out over choked strained “breath-moans”.

    please let me close with an apology, i’m sure i am guilty of exactly what i’m railing against about your blog entry. by even commenting in the first place.

    it just gets to me sometimes…
    (feel free to stop reading from here on out,)

    most of the anti tobacco money and ads and everything else… are coming from big tobacco… you see, because they cant spend that money on ads that will get kids and people smoking… so they spend it on the only other way to CONSTANTLY GET THE WORD OUT ABOUT SMOKING. people (children especially) are notorious for missing the point. (often times missing it so hard they run with open arms into the danger) i speak from experience on this as i was the kid that wanted to be above the influence of “THE MAN” telling me what to do, man.) but whats the one thing every ANTI tobacco has in common …how often they work the words smoking, and cigarettes into it. its subliminal… and its genius.

    (i think i just made the best smoking ad and it harkens back to when people caught there kid smoking and made them smoke the whole pack or carton…) “hey kids… light em up, smoke em if you got em. suck that sweet sweet tobaccy down into those lungs of yours, cancer will be the next facebook just you wait, cronic ahsmah and upper respiratory issues are the next kardasian sisters. hell, the worlds got 7 BILLion other people.” ::then a quick succession of a montage of ACTUAL smokers being generally gross and wheezy and caughy:: then a somber “i mean unless you don’t want any of that.”

    • Julia August 21, 2012 at 6:35 am #

      I’m not sure I followed everything, but a few points: I clarified what I meant when I said “translation.” I was translating what cancer meant in my eyes..I did not mean that everyone who smokes WILL get cancer. I just don’t think people in general realize how awful the disease can be. I HATE it. I HATE the pain it causes people, and I wish people could grasp the seriousness of it.

      And yes, smoking gets stigmatized. I have always felt this unfair when there are tons of other unhealthy things people do (like the seatbelt example). Not all smokers get lung cancer, and not all lung cancers are caused by smoking, but smoking IS a risk factor. That has been proven.

      My point was not to target smokers, but to make the point that I don’t think a lot of people in general fully understand what certain diseases involve. If you told me, you may get melanoma from going tanning, I’d be like, hmm, yeah, that sucks, but I wouldn’t really understand what that meant, and I didn’t until I started working in medicine and saw how it destroyed your body and read personal stories of people who have had it.

      I think health education is so important, and as someone who can’t stand beating around the bush, I personally like to be told things bluntly. It works for me. Not saying it works for everyone, but the fear/reality factor definitely influences the actions I take, and so I think it should be a tactic used amongst others in health education and prevention. If our country is to require everyone to be insured, and several of the most costly conditions are chronic (multifactorial!) disease, then we all have a personal responsibility as citizens receiving government money to take care of ourselves and do our best to stay healthy regarding the things that we can control and have choices over. And as a medical field, I believe we have personal responsibility to educate people. Ultimately, the choice is still yours.

      • Bob Smothers August 21, 2012 at 3:14 pm #

        ok… now that i have re-read everything. I realize that not only did you have a great point, but that i got needlessly personal in my comment/tirade. namely because of the huge chip on my shoulder when it comes to tobacco.

        But now, allow me to say. that i think your head is in the right place, but personally, i don’t think its the governments job, or some ad counsels job. (to put up posters, billboards and TV spots) but rather keep pressuring schools and parents. to do that educating. Provide resources for the real influential people. (as in my rant, i think i was getting at… kids and people being generally turned off ANY time they get PSA in there face) because it comes off as “some one who doesn’t know me, trying to tell me how to live my life.”

        so i guess what i am saying is, that by the time people can make proper sense of the TRUE and righteous kernels of information. (due to being older and hopefully wiser) its like you said… its too late by then.

        so if we had a public school system that wasn’t a joke. (that will then have a comprehensive heath class (at least a few semesters worth) ) And a “How to be a responsible parent .gov”

        imagine what other problems aside from health that could be fixed.

        i love this idea now. build a framework for actually educating “the children” as though they were … oh i dunno… …adults that are small and don’t understand much?

        not sure… but rather than get into a diatribe about the things we are taking away from children without knowing that we are doing so.

        So, yeah. Educate the people all day every day… but don’t beat them over the head with hackneyed, pushy, oftentimes misleading, and always a nuisance ad campaigns. (dag gum it, i forgot to say EXPENSIVE)

        (also a side note, thank you for seeing my nonsense and not responding with nonsense the way a typical internet does)

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