Oh sh–! Almost forgot it’s C. diff Awareness Month!

By | November 12, 2018

Various advocacy interests have proclaimed November as the national (or global) awareness month for stomach cancer, osteoporosis, pancreatic cancer, prematurity, lung cancer, bladder health, Alzheimer’s disease, home health, family caregivers, and hospice/palliative care.

3D Animation of C-diff

And for the past four years, you’ve also been asked in November to heighten your awareness of Clostridium difficile — or “C. diff” for short. The campaign is spearheaded by the C Diff Foundation.

C. diff is an opportunistic bacterium that most commonly infects older adults who’ve been hospitalized, institutionalized, or had prolonged exposure to antibiotics. Community-acquired cases are also starting to emerge. The CDC estimates it infects just under half a million Americans each year, and can result in a full range of symptoms from moderate diarrhea to life-threatening inflammation of the colon.

But it’s not the science or statistics of the infection that’s caught my attention, even though my 86-year-old mother just got over a classic case of it, after three hospitalizations and several courses of antibiotics for another infection. Rather, I keep wondering whether and why we really need a “C. diff Awareness Month.”

Would increasing my mother’s “awareness” have helped her avoid the infection? Since she can’t do much about her age or being hospitalized, the only potentially preventative measures she could’ve taken are the same common sense steps any of us should take when it comes to infection: basic, good hygiene and the judicious use of antibiotics under medical supervision.

Yes, this can be a serious disease, and the injudicious use of antibiotics and emerging virulent strains most likely play key roles. But equally important is pausing to consider this: How much can making you, me and our neighbors more “aware” really help? Or, who really benefits from the “awareness”?

It was the Mayo Clinic News Network — part of their PR effort — that caught my eye with the offer of Mayo experts who could be interviewed on C. diff. Does the PR reminder that “Mayo Clinic has C. difficile clinics at its Rochester, Minnesota, Scottsdale, Arizona and Jacksonville, Florida campuses” qualify as awareness — or marketing?

Money, state proclamations, and Clorox-sponsored radio

This past weekend’s 6th Annual International C. diff. Conference and Health Expo may provide another clue. Roughly half of the featured speakers — both MD’s and PhD’s — have financial ties to biomedical companies that sell C. diff treatments or disinfection products. At least a dozen of these companies were major sponsors of the meeting.

The C Diff Foundation’s website, its Facebook page, and their radio program all prominently feature fundraising and industry-sponsored studies despite this disclaimer regarding their Code of Ethics which:

“… prohibits the endorsement and paid promotion of products, services, medications, or clinical studies in progress.”

How do the fundraising, petitions for state proclamations of “C. diff Awareness Month,” and the Clorox-sponsored radio program help consumers? Let’s say they achieve widespread “awareness” — whatever that is. Now what?

“What bothers me about C. diff Awareness Month is what bothers me about all such campaigns,” says Andrew Holtz, an Oregon-based health care journalist, and past president of the Association of Health Care Journalists. “It’s easy to see how they benefit fundraisers and companies selling treatments, but not so clear how ‘being more aware’ helps the average person.

“In the case of C. diff there isn’t much public awareness, but there isn’t a compelling need for more. In the case of diseases like breast cancer, there’s almost universal awareness, so there’s little benefit to the public of an awareness campaign. These campaigns too often bear little relationship to the public health burden of the featured disease, or the usefulness of broader public education about it.”

‘A market of alarmed consumers’

Here’s what we really need awareness of: a commercialized medical juggernaut fueled by financial incentives that has lowered the thresholds for what isn’t normal and what does need treatment, while shifting the focus from the sick to the worried well.

One of the more erudite and provocative distillations of this was composed by Harvard psychiatrist Arthur J. Barsky, MD, in this 1988 New England Journal of Medicine essay, The Paradox of Health:

“Each producer tries to convince the public that something is dangerously wrong, or about to go wrong, and that immediate steps must be taken to remedy the situation. An indifferent public is first galvanized into becoming a market of alarmed consumers by constant reminders of myriad threats to health, and then convinced of the need for more and more products and services to protect them. In the process, deep-seated fears about disease are mobilized, and insecurities about health and longevity are intensified. As a result, many come to feel less secure about their health, more worried about the possibility of disease, more absorbed in trivial symptoms … amplifying the public’s sense of somatic vulnerability and apprehension of illness.”

This is another sort of “awareness” — a dysfunctional variety, not the health-promoting kind — that can emerge from campaigns where there isn’t really a need for awareness. It runs deeper than financial interests because it shifts our awareness away from actionable health choices and toward an unnecessarily medicalized life.

To be aware is to be “wary, vigilant, and cautious.” Next time you come across a health-related awareness campaign, ask your self what you really need to be wary, vigilant, and cautious about.

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