Too much silence in branding epidemics


WASHINGTON -- As the public affairs director of a nonprofit health institution, I spend much of my time reading news stories about medical advances. But I must say to my friends in the news media and my colleagues in public relations that if I see or hear the phrase "silent epidemic" one more time, I am just going to (deleted).

What is a "silent epidemic"?

Is it an outbreak of bone disease or upsurge (or downturn) of erectile dysfunction? What is not a "silent epidemic" -- thousands of people writhing and screaming from bubonic plague, or, perhaps, the pain of something as frequent and joyful as childbirth?

Only the rubella outbreak of the 1960s, which caused an inordinate number of babies to be born deaf, could accurately be called a "silent epidemic." But a cursory scan of headlines for the past six months reveals the following "silent epidemics," "silent killers," "silent diseases" and, most recently, the "silent infection" known as West Nile virus:

Bone disease in men

Erectile dysfunction

Decreased sexual desire in women

Oral disease among the poor

Chlamydia among the young

Traumatic brain injury

Asthma (which if you live with or near it is not so silent)


Inhalant abuse

Hepatitis C




Ovarian cancer

(Surveying different disease advocacy groups will reveal even more silence regarding such ailments as obsessive compulsive disorder, anterior cruciate ligament injuries in female athletes and gastrointestinal stasis.)

So, one is tempted to ask: If the disease organizations lobbied in a forest, wouldn't all epidemics be silent?

There is much to be learned about all of these conditions, none of which is the least bit funny to those who have them, and labeling them silent epidemics is an easy way of getting a reporter's -- or congressman's -- attention.

But their attention ought to be more on the real science that tells us how to prevent, treat and live with chronic illness.

Nearly half of us live with chronic conditions, yet they may well have been caused by behaviors that are changeable. Studying behavioral change is a productive -- yet silently under-funded -- field of inquiry.

Gene therapy may provoke a gee-whiz from the science writers and the public, but the reality is that half of the deaths in the United States are caused by things we already know about and can stop.

Unraveling the human genome is a breathtaking achievement, but what kills us is not simply a matter of switching a gene on or off the way you do a transistor. The promise of gene therapy still can't be expected to stop us from smoking, drinking, eating and worrying ourselves to death.

Unfortunately, the funding tends to follow the disease -- the "epidemic" -- not the cause. All diseases are worth studying and trying to cure, but not all are silent, and not all are epidemics. What we can do is to apply the knowledge we already have about the psychological, behavioral, social and environmental causes of illness and translate them into better practices by caregivers.

We might, while we're at it, retire the clichM-i of "silent epidemics" and concentrate on how medical science and public health research can be heard and heeded more effectively.

Ira R. Allen is public affairs director of the Center for the Advancement of Health, a nonprofit institution that promotes greater understanding of the psychological, behavioral, social and environmental determinants of health.

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