With changing health guidelines, how do you know who to trust?

The idea that there are health fads that cycle in and out of the medical mainstream, not to mention the popular consciousness, is not new. (Was margarine ever a staple in your kitchen?)

This kind of evolving advice is normal in a realm informed by science, because science is ever-developing. Studies done in volume and over years help change medical opinion. The frequency of certain tests and the recommended schedule for certain vaccines has been changing for a long time, well before the Covid-19 pandemic thrust the messaging about health into existential territory.

But never before has the whiplash been so blatant and extreme as it has under the administration of President Donald Trump. There are even scientific studies evaluating his messaging about Covid during his first term. The peer-reviewed Journal of Medical Internet Research evaluated 11 of Trump’s tweets about unproven therapies and 65 times he mentioned those therapies – including hydroxychloroquine and chloroquine – in 2020. The conclusion: “Individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals’ claims are unverified. Public health officials must work to dissuade the use of unproven treatments for Covid-19.”

How much sway public health officials hold is certainly open for interpretation. I asked Karen Smith, the public information officer for the County of Monterey Health Department, if information ever has flowed in a straight line. “There was a time that the [U.S. Centers for Disease Control] and [California Department of Public Health] and locals would pretty much be singing off the same sheet of music,” she says. These days, the County follows vaccine guidelines from a new four-state West Coast Health Alliance rather than the feds. “It’s a dance, because everything is in such flux,” Smith says. “It’s very frustrating; I feel sorry for the public.”

The flux is not new, Smith says, but the proportion is new as of Covid-19. I don’t think it’s fair to shift the blame entirely onto Trump – health officials also struggled to articulate openly and honestly the nature of their own uncertainty about appropriate interventions, and failed to openly acknowledge they’d been wrong. (Remember that era of spraying down grocery bags?)

“All we could say was, ‘don’t, just don’t.’”

The U.S. Department of Agriculture and Department of Health and Human Services released new nutritional guidelines this month, essentially flipping the old food pyramid – long since debunked – upside-down. It’s easy to hate the messenger (Health Secretary Robert F. Kennedy in particular has advanced many controversial, unsupported and potentially dangerous views) but in this case, the message seems to generally be a good one, with a focus on real food and consuming more fruits and vegetables. There is controversy around its embrace of saturated fats, but it still looks better based on current information than the food pyramid I grew up with.

Another communication problem comes in the form of hard prohibitions. I was troubled by a do-not-eat advisory around foraged mushrooms earlier this winter, when I thought more sensible advice would have been to exercise extreme caution. “Because death caps are hard to differentiate and the number [of hospitalizations] was high, all we could say was ‘don’t, just don’t,’” Smith says.

For people who, like me (OK, like all of us?), raise an eyebrow at “just don’t” advice, Smith sees a solution. Community health workers became increasingly significant during the pandemic. These are not medical professionals but regular people trained in understanding public health guidelines, what we do and don’t know and able to answer people’s questions about “why.” The concept was so effective that the Health Department launched its own pilot program, Communities Reaching for Equity (CORE), about a year ago, with five community health workers now.

“Healthy skepticism is a good thing,” Smith says. “But the toughest thing about public health communications is getting through the mis- and disinformation that’s confusing people.”

The hope is that local people who earn trust and have time to talk through people’s hesitations can cut through the confusion. It’s a good model well worth replicating.

SARA RUBIN is the Weekly’s editor. Reach her at sara@montereycountynow.com