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ScienceI’m Sandro Galea, dean of Boston University’s School of Public Health. I’ve also studied natural disasters and their impact on our health. AMA.

Sep 13th 2017 by SandroGalea • 7 Questions • 41 Points

Since 2005, I've worked through my websites and personal seminars to educate people about ID theft issues. In that time, I've traveled to various schools, businesses, military bases, and conferences to talk about ID theft and created a recent video series due to the OPM data breach in 2015: https://www.youtube.com/watch?v=yH7bfxIHuvQ

ID theft is a dirty industry that is full of scams and dirty tricks like monitoring and insurance plans. Every time there's a breach, they give you the same bad information about what to do and try to shift the blame to the hackers when it's almost always their own negligence at fault.

My goal today is to make sure everyone gets the RIGHT information about how to handle the Equifax breach (short answer: Freeze your credit reports)

Proof: http://www.thegeekprofessor.com/about/ (at the bottom).

Proof of my history: https://www.google.com/search?q=lifelock+sucks&ie=utf-8&oe=utf-8 (check out the top non-ad link :) )

Q:

Will the communities affected by recent hurricanes be able to rebuild before another natural disaster comes right back for the same area? National and international (I'm thinking about Haiti specifically which repeatedly gets pounded by natural disasters). At what point do people need to permanently move away from high risk areas as climate change worsens?

A:

For someone who has absolutely no clue whether or not they've been affected, how do you go about being safe about security breaches such as this?


Q:

Yes, this is a good question. In many ways the core determinants of wellbeing after a disaster are the infrastructural conditions that exist before an event. So disasters are an opportunity for rebuilding and rebuilding healthy. We just wrote a recent piece making the argument for better building after Hurricane Harvey in Jama. See: https://www.ncbi.nlm.nih.gov/pubmed/?term=Shultz+galea. The issue of whether some areas should be re-inhabited at all is a complex one. We need to respect that areas and geography are important to their inhabitants and we need to be duly careful about ever recommending the opposite. At the same time, areas that are known high flood plains with high likelihood of injury for those living in them may be better repurposed for other use that does not put people at risk of injury or death on a regular basis.

A:

The key with breaches is prevention as much as possible. Try to limit the amount of data companies have on you when you can. That's a biggish topic, but I won't go into it here, because we're in "too late, what now" mode now.

As far as preventing nasty types of ID theft like medical and otherwise, hope is your only defense (not very good either, but that's the truth). The good news (for some definition of good) is that most ID theft is credit-based. That means if you block credit report access, you can prevent the ID theft.

While not perfect or 100%, freezing your credit reports is easy, cheap, and the ONLY really effective means of protecting yourself. Freeze all of your credit reports to prevent thieves from getting credit in your name.

In short, this works because a credit report under freeze needs your data AND a PIN that's set when the freeze is enacted. Right now all I need to use your credit is the basic information that has been lost.


Q:

What are your thoughts on the ethics of making public health advisories/recommendations based on correlational data that are true at an epidemiological level of analyses but may not be true for every given individual, when the more proximate explanation is readily available? I notice that public health organization do this very often.

For example, if we know at an epidemiological level that people who do/are/have X action/condition/environment disproportionately develop Y health problem, but we also know that the true proximate cause of Y is Z, and Z just happens to correlate with X. Do you think it's ethically defensible or indefensible to mislead the public about causal relationships when you know that doing so will in the end result in better health outcomes on account of the fact that enough people are statistically illiterate?

A:

So if I need to open a line of credit or something that requires a credit check, the person checking would need my pin to do it right? That would still allow me to function normally but prevent ID theft?


Q:

I think this question gets at many issues. 1. Causal thinking is complicated and complex. I have written a fair bit about this as have others and for anyone interested in a read about how to think critically about what is a cause or what is not, take a look at my book that covers this in some of its chapters: https://global.oup.com/academic/product/epidemiology-matters-9780199331246?cc=us&lang=en& 2. The challenge frequently is not so much determination of causation as much as how we communicate our understanding. The gap between science that gives complex answers (of the type that says "we know X, but not with certainty, Y may also matter") and media messaging that is, of necessity, brief, to the point ("X matters") sometimes results in partial messages that then are easily contradicted and are confusing. This is an important area that needs attention. 3. Ultimately action and policy frequently has to happen on imperfect data and requires wisdom that is not going to exist in the data. it seems to behoove us to be humble, but not paralyzed, by imperfect information.

A:

Yes. The key is that you have to "pre unlock" your credit any time you want to use it. This is called a "thaw" and usually costs another one-time fee to do. You specify a period of time to leave it unlocked (a week is usually good) and it relocks automatically afterward.

Because the thief won't have the PIN, they are unlikely to get credit. Note some places will allow credit without a check, but those are pretty rare IIRC.


Q:

Who are the people most vulnerable to PTSD after a natural disaster? And are the symptoms different from other instances of PTSD, say that suffered as a result of military combat?

A:

Thank you!


Q:

Two questions here. On the first, answers. 1. People who are injured by a disaster 2. People who lose loved ones in an event 3. People who lose possessions (e.g., houses, pets). Second question, the answer is probably not, that PTSD is PTSD and is a disorder with a fixed symptom set regardless of the etiology. However of course PTSD is a heterogenous presentation and there can be many different forms of presentation of PTSD. it is unclear whether these different forms are linked to different causes though.

A:

You're welcome! Let me know if you have other questions.


Q:

what are some public health problems that are disproportionately present in the boston area and/or boston student population (compared to other metro areas)?

A:

I determined that my information was among the breached data. Should I be worried? I was a Bank of America customer a few years ago when they were hacked and I was never affected.


Q:

Boston is one of the healthiest metropolitan areas in the country. The challenge with Boston is not its overall health but its immense inequality in health across different parts of the city. For example, areas just 2 miles apart have fivefold difference in health outcomes like diabetes, heard disease etc. This is not because these areas have no access to doctors, but rather because the context in which people live is different and produces poor or good health. I wrote a piece on this where I showed this on T-stop maps, showing the enormous differences in health by T-stops. That piece is at: http://commonhealth.wbur.org/2015/03/boston-neighborhoods-health-t-stop

A:

This is a Risk Management problem. Should you be worried? Well, what I can tell you for sure is that ID theft is easy to commit and all they need is basic information about you that the hackers now have.

When it comes to countermeasures, the best one is to put a "Freeze" on all your credit reports (that's three total). It will cost you about $10 per ONE TIME (not monthly) and can be done through their websites.

I'd recommend AGAINST accepting any kind of free monitoring (which Equifax is offering) because it's pointless, they will likely try to charge you once the "free" period is up, and, according to the comments on the FTC page about the breach, Equifax hid language that exempts you from suing them if you do.


Q:

Hi! This is such a perfectly timed AmA, my undergraduate research focused on physiology and ecology though I did try and take courses that were related to health and medical fields. I'm planning on going onto grad school in epidemiology Fall 2018. What are some things I should be thinking about during this process to be a more attractive option to schools and be more prepared when I do start?

A:

Equifax clearly stated that there are no waivers of your right to sue in this case.


Q:

That is great. In general most graduate schools of public health will accept students from a broad array of fields. If you are interested in epidemiology specifically you will need to make a case that you are qualitatively inclined, through your undergrad courses, or through GRE scores, or through work you have done before the degree. Of course if you can do some work in public health, research or practice, that helps make the case that you are serious, but in no way is that necessary. And good luck--public health is an interesting and worthwhile path.

A:

Thanks for keeping me honest! I went to check directly instead of depending on rumor-mill and it appears that normally they DO have waivers, but they've suspended that for this incident.

2) No Waiver Of Rights For This Cyber Security Incident In response to consumer inquiries, we have made it clear that the arbitration clause and class action waiver included in the Equifax and TrustedID Premier terms of use does not apply to this cybersecurity incident.

The two things that stick out to me are:

1) They did this in "response to customer inquiries". I read that as "we only did it because people were complaining".

2) They have this language normally. That's horrifying. The fact that you are waiving your right to legal response by signing up for their bogus service makes it even worse than it normally is.


Q:

With Senator Sanders introducing a Medicare For All single payer bill today co-sponsored by 16 democratic senators, I am curious what your thoughts are on this type of sweeping reform of health insurance in the United States? Would taking a more gradual approach (implementing public option) be better strategy? Appreciate your feedback!

A:

Thanks for the AMA. Any opinions about TransUnion's TrueIdentity service? The are saying that it is free.


Q:

I think this is a very interesting moment for healthcare. I have previously written that I think this may be a unique moment of opportunity for Medicare for all. See this article in the Harvard Business Review: https://hbr.org/2017/07/is-the-u-s-ready-for-a-single-payer-health-care-system. Now, of course, ironically, the moment of opportunity for Medicare for all emerges from the Republican effort to repeal Obamacare that has somehow resulted in the pendulum swinging not just in favor of Obamacare but going even further to making single-payer a real option. In general I think that a single-payer option is a necessary step towards rationalizing our approach to health in the US, and without it we will continue to have ever higher costs with limited outcomes, so if there is popular and political support for single-payer, this may indeed be doing the country a real service.

A:

How surprising. I expected to see them ask for a credit card at some point (your hint that it's not actually free), but it says they don't ask for a credit card. I notice the website is "trueidentity" and not Transunion, but based on what I see, it's owned and operated by Transunion so we're not giving information to some third party.

That said, the terms of service say that you're authorizing them to access data from your other credit reports too (Equifax etc), and that you're agreeing to receive advertisement and such in exchange for the service. Additionally they'll share some information with "3rd parties".

You understand that in order to receive the free products, you must agree to receive targeted offers by TransUnion and other third parties. The terms of any free product are specific only to the product.

It seems ok all things considered. Personally, I don't think I'll do it because I have my reports frozen anyway and I don't want to spread my information around any more than it is, but it's not probably a huge risk if you want to try it.


Q:

Not related to natural disasters, but I'm a pharmacist and I'm thinking about going back to school for Public Health (MS). Do you find this to be a common thing and what would you say is the most beneficial gain for health professionals to get this degree?

A:

Thanks for the reply! I looked into it a bit more, and they provide a 'premier' option with more beneifts (insurance, concierge service, etc.). That costs $9.95 per month. But the free service allows 'free' freeze/unfreeze of your credit. Seems like something to consider.


Q:

There are two kinds of first level graduate degrees at Schools of Public Health, MPHs and MS. The MPH is a more general degree although it is a degree that in different schools can come with various degrees of specialization. In our school the MPH allows you to take a variety of advanced certificates. See for more information here: http://www.bu.edu/sph/admissions/.
The MS tends to be more directly specialized from the beginning, usually a bit shorter because students know exactly what program they want and focus only on a narrower area. I think these degrees allow one to go to the next level in their career, both in terms of leadership positions but also in terms of scholarship and better grasp of content.

A:

Remember that even if you have to pay for unfreeze, how often REALLY do you apply for new credit? Chances are, it would be FAR cheaper to just unlock it now and then than pay a monthly fee.


Q:

Sorry yes, my bad, I meant the MPH. I guess my question was, is it pretty common for MDs, DOs, and RPHs, to go back for this degree? What is the feedback you get from them and does it actually enrich their career?

A:

Yes, we do get quite a few folks with those degrees. I had an MD before I went back to get an MPH then a DrPH. It indeed is life changing; it certainly was in my case!


Q:

What's your opinion on the spread of legal recreational marijuana? Is it good, bad, or neither for public health?

A:

Well, that is a complicated question. The general idea behind it is that it minimizes the unnecessary social and economic cost associated with enforcement and also the undue and disproportionate burden borne by disadvantaged groups for crimes related to marijuana. So, legalization can have a big impact in that arena. The question is whether legalizing marijuana will result in more dependence or more use/dependence of other drugs. That remains, to my mind an open question and one that I hope research shall answer. In particular I hope that judicious implementation of careful regulation of legal marijuana can mitigate these adverse consequences.