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Why a doctor turned to comics to educate his patients about asthma

By Emma Mizrahi-Powell

This is a summary of Episode 8 Interview with Dr Alex Thomas - using comics help educate patients about asthma.

Dr. Thomas is not an ordinary doctor. Nor is he an ordinary artist. Dr. Thomas is the talented mastermind behind "Iggy and the Inhalers," an educational asthma comic! He is also the co-creator of Booster Shot Media, a company that creates health educational materials for patients and healthcare providers. 

As a child, Dr. Thomas had asthma. Fittingly, his mom was an allergist! Even with a mom who was an expert in his condition, Dr. Thomas was perplexed about his asthma medications. He didn't know how they worked, or which ones to take and when. His creative mind took hold to help him learn. He would look at his inhalers, imagine that they were characters, and try to imagine what each inhaler would teach him if they could talk. 

When Dr. Thomas was eleven years old, his mom ran a support group for families of kids with asthma, for which she would send out a quarterly newspaper. Despite her extensive medical expertise, Dr. Thomas's mom was completely computer illiterate in the 1990s. She tasked the young Alex Thomas with typing up the quarterly newsletter for her. As a reward for doing this work, his mom let him draw a comic strip in each newsletter. Once Alex's pencil hit the paper, the talking inhalers that he had once imagined suddenly came to life, and Iggy (with a squad of other inhaler characters!) was born.  

Dr. Thomas recounts this initial endeavour into asthma comics as a way for him to try to understand the medications that he was using. Creating the comics helped him realize that all of the asthma medications did very different things. The comics helped him remember how to use them appropriately to control his asthma. He admits that his original comics were only somewhat accurate, and there were lots of things that he got wrong as a kid. 

Years later, Dr. Thomas followed in his mom's footsteps and went to medical school. When he finally had accurate, in-depth knowledge of how asthma and the medications worked, he wanted to revisit those characters that helped him as a child. He wanted to see if he could update them and make them more scientifically accurate so that they could help other kids. 

Asthma Education and its Gaps

Dr. Thomas first noticed that there was a significant deficit in asthma education when he was working as a medical intern in the Intensive Care Unit. He saw that kids were being admitted, readmitted, readmitted, and readmitted for asthma exacerbations. As he got to know the kids, he realized that they had severe misunderstandings and confusion about their asthma medications. 

The educational materials being used at the time were not doing well enough to prevent more hospitalizations. Additionally, the discharge process was often rushed, and high-quality one-on-one teaching usually wasn't available. 

These gaps in medical education inspired Dr. Thomas to try to make an educational program that could simultaneously be of higher quality and fit into the busy schedule of healthcare professionals. The tool must provide kids with a better understanding of which medications to take and how they work so that they would be less likely to get them confused. Its also needed to communicate this information to the parents.

Explaining Asthma Medication

Asthma medications pose a challenge because they all look very similar, but all do very different things. Because physicians might not know which brand a patient will receive from the pharmacy, using the inhaler's colour is not the way to explain which medication does what. Dr. Thomas aimed to create a deeper understanding of the mechanism behind the medications so that the learning would be long-lasting. 

When he first started, Dr. Thomas says that there was so much he didn't understand about health education. He didn't know what the right literacy level was for kids, or how kids would read the sequence of the comic. 

At a wedding, Dr. Thomas met an expert in health education (and soon-to-be co-founder of Booster Shot Media) named Gary, and he knew right away that Gary was the perfect partner to help him carry out his vision. Dr. Thomas describes their creative process as very collaborative. They periodically have the Iggy comics audited by asthma educators to look through it and ensure details such as updated terminology. For example, the name "rescue inhaler" was changed to "quick reliever" because the term "rescue" makes kids think that they should only use them when they are incredibly desperate. 

Whenever they work on a project that is outside of Dr. Thomas's specific expertise, they collaborate with other educators and receive feedback at every stage of the creative process, including the script, storyboards, rough draft, and final version. Because of this collaborative attention to accuracy, quality, and detail, each comic takes months of work to finish.  

Making Education Fun!

Dr. Thomas recounts how, when he worked in the ICU, the educational handouts printed off the hospital website and given to the patients would be thrown away before the patient even left the room. The great thing about Dr. Thomas's comics is that it's higher quality than a dull piece of paper! Because it's an exciting and enjoyable object, a child is less likely to want to toss it, and the parents and child will want to read and reread it. Sometimes the comics even serve as a bedtime story that parents will read to their kids.

A study was conducted in Wisconsin on the effectiveness of Iggy in the public school system. The research showed that after the intervention of reading comics and watching videos created by Booster Shot Media, the kids had a significant improvement in asthma knowledge after the program. What Dr. Thomas found the most exciting was that their asthma knowledge one month later was still as good as it was immediately after reading the comic. 

While Dr. Thomas and his team aren't exactly sure why this is, he thinks that the knowledge is retained so well because the kids kept the comics reread them. They also have asthma trading cards, which the kids are likely even playing with. This engagement with the material reinforces these lessons and allows the kids to have fun while learning.

Additional Fun Asthma Education Tools

The creative team used Pokemon as a model for Iggy. Pokemon fans have a comprehensive knowledge of super complicated information about the world of Pokemon. Kids know the strengths and weaknesses of hundreds of different characters, as well as all the cool things they do. Contrary to popular belief, kids take pride in knowing things and being an expert. So the Iggy team created trading cards (similar to Pokemon cards) where each medication has a strength and a weakness, and each allergic trigger villain has a hideout and a weakness. The team aimed to make it fun so that kids would play with the cards and in the process, also happen to understand complex asthma pathophysiology and the mechanisms of action for their medications.  

Dr. Thomas also shares how Iggy has been able to help reduce the stigma surrounding kids with asthma. Children sometimes feel a bit different because they have asthma, and kids with asthma are often portrayed as geeky in the media. Through learning about asthma in such a cool way, it teaches kids that asthma isn't geeky and that they shouldn't be ashamed of it. Dr. Thomas strived for kids to treat asthma as something that they can manage and be proud of managing. 

The Iggy comics and educational programs are used in asthma camps nationwide, and Dr. Thomas also has food allergy comics debuting soon! At camp, kids bond over Iggy and the trading cards, which also contributes to the destigmatization of asthma. 

Learn more about how Dr Thomas is spreading his creative passion to medical students to help make them better communicators in Episode 8!