February 14, 2007

Book of the week

Filed under: fear, politics — ubikcan @ 10:43 am

(Updated below)

New feature.

This week’s book: Marc Siegel False Alarm. The Truth about the Epidemic of Fear.

Siegel is an MD who has appeared a lot on TV and in the LA Times, and he carries a timely and articulate message to counter the rampant paranoia and fear that is being bred into America today. Siegel examines a lot of fears that we have today and finds that many of them are either groundless or promoted for political gain:

Bugs de jour–think SARS, Lyme disease, avian flu, and mad cow disease
Terror alerts
Lethal gas attacks

One the one hand, research has shown for some time now that we are very bad at assessing risk probabilities (we get scared of avian flu when zero Americans have died from it, but ignore regular flu, which kills 36,000 Americans every year). On the other hand are people all too willing to exploit this misinformation for profit and political gain.

Test yourself. How many Americans die annually from the following causes. If you’re not sure, just try to rank order them from most deadly to least deadly.

Falling out of bed in the morning
Heart disease
Vehicular accidents

Okay, here’s the answers!

Get them right? Many people don’t. We over-fear some risks compared to their severity (driving is far more dangerous than flying–it’s been said that if you drive 12 miles to the airport for a 4 hour flight, the most dangerous part of your journey is already over).

Here’s an example and it unfortunately comes from a famous liberal blog, Daily Kos, and shows how the best intentions can lead to unnecessary fear and misapprehension of risk. This involves avian flu. (The writer is a front page Kos blogger known as DemFromCT.)

DemFromCT wrote approvingly about a new color-coded warning from the CDC, which comes with a nice graphic:

This all follows the release of the CDC’s Community Mitigation Strategy on Thursday, which is a remarkable document that lays out a variable approach to pandemics based on severity. It treats pandemics like hurricanes, assigning a category score from 1-5. A cat 4/5 pandemic would require severe measures such as closing the schools for up to 3 months (the social disruption would be justified by the desire to save lives) whereas milder cat 1 or cat 2 pandemics would require simpler measures.

There’s more in this vein. Yet how at risk are we? DemFromCT pointedly notes that avian bird flu has this year a mortality rate of 88%! Sounds nasty. But the problem is that that is only using an extremely small number of people–most of whom were elderly, and none of whom are in the USA. Yeah, 8 out of 9 is an 88% mortality rate. 8 deaths, worldwide, 2007. I’ll take those odds.

[I won’t even comment on how misleading this map is! Can you say Mercator projection? Ecological fallacy?]

Read the comments to the article to see more discussion and information that we provided about this, a discussion DemFromCT seemed unable to assimilate.

Siegel’s book is a good counter-weight to all this:

[Speaking of news reports on avian flu] The problem with this sort of rhetoric was that while professing calm, it simultaneously spread fear. People could wrongly conclude from this that something terrible might be in the offing. Hype breeds fear, unless a person is trained to assess risk independently.

He goes on to distinguish between potential and actual risk (we made this point to DemFromCT but it was not taken up). A lot of things might happen, but considerably fewer have a real potential to happen.

Siegel notes that the extreme over-reactions, such as killings hundreds of thousands of poultry is “public health posturing” (p. 170). He also notes that the Spanish flu of 1918, which infected close to a billion people and killed 50 million, had a different molecular structure than the 2004 bug, and there is no direct evidence that the present bug will mutate so it can pass from human to human. Yet this is the comparison fear-mongers make (DemFromCT included).

This kind of thinking is what gives us the “one percent doctrine,” the idea that if there’s even a 1% chance of something bad happening (a terrorist strike) we should act as if it is going to happen. This leads to panic and a public willingness to permit intrusive counter-terrorist measures such as surveillance and warrantless wiretaps. The trouble with this doctrine is that there’s still a 99% chance that it won’t happen. Yet we’ve surrendered our liberties on the off-chance.

After reading the DailyKos story, one commenter had this to say:

So far nothing has dissuaded me that a full blown Avian Flu pandemic would kill off about 1/5th of the human race.

The response? “Kudos for that kind of thinking.” No denial, no setting things in a more realistic context. No observation that we’re dealing with dozens of human deaths, none of them in the USA.

I don’t mean to criticize DemFromCT specifically, but he/she has fallen into the fear gap and is unable to distinguish potential from actual risk. Public health agencies don’t help when they ask the public “should a pandemic arise, we won’t have enough vaccines. Help us decide how to distribute them.” How can the public respond to that? Surely part of the answer is knowing how likely it is that a human-to-human avian flu pandemic will arise? (Experts say there’s a 90% probability it won’t, and even if it does that doesn’t mean a pandemic will occur.)

Siegel’s book is a refreshing change from the fear-laden mystifications usually on offer.

Update: DemFromCT does it again, this time linking approvingly to a scary media story that gives a mortality rate of 61%. Just for good measure, DemFomCT is now predicting that the internet will be brought to its knees during a pandemic. When a commentator repeatedly tries to point out the uncertainties of this prediction, an appeal to “the experts” is proferred. I tell you, it’s a scenario described repeatedly in the Siegel book.


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