Risk
The science and politics of fear
By Dan Gardner
Virgin Books, 2009 (paperback); ISBN 9780753515532
This is one of those great, elegant, clear books about complex subjects which are a joy to read.
Its scope is an understanding of the psychology, sociology and politics of risk and risk perception in almost all aspects of our lives, from familiar, everyday risks like car-travel, to the big perplexing issues of environmental toxicology and terrorism. There are some specific examples from medicine and pharmaceuticals (the US silicone breast implant crisis, and lots about cancer and cancer risks statistics among others), but the book deals with much broader issues which shine a bright light on all aspects of risk in healthcare.
In my book, we discuss how illogical our perception of risk often is. Gardner takes as one of his central theses the conflict between ‘Gut’ (our unconscious, hard-wired, survival responses) and ‘Head’ – the rational, analytical, considered response which has such trouble moderating the instincts through skeptical questioning and the examination of probability. Dreadful things, he points out, are, for reasons he examines, instinctively felt to be more likely even when there is little or no evidence or plausible likelihood.
A recurrent theme is the use of fear to intensify perception of risk, which serves the interests of those who have products to sell (drugs, health supplements, media outlets, security devices, military equipment, and so on); those who need to raise funds or attract public support (environmental groups, NGOs, police, parent pressure-groups); or have political agendas (‘Vote for us and we’ll protect you!’). He recounts, with extensive, convincing evidence, how far all these constituencies camouflage, distort or ignore facts and probabilities in the pursuit of increasing fear, making people believe they are at imminent risk of harm, and so manipulating them into buying products, taking action or supporting causes the needs for which simply cannot be justified by the neglected facts.
The book is full of stunning examples of human irrationality. Gardner points out that, after 9/11, Americans abandoned flying in huge numbers and took to the roads. He calculates that about 1,500 lives were lost in road accidents which would not have happened if people had continued flying, because the probability of dying in a road accident was vastly greater than the risk of boarding a plane that would be hi-jacked (in the aftermath of 9/11, a risk that was virtually zero). Fear ruled the decisions.
Another example, this time illustrating the impact of immediacy: after an earthquake, people are conscientious about insuring their property and possessions (at a time when the risk is probably at its lowest), but, as time passes, and as the risk actually increases, they become careless and neglect to renew their premiums.
In vivid detail, with extensive evidence, the book blows apart the basis for many common misconceptions and fears, particularly with regard to the probability of dreaded events happening (abduction of a child by a stranger; age of onset of breast cancer, for example). It also highlights how we seem to ignore the highest and commonest risks – smoking and obesity, for example, road deaths, accidents in the home – which are the causes of more deaths than all the fantasy risks put together (including terrorism, of course).
Gardner’s conclusion is that, in the developed world certainly, we are healthier, wealthier and safer than at any time in human history, yet we are consumed with fear about the future and about many risks which are almost invisible.
As background to the whole discussion of risk and risk communication in healthcare, this is an invaluable and wonderfully readable book.
Tags: fear and risk, irrationality, medical crisis, Risk, risk perception