Policy That Feels Right But Raises Our Risk

Do you use a cell phone when you drive? Not to text, or watch videos, which is just plain stupid. Just to talk, so at least you can keep both eyes on the road, if not both hands on the wheel.

Or maybe you use a hands-free device, one of those in-your-ear Star Trek looking things, or a voice-activated system built into your car. That would be better, right? Eyes on the road AND hands on the wheel. More Control = Safer, right? That’s what a lot of drivers say who use such devices. It’s also what the Massachusetts House thinks, having just passed a bill that would permit DWP, Driving While Phoning, but only using hands-free devices.

That may feel safer. But it’s not. Research by the Insurance Institute for Highway Safety found that when three states and the District of Columbia passed laws like the one proposed here, accidents rates did not go down, based on the number of insurance claims for crash damage. Laws like the one being considered in Massachusetts don’t work.

This should not be a surprise. It is well-established that using a cell phone while driving distracts your brain, whether the phone is in your hand or hanging on your ear. But that evidence has apparently been disregarded by legislators here and in 6 other states, and more than 40 countries, who passed similar “hands-free only” laws to reduce the risk of DWP. Why? The answer lies in a deeper understanding of the ways humans perceive risks in the first place, an understanding that might help us make future public health and safety choices more wisely.

Risk perception is a mix of fact and feeling, cognition and intuition, reason and emotion. In this case, the specific emotional factor is control. A sense of control makes any danger feel less dangerous. So the illusion of giving drivers more control is appealing to lawmakers. It just feels like it should make things safer.

But such laws could well make things worse. If you’re DWP using a hands-free device, and you think you’re safer because you’ve done something to increase your control, there is a good chance you’ll be less worried. You are likely to drive less cautiously (even though your brain is just as addled), and the risk to you, and everyone around you, is either the same, or possibly even greater. Laws making it official that hands-free DWP is safer, when it isn’t, contribute to the problem.

The affective nature of human risk perception, ingrained deep in ancient subconscious neural architecture and information processing systems, often leads to policies that feel good, but don’t maximize public health and safety. Risks that involve particularly painful outcomes evoke more fear, for example, which is one reason why America spends way more on cancer research than heart disease research, though both have deep unanswered questions that need such basic research, and though heart disease kills roughly 20% more people - more than 100,000 - every year. (The National Institutes of Health research spending in 2006 came to $9,958 per cancer death, $2,429 per heart disease death.) We’re afraid of risks we have trouble understanding, or that we can’t detect with our own senses, stigmatized by high-profile events. So after Three Mile Island (death toll - 0) and Chernobyl (estimated lifetime cancer death toll - 4,000, according to the World health Organization) we chased nuclear out of our energy mix and ended up with more fossil fuel, which kills thousands every year from particulate pollution, and fills the atmosphere with climate-changing CO2.

We look to government to protect us from many things. But that means more than just protecting us from too many parts per million or drivers using cell phones. We also need government risk managers to protect us from The Perception Gap, when our instinctive risk perceptions leave us more afraid of some things than we need to be, or not as afraid of some threats as we should be. Government decision making impaired by the instinctive way we perceive risk, as right as it might feel, can be a risk all by itself.

The Risk of Fear of Risk (Nuclear)

The last surviving double hibakusha has died. Tsutomu Yamaguchi, who had the incredible fortune of surviving both atomic bombings in Japan, has succumbed at age 93 to stomach cancer, after leading an otherwise healthy life since he was in Hiroshima on August 6, 1945, and Nagasaki three days later. His story, and those of all the survivors, known in Japan as hibakusha, teach us many things. One of them is that ionizing radiation from nuclear energy is indeed a carcinogen. But it’s not nearly as potent a threat as many people believe. Another lesson is that our fear of nuclear radiation may actually be making things more dangerous, not less.

The atomic bombings of Hiroshima and Nagasaki created a horrible human experiment from which we have learned just what this type of radiation can do to human health. Nearly 90,000 hibakusha have been followed by epidemiologists for nearly 65 years. Scientists compared them to a non-exposed Japanese population, to see what the radiation exposure did. The current estimate is that 572 hibakusha have died prematurely from radiation-induced cancer. To many, that is a surprisingly small number.

Research by the international Radiation Effects Research Foundation (RERF) http://www.rerf.or.jp/ also found that the developing children of pregnant hibakusha women suffered horrible birth defects. But, awful as those impacts are, that’s about it. Studies by RERF and many others have found little other long-term health damage, even among the 54,000 hibakusha who were close to the explosions and were exposed to extraordinarily high levels of all sorts of radiation. (Ionizing radiation comes in various sorts of radioactive bits and energy waves, each of which has a different penetrating power and thus, danger.) Not even genetic damage. “Thus far, no evidence of increased genetic effects has been found,” the RERF scientists say.

The World Health Organization estimates of the health effects from Chernobyl rest on what those atomic blasts in 1945 taught us. Based on a meta analysis of the epidemiological research done post-Chernobyl, the WHO says that of several hundred thousand people exposed to potentially dangerous levels of ionizing radiation, over the entire lifetime of that population, roughly 4,000 might die prematurely from cancer caused by the radiation. http://www.who.int/mediacentre/news/releases/2005/pr38/en/index.html

Again, tragic. But again, a smaller number than many people assume.

But there are other reasons why nuclear radiation is scary. It’s invisible, which makes us feel like we can’t protect ourselves, and a lack of control contributes to fear. It causes cancer, a particularly painful end result, and the more pain and suffering something causes the more afraid of it we are likely to be. It’s human-made, and that makes it scarier than natural radiation risks, like the sun (which kills an estimated 8,500 Americans per year from skin cancer. www.cancer.org/downloads/STT/500809web.pdf).

Atomic bombings, and events like Chernobyl, are large scale and sudden, and catastrophic events tend to freak us out more than chronic killers, like skin cancer, or the air pollution from burning fossil fuels, estimated to cause tens of thousands of deaths each year in the U.S., 3 million globally according to the WHO.) The huge amount of attention these catastrophic events receive - rightfully - tends to burn the fear deep into our memories, raising our sensitivity to any similar risks when they come along.

Risk is subjective, a matter of both the facts and our feelings. Despite the evidence from the hibakusha and Chernobyl, nuclear energy scares many people, who resist it as one of the solutions to climate change, or a low emission way to reduce local air pollution. Their questions - “What about another Chernobyl or Three Mile Island,” “What about terrorist attacks on nuclear plants near big cities,” “What about the waste?” are all fair concerns that must be addressed. But, as we have learned from the experience of Mr. Yamaguchi and his fellow hibakusha, we should also honestly look to what science can tell us about this risk, or any risk, and keep the actual level of danger in mind as we weigh what to be afraid of and just how afraid we need to be. Otherwise the choices we make, both as individuals and as a society, may feel good, but may actually make things worse, not better.

JOURNALISM, SCIENCE, AND CONFUSION ABOUT HOW TO PROTECT OURSELVES

What a tricky business it is trying to figure out how to stay safe these days. One scientific study says one thing, the next one says something else. And the scary parts are magnified by the 24/7 barrage of news reports screaming about the risk du jour. How are we supposed to make informed decisions about our health and safety?

A recent example illustrates the broader dilemma. The news media have reported at length that mercury can damage cognitive development in the fetus. The biggest source of exposure to mercury for pregnant women, we are warned, is consumption of seafood. The safe thing to do, then, is eat less fish, right?

But seafood is rich in all kinds of nutrients, particularly the fatty acids the fetal brain needs for healthy development. A study a few months back in the British medical journal The Lancet found that the less seafood pregnant women ate, the worse their kids did on a raft of developmental tests. Kids born to mothers who ate less than about three quarters of a pound of seafood per week were at risk of having lower verbal IQ scores, and “… increased risk of suboptimum outcomes for prosocial behaviour, fine motor, communication, and social development scores. For each outcome measure, the lower the intake of seafood during pregnancy, the higher the risk of suboptimum developmental outcome.”, the authors write.

So what’s a pregnant mom to do? Some science says that more fish = more mercury = possible brain damage to the unborn child. Other science says less fish = less nutrients = possible brain damage to the unborn child. Conflicting scientific evidence. How are we non-scientists supposed to decide?

The news media could help, but in several ways they make things worse. There is generally more emphasis on the threatening side of things, so a story about how “Fish Is Bad For Your Kids” will get more play than one that says “Fish is Good For Your Kids”. In the three days after the Lancet study was published, there was less reporting about it (fewer stories, smaller stories, buried-inside-the-newspaper stories) than there generally has been about the dangers of mercury in seafood. (The New York Times didn’t report on the Lancet study at all, based on a search for the words “Lancet” “seafood” and “mercury”.) That means some people won’t learn about these new findings. It’s hard to make an informed choice about conflicting scientific evidence if some of it, particularly the more reassuring information, is missing.

Sometimes the information is widely reported, but misleading. Many news reports about scientific findings suggest that the study being described offers THE definitive answer. Several stories about the Lancet study had headlines like this one from a Texas TV station’s website; “Study: Eating fish while pregnant leads to smarter children.” Case closed. Scientists know it takes a lot of evidence from a lot of studies to develop a clear answer. It shouldn’t be hard for journalists to acknowledge this. In fact, for the sake of accuracy, it is their obligation.

News reports about risks also usually fail to give both sides of the risk-benefit tradeoffs involved. Mercury and seafood is a classic example. There were lots of scary stories about the dangers of mercury in fish, but only some of them, usually late in the story, mentioned the benefits of seafood. The mercury story isn’t the only example. Stories about estrogen replacement therapy cite the cancer risks, but rarely mention the potential heart and bone protective benefits. Stories about the risks of nuclear power almost never mention the tens of thousands of people who get sick or die each year due to air pollution from burning coal and oil. There is no general right or wrong to any of these risk-benefit choices. It’s up to each individual to decide. But in order to make informed choices we need to know what the tradeoffs are.

Journalists are only part of the problem. Too many scientists trumpet their findings as THE answer. Some do it out of intellectual arrogance, some out of honest passion on their issue, many out of a desire for career advancement and more research money. And many scientists need to win the war of ideas. It matters to them personally, intellectually, that they’re right, that their view prevails. Conflicting studies breed disagreement between scientists with differing views that can be really personal and nasty. The public and policy makers get caught in the confusion of this intellectual combat.

We deserve some of the blame too. In our rushed, short attention span world, we want things black and white. What’s safe and what’s not. Spare me the details, my cell phone is ringing. Even if the news story has all the relevant facts, if we don’t read more than the headline and the first few paragraphs, shame on us for not knowing what we need to know.

Many of the hazards of our modern world are complex, and our scientific understanding of them can only develop one piece at a time, each new study adding another piece to a giant jigsaw puzzle. Sometimes the new piece doesn’t seem to fit with the ones already laid down. But there are solutions to the confusion from conflicting scientific evidence. Scientists have to be honest about how they develop, interpret, and report their results. They have to be careful about claiming that their findings are THE answer. And we have to be smarter news consumers and collect more information before we make up our minds.

But in the end, a great deal of responsibility falls on the news media. Beyond our own personal daily experience, what we know of what’s going in the larger world is determined by what the news media tell us and how they tell it. What stories get covered, how the reporter gets his or her information, how the story is written…they all involve decisions. There is a huge public trust involved in how journalists make those choices.

We can’t expect journalism to be some high-minded calling that serves only the public interest. Journalism is largely a for-profit affair and journalists are driven by self-interest. The bosses want news that will grab our attention. Reporters want news that will make the front page. Both motivations are inescapable realities, and both encourage coverage about threats and danger that is more alarming, not less.

But we are their customers. We can and should demand better. We should reward with our readership and viewership and listenership those news organizations that report risk well, with accuracy, balance, a bit of caution, and an occasional touch of context, so we can make sense of conflicting and incomplete scientific evidence about the risk-filled complexities of our modern world.