Thursday, March 18, 2010

Nuclear Power. It's not about the facts. It's how those facts FEEL

The Vermont Yankee nuclear power issue teaches clear and valuable lessons about the powerful influence of affective risk perception on public policy issues. A survey of Vermont citizens by the Civil Society Institute found two thirds opposed to re-licensing the plant in 2012. But what do the people who live near Vermont Yankee think? The people who look out of their kitchen windows and see the steam from the cooling towers, who drink water from local sources that would potentially be threatened by underground leaks from the plant, who see those emergency sirens on the local power poles that would sound the alarm if some sort of accident caused radiation was to be released?

Interestingly, the people who live in the immediate shadow of the threat are not nearly as worried as those who live further away. Though their actual risk is much higher should anything go wrong at the plant, the local residents reap great benefits from Vermont Yankee; high paying jobs (that average $100,000/yr. including benefits), revenues to the town that have allowed Vernon, population 2,100, to have a wonderful new library and expanded elementary school, and low taxes and high property values.

So to the plant’s neighbors the benefits outweigh the risks. The risks also seem less worrisome because residents are familiar with it, they’ve lived with for 38 years, and familiarity generally makes any risk less worrisome. There’s another reason, too. The local residents trust the people who operate the plant, because the operators are neighbors. The owners may be from out of state, but the people with control over the actual operation live down the road. When those local plant operators make promises of safety, and share concern about leaks, they make those promises on a first name basis to people they know, to people whose families they know.

Trust. Risk vs. Benefit. Familiarity. These are intrinsic factors that subconsciously play a huge role in how people see risks. Consider how these same factors color the views of opponents. Many, including anti-nuclear activists from out of state who have campaigned against nuclear power for decades all over the country, point out that the corporate owner, Entergy, wants to spin Vermont Yankee and several other nukes into a subsidiary company, and say this is a reason not to trust the company’s promises to Vermont. They cite the company’s misleading statements regarding the presence of underground pipes as further reason to doubt Entergy’s trustworthiness. They say that collapsing cooling towers and leaking pipes (of less concern to Vermont Yankee’s neighbors) should not happen at a nuclear power plant, and are evidence of how the public is at risk. And they say that despite benefits to the local population, or helping combat climate change by reducing CO2 emissions, the risk to the public from nuclear power is too high. In short, factors like Trust and Risk v. Benefit are important to the opponents too. But to them these affective perspectives argue against Vermont Yankee, not for.

Both sides are right. From their point of view. The point here is that it’s these points of view, not the facts about Vermont Yankee, that are being debated. It’s the feelings about the facts, not the facts themselves, that are driving Vermont’s decision making about how to supply itself with electricity (the plant provides one third of the current supply). That’s appropriate in a democracy. Values and facts must both play a role in any final decision. But the facts can be more clearly analyzed if the distorting lenses of risk perception are removed as that analysis is done. As Vermont’s policy makers move forward, as part of their process they would do well to separate out these affective perspectives, at least while a fact-based analysis can be done to help inform the final decision, if they want to honestly figure out what’s best for the people they serve.

Sunday, March 14, 2010

The Risk of Fear of Vaccines

I posted something on Facebook about the U.S. Vaccine Court denying claims of parents who said their kids’ autism was caused by vaccination. I suggested that the arguments over this supposed link are no longer really about the science of vaccines, which is far more settled than the science on, say, climate change.(The U.S. National Academies of Science meta analysis of dozens of studies is summarized at I suggested that the fears of those who still argue for the link are better understood by the science of risk perception, which helps us see that the fears are real, and must be respected, but they're not really about the facts regarding vaccines.

Several risk perception factors are at work here. Those who refuse to acknowledge the overwhelming evidence that there is no link between autism and vaccines don’t trust the government and pharmaceutical industry, and mistrust fuels fear. Parents with autistic kids have so little control over their children’s fate, and lack of control fuels fears. And any risk to kids evokes more fear than the same risk to adults. These risk perception factors are real, as real as the evidence disproving the autism-vaccines link. So despite a mountain of such evidence, the fears persist, and fuel a rising doubt about vaccines in general. I observed that this Perception Gap between the fear and the facts is dangerous, not only for parents who choose not to vaccinate their kids, but for everyone else, since herd immunity is important to keep largely defunct diseases like measles from spreading again.

I got two replies. One suggested that sometimes the cure – vaccination - is worse than the disease. Maybe in some rare cases, but not with measles, and other common diseases against which fewer people are being vaccinated. The danger of those illnesses is greater than the risks of the vaccines, which in rare instances cause allergic reactions, but according to worldwide scientific consensus do not cause the things the fearful parents claim. The body of evidence disproving the connection between autism and vaccines is as clear as one can possibly hope for in science, passionate doubters notwithstanding. One persuasive piece of evidence is the fact that thimerosal, the supposedly dangerous preservative in the MMR vaccines, was removed years ago under pressure from worried parents (despite no medical evidence that it posed a risk), yet the number of cases of childhood autism continues to rise.

Yet a few concerned people continue to doubt the safety of the Measles/Mumps/Rubella (MMR) vaccine, and their passion has spread to a rising fear of all vaccines. 54% of American parents worry about vaccines having serious side effects on their kids, and one parent in eight has refused at least one vaccine their pediatrician has suggested. (The University of Michigan study is summarized at Herd immunity to measles has dropped so low in some places that measles cases are rising dramatically, and in a few tragic instances it's killing children again. In 2008 the U.S. had more measles cases than any year since 1996. (It’s even worse in the U.K., Germany, Switzerland and Israel, among other countries.)

There is another risk perception factor at work here too. Risk v. Benefit. Not long ago when measles and other childhood diseases were widespread, and lethal in hundreds of cases, the benefit of the vaccines outweighed their risk. Now the risk of the diseases has become so low that we only worry about the drugs. Curious. Because they’ve succeeded, we worry more about the vaccines than the diseases from which they are protecting our children.

The other note I got, from a thoughtful friend and father of an autistic child, was rife with mistrust of scientific findings that disagree with his beliefs. He focuses his mistrust on only one or two studies denying the vaccines-autism link, about which conflict of interest questions have been raised, but ignores hundreds more that find the same thing. He mistrusts government and pharmaceutical companies. As we all should, to a reasonable degree. This thoughtful friend says that if the science is that strong, it will stand up to scrutiny. It has, many times over, at least to those not seeing the issue through the perspectives of their fears. When is there enough evidence? Only when it agrees with what we want it to say? When is there enough evidence so that we don't automatically dismiss as untrustworthy anyone who provides an answer which conflicts with our fears?

This isn't about denigrating the real and passionate concerns of those whose fears don't match the mountain of evidence that says they're wrong. Trust matters. Control matters. Risks to kids will always evoke deep concerns. It makes sense that we're less worried about diseases that are mostly forgotten so the benefit side of vaccines is less obvious than the risk side of the tradeoff. In the context of risk perception psychology, these fears make sense.

Rather, this is about making healthy choices. Not just for our own children, but for our friends and neighbors and society at large as well. Decision making from the heart, no matter how right those passions feel, may lead us into greater danger. We need to find out what is causing the rise in autism. Focusing on the disproved link with vaccines diverts time and attention from potentially more telling lines of investigation. It fuels a growing public mistrust in science and government. Sometimes our worries, as valid as they are, can get so unreasonable that the Perception Gap becomes the greatest risk of all.