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 http://www.civilsocietyinstitute.org/media/030110release.cfm 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.

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 http://tiny.cc/o5X9X) 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 http://www.businessweek.com/lifestyle/content/healthday/636473.html) 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.

Antibiotic Resistance, A Risk We Don't Worry About Enough

We fret a lot about all sorts of things, but sometimes the real threats are the ones we don’t fret about enough. A HUGE risk that most people know nothing of is antibiotic resistance, the ability of bacteria to mutate and develop traits that resist our drugs, faster than we are coming up with new and better drugs.

A current story on this is at http://tiny.cc/kYSxv, about a whole new class of germs call gram negative bacteria that are developing the ability to fight the arsenal of drugs we rely on to control them. But this is just one small additional chapter in a truly frightening story that’s really about two things. First, it speaks to the arrogance of the human belief that we are smart enough to control nature, since nature in this case definitely has the upper hand. Second, this issue is a clarion example of the peril of The Perception Gap, the gap between our fears and the facts. Sometimes when we worry too much we make decisions that are dangerous. But in this case, the problem is not worrying enough.

So it’s important to understand why the huge threat of antibiotic resistance does not evoke more concern. First, as catastrophic as the numbers already are (tens of thousands of deaths per year in the U.S., 19,000 just from methicillin-resistant Staphylococcus aureus or MRSA, the one antibiotic resistant germ getting a bunch of media attention), the risk of antibiotic resistance doesn’t feel like a catastrophe, a large a single high profile event. Catastrophic risks scare us more. Chronic risks scare us less. This helps explain why many of the major killers, like heart disease, stroke, diabetes, even accidents, don’t raise as much concern or get as much attention as risks that kill far fewer people but do so in catastrophic ways, like plane crashes or mass murders.

Second, when we get sick we think we can just go to the doctor and get a pill. We have some control. That is DANGEROUSLY naively wrong. Many of the germs our pills used to kill can now resist them. We are losing our ability to control bacterial infections like pneumonia and staph. But we still think we have that control, and that feeling of control makes us less afraid. Actually, this feeling of control over illness is making the problem worse. Patients often demand a pill from the doctor for a viral infection that antibiotics can’t fight (they only fight bacterial infections). This kills off the weak bacteria in our system, but the ones that can resist that drug thrive and proliferate and spread, and gradually the drug works less and less.

Finally, there is a general lack of awareness. This matters more than just that we don’t know about the problem. The brain uses a set of subconscious cues to judge how dangerous something is, and the more readily it can summon up information on a risk, the more emphasis that risk gets. A risk that doesn’t immediately ring alarm bells, won’t ring those bells as loudly, even when they do finally go off.

We can fight back against that last component of the Perception Gap. We can learn more about this immense problem. There are few risks out there where learning more can help as much. Here are some links that tell you a lot of what you need to know to keep yourself safer. (The first is another post on this blog, but it’s actually Chapter 38 of my book, RISK! A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You.)

http://onrisk.blogspot.com/2010/02/risk-of-antibiotic-resistance-explained.html

http://www.cdc.gov/getsmart/antibiotic-use/anitbiotic-resistance-faqs.html

http://en.wikipedia.org/wiki/Antibiotic_resistance

http://www.acponline.org/patients_families/diseases_conditions/antibiotic_resistance/

The Risk of Antibiotic Resistance Explained

Antibiotic Resistance
from "RISK! A Practical Guide for Deciding What's Really Safe and What's Really Dangerous in the World Around You"

In 1941, when penicillin first became widely available, it was hailed as a wonder drug that could control several serious bacterial infections like staph and strep. Medical experts quickly predicted that infectious diseases would become a thing of the past. But within two years, doctors began reporting cases of a common bacterium, Staphylococcus aureus, which somehow could resist the effects of penicillin. Almost as soon as antibiotics became available, bacteria began developing ways to resist them. Ever since, we’ve been in a race between the development of new and more powerful antibiotics, and the ability of bacteria to adapt in ways that defeat those drugs. Many experts say the race is a dead heat. Some say the bacteria are winning.


The Hazard

All microscopic organisms – microbes – secrete a variety of chemicals. Some of these secretions kill or impair competitors. Antibiotics are based on these natural microbial secretions. Penicillin, for example, is based on a secretion from the mold Pencillium notatum which kills bacteria by destroying their ability to build a cell wall.
Antibiotics, also known as antimicrobials, bond to specific parts of specific bacteria, and either kill or impair them. Killing the bacteria outright, of course, eliminates the infection. But sometimes just impairing them can be enough, because that gives our natural immune system a chance to gain the upper hand in the battle against the bacteria and finish the fight. Most antibiotics bond with molecules that only occur on the surface of bacteria, which is why they don’t harm human cells and why they don’t kill viruses. And individual antibiotics only work on specific bacteria because their “attack” molecules only bond with specific molecules on those target bacteria. Think of the bonding as a kind of lock-and-key system. It takes a specific key (the right antibiotic molecule) to fit in a specific lock (the receptor molecule on the target bacterium).
But the bacterium that are under attack don’t just take this lying down. In the evolutionary competition between these attacking microbial secretions and the bacteria, the bacteria evolve ways of fighting back. They respond via the natural process of occasional changes to their DNA. These changes lead to the development of new traits, some of which allow the individual bacterium to counteract the effects of the antibiotic substance. A single bacterium that evolves a way of fighting off antibiotics has a survival advantage compared with it’s neighbors of the same species. It survives, and passes that resistance trait on to its offspring and they become the variation of the species that survives over time.
Bacteria are really good at this, for two reasons. First, they can undergo changes to their DNA in several different ways. They even have the ability to share sections of their DNA between species. So a resistance trait that arises in one bacterium can be passed to other types. Second, bacteria evolve quickly because they reproduce prolifically, as frequently as once every 20 minutes. If you put a single bacterium cell in an optimal growing environment, within twelve hours you can have as many as 68,719,476,736 copies of that original cell. That creates the likelihood of tens of thousands of mutations, each of which might produce a resistance trait that helps it fight off an antibiotic.
Over time, the resistant strains proliferate while the ones that can’t fight the drugs die off. And as they do they may spread their new, successful resistance trait to other strains within the same species, or even to other species of bacteria entirely.
The widespread use of antibiotics speeds up this process. When a microbial population of various organisms is exposed to an antibiotic, the bacteria susceptible to the antibiotic will be killed. Organisms that have some resistance survive. Without the other species around to compete for food and resources, the resistant strains find it easier to proliferate. Those strains then pass their resistance traits to their own offspring, or share their resistance genes with other bacteria. The result is that as antibiotics kill off the bacteria they work on, they increase the prevalence of strains that can resist them.
The most significant human contribution to this accelerated antibiotic resistance is the indiscriminate and often unnecessary use of antibiotic drugs. In the United States, between 160 and 260 million courses of antibiotics are prescribed each year. An estimated 75 percent of these are for respiratory infections, but between one third and one half are unnecessary, prescribed to people who have viral infections that aren’t treatable with antibacterial medication. Most doctors acknowledge they prescribe antibiotics to patients simply because the patients demand them. Since every application of antibiotics encourages the growth of resistant strains, mis-prescribed use of antibiotics accelerates the problem.
In addition, in hospitals, broad-spectrum antibiotics are often used when a more targeted drug that only kills the specific bacterium causing an infection would be enough. The advantage for the patient is that broad-spectrum antibiotics wipe out a wider range of susceptible species. But the downside is dthat this goes even further in clearing the playing field for the toughest, most resistant strains that are left behind.
Bacteria also get human help in developing antibiotic resistance when we fail to take the full course of a prescription of antibiotic medication. The weakest germs are killed within the first few days. Often, this eliminates the symptoms of the infection, so we stop taking the drugs. But the stronger bacteria that can resist the first few days of medication, survive. The full course of the medicine might have killed them off. Instead, these slightly more resistant bacteria survive and proliferate and spread the trait that helped them fight off the first few days of the drug.
Another way that humans are accelerating antimicrobial resistance is the use antibiotics in farm animals. As much as half of all the antibiotics produced for use in the United States are used on farm animals, mostly at low doses over a long period to encourage growth. But the low doses allow the more resistant strains of bacteria in animals to out-survive the weaker ones. Some of these resistant bacteria, like strains of salmonella, shigella, and E. Coli, can be transferred to people in improperly prepared foods. Then, when people develop bacterial illness, the strains of these bacteria are resistant to the drugs that used to control them.
Antibiotic resistance is also amplified in certain settings, like schools, hospitals, and chronic care facilities, environments where there are a lot of people with less effective immune systems carrying a lot of bacteria, so the chances of individual strains swapping their resistance genes is higher. And finally, bacterial resistance accelerates because of the global transportation system. People and goods spread microbes around the world. In many parts of the world, antibiotic drugs can be purchased without a prescription, and are often taken improperly. This can lead to resistant strains that then spread worldwide.



The Range of Consequences

In general, antibiotic resistance raises the likelihood that infections will have a more serious effect on a person’s health. It raises the likelihood that an otherwise treatable infection might turn lethal. In developed countries like the United States, with greater access to advanced medical care and pharmaceuticals, a frequent consequence of antibiotic resistance is that a second, third, or fourth type of drug has to be used when the principal agent against a particular bacterium no longer works. These backup drugs sometimes have more side effects. They are usually in shorter supply. And they are almost always much more expensive.
It is difficult to quantify the consequences of antibiotic resistance. Sometimes the drugs fail outright. Sometimes they merely don’t work quite as well as they used to, and a patient gets sicker and stays sick longer but then recovers. Often these effects occur outside a hospital, nursing home, or other facility where accurate surveillance records can be kept. But a pattern of chilling statistics comes from a number of sources.

* Staphylococcus aureus is a common bacterium. Most of us carry it in our noses or on our skin. It can cause minor infections, or life-threatening diseases like pneumonia. Penicillin used to kill it. But in the 1950’s, less than 10 years after penicillin hit the market, Staph aureus had become so resistant to penicillin that healthy people going to hospitals got sick and died. Many hospital maternity wards had to close. So drug companies developed methicillin in the 1960’s. By the 80’s, Staph aureus was resistant to methicillin. The CDC estimates that as many as 80,000 people a year get a methicillin-resistant Staph aureus infection after they enter the hospital. So doctors switched to the antibiotic vancomycin, a broad-spectrum drug widely thought of as the antibiotic of last resort. In 1997, the first cases of vancomycin-resistant Staph aureus showed up in three geographically separate locations. Many more have since been reported. In 2000, the first revolutionary new type of antibiotic to come out in 30 years, linezolid, was approved, offering promise in the fight against Staph aureus and other multi-drug resistant bacteria. It took less than a year for the first cases of linezolid-resistant Staph aureus to show up.
* According to the Centers for Disease Control, each year the bacteria Streptococcus pnuemoniae causes 100,000-135,000 hospitalizations for pneumonia, 6 million ear infections, and more than 60,00 cases of other invasive diseases, including 3,300 cases of meningitis. Of these, they estimate that at least 40 percent are caused by drug resistant strains of S. pneumoniae. Between 1993 and 1998, 45 states and the District of Columbia reported at least one case of tuberculosis that was multi-drug resistant. Health officials once thought tuberculosis had been all but wiped out in the U.S. Resistant strains threaten a comeback.
* The CDC estimates that 2 million people a year get infections after they enter the hospital, so-called nosocomial infections. Approximately 90,000 of these people will die because of these infections. It is not known how many of these fatal nosocomial infections are drug resistant, but it is believed that a significant number probably are. Between 1979 and 1987, only .02 percent of the pneumococcus strains infecting patients in 13 hospitals in 12 states sampled by the CDC were penicillin-resistant. By 1994, that number had risen to 6.6 percent.
* In a 1999 nationwide sampling of food borne bacteria by the National Antimicrobial Resistance Monitoring system (NARMS);
• 26 percent of the non-Typhimurium Salmonella samples were resistant to one or more antibiotics
• 49 percent of the Salmonella Typhimurium samples resisted one or more drugs
• 91 percent of the Shigella samples resisted one or more drugs.
• 10 percent of the E.coli samples resisted one or more antibiotic.
• 53 percent of the Campylobacter samples were resistant to one or more antibiotic.
* Food borne disease outbreaks are often caused by drug-resistant strains of bacteria. In 1998, 5,000 people in America fell ill from Campylobacter caused by contaminated chicken. The strains of bacteria found in the victims were multidrug-resistant. In 1968, 12,500 people in Guatemala died in an epidemic of Shigella-caused diarrhea, from a strain of the bacterium that was resistant to four antibiotics. A deadly drug resistant strain of Salmonella called DT104, more virulent than other strains, appeared in the late 90’s. It has killed people in Great Britain. 28 percent of the Salmonella Typhimurium samples tested by NARMS in 1999 had traits similar to DT104. (The Food and Drug Administration has approved a test kit for rapid detection of DT104.)
* Overseas, nearly every case of gonorrhea in Southeast Asia are multi-drug resistant. In 1990, cholera bacteria in India were susceptible to common antibiotics. Just ten years later, none of those drugs worked on cholera anymore. And our global world spreads some of these strains far and wide. Between 30,000 and 80,000 U.S. travelers returning from overseas suffer from a bacterial-caused diarrhea that is drug resistant. 2,500 travelers a year return with malaria that could not be prevented by prophylactic antibiotics that used to work. Investigators have documented the migration of one strain of multidrug-resistant Strep. Pneumoniae from Spain to the U.K., the U.S., South Africa, and elsewhere. Two cases of multidrug-resistant Staph. aureus were traced to Northern India. Most of the multidrug-resistant strains of typhoid found all over the world have been traced to six developing nations.
* Vancomycin-resistant enterococci, a normally harmless bacterium that lives in the human gut, were first detected in France and England in 1987. One appeared in New York in 1989. By 1993, 14 percent of patients in intensive care units in the U.S. had vancomycin-resistant enterococcus, a 20-fold increase in 6 years. Given the ready swapping of genes between different species of bacteria, the ability to resist vancomycin, currently the antibiotic given when others fail, could easily spread from enterococcus to other more harmful species.
One top U.S. health official said the ultimate consequence from the growing problem of antibiotic resistance “…could be a return to the days before antibiotics, when common diseases were often lethal.” “ We are skating on the edge of the ice,” he said.

The Range of Exposures

We are exposed to bacteria constantly. There is literally no setting in which potential exposure to drug resistant bacteria is not a concern. As mentioned above, people most at risk are those who have weakened immune systems. These include people already ill from something else, infants with still-developing immune systems, people taking steroidal medication, and the elderly, whose immune systems are no longer as effective as they used to be.
However, health officials are particularly worried about drug resistant bacteria in hospitals and nursing homes, places where a combination of factors raise the risk. A significant number of people who are hospitalized come in with weakened immune systems or undergo treatments such as chemotherapy that impair their immune response. These people are at risk of more serious illness, or death, from infections that neither they nor drugs can fight. In addition, a significant percentage of people who are hospitalized are elderly, with immune systems compromised simply by age. (This is one reason why exposure to drug resistant bacteria is also a concern in nursing homes and assisted-living facilities.) In addition surgical patients are more susceptible to any kind of bacterial infection simply because their skin has been opened. Open wounds, or healing wounds, are another potential route of nosocomial infection. Also, hospitals are, by definition, locations where a lot of people are carrying infections. They bring various strains of bacteria in with them. There are simply more infectious bacteria around in hospitals. Inadequate hygiene by people who work in hospitals, particularly something as simple as thorough and regular hand washing, allows drug resistant strains of bacteria to spread.
Another setting where exposure to drug resistant bacteria is a concern is day care centers, especially for infants. Here, a combination of children with still-developing immune systems, lots of direct contact between children and their care givers, and an environment where one or two people are frequently sick at any given time, increases the chances of spread of bacteria, accelerating the spread of resistance traits.


Reducing the Risk

There are several steps you can take to help slow the proliferation of antibiotic resistant bacteria.
* Don’t demand antibiotics any time you get sick. Remember, between one third and one half of antibiotics are mis-prescribed to patients that don’t really need them. Don’t automatically demand antibiotics for your children if they have what appears to be an ear infection. Medical authorities now think that mild cases may go away by themselves. And they say that not all ear infections are bacterial.
* Pay attention to simple hygiene. Cover your nose and mouth when you sneeze, to avoid spreading germs. Wash your hands frequently. Wash fruit and vegetables thoroughly. Cook meat, chicken pork, and fish well enough to kill any germs they may contain. And don’t forget that a piece of meat that you prepared on your kitchen counter might have contained a few germs. While you may kill those germs when you cook the meat, the germs are still there on the counter that you then use to prepare your salad. So wash your food preparation areas each time you finish working on one part of a meal.Sponges are a problem – throw them out or put them in the dishwasher.
* Diapers can be a source of bacteria. People handling diapers should be extra careful about washing their hands thoroughly.
* Finally, maintaining a good diet, getting half an hour of mildly aerobic exercise a few times a week, and other simple steps for staying healthy are good ways to avoid bacterial infection of any kind.
* FOLLOW THE INSTRUCTIONS FOR TAKING ANTIBIOTICS. DON’T STOP TAKING THEM AFTER YOU FEEL BETTER. SOME OF THE TARGETED BACTERIA MAY HAVE JUST ENOUGH RESISTANCE TO FIGHT OFF THE FIRST FEW DOSES. THEY MAY STILL BE LURKING, READY TO PASS ON THEIR RESISTANCE TRAITS. FINISHING THE FULL COURSE OF THE MEDICATION WILL HELP FINISH OFF THESE SLIGHTLY STRONGER GERMS.

For More Information

The Centers for Disease Control has a good website with basic information on this issue, and links to other sources.
http://www.cdc.gov/drugresistance/
You can call the CDC AT 1-800-311-3435

The Alliance for the Prudent Use of Antibiotics is a nonprofit organization working on this issue. Their website is
http://www.healthsci.tufts.edu/apua/apua.html
APUA
75 Kneeland Street
Boston, MA 02111-1901
617-636-0966

This chapter was reviewed by:
Marc Lipsitch, Assistant Professor of Epidemiology at the Harvard School of Public Health, who has done research on antibiotic resistance,
and by Dr. Don Goldman, Epidemiologist at The Children’s Hospital, Boston.

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.

Autism, Vaccines, and the Affective Response to Risk

In February 1998 The Lancet published a small paper by A. J. Wakefield, et. al., which studied 12 autistic children and found no link between their autism and the fact that the kids had received the measles/mumps/rubella (MMR) vaccine. “We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described” they wrote.

But at the news conference announcing the findings, the lead author, Dr. Andrew Wakefield, suggested such a link, setting off a firestorm of fear that has had profound consequences for public health around the world, even for the public’s fading faith in science itself. The formal retraction of the paper by The Lancet Tuesday gives us a chance to step back and consider why this profound disconnect between our fears and the facts occurred, and the consequences, so we might think more carefully about risks moving forward.

Scientists think of risk as something measurable, quantifiable. To them, more probable = worse. But to you and me risk is more than a number. The Cambridge Dictionary defines risk as “the possibility of something bad happening.” Bad to you, and bad to me, can be very different things, at different times, under different circumstances. To us, it’s not just the probability of the unwanted outcome. It’s the nature of the badness too.

Humans have a powerful, complex system that helps us detect and respond to the possibility that something bad might happen. Most of this risk perception goes on below cognition, powered by ancient brain wiring and chemistry, and patterns of information processing, that rely on a host of subtle affective cues which help our brains instantly gauge whether some sight or sound or smell, or idea or memory, holds potential danger. The system rests on a hair wire trigger set to react to potential threats instinctively, before the cognitive parts of our brain even have a chance to get the information and think it over. And in the ongoing risk response that follows, emotions and instinct continue to have the edge over reason and purely fact-based rationality. As Joseph LeDoux, a pioneer in the neuroscience of fear, wrote in The Emotional Brain, “…the wiring of the brain at this point in our evolutionary history is such that connections from the emotional systems to the cognitive systems are stronger than connection from the cognitive systems to the emotional systems.”

One of the affective cues that will set off this system is a risk to our kids. (Look at our excessive fear of child abductions.) Wakefield’s suggested link between MMR vaccines and autism certainly tapped that sensitivity, especially among parents with autistic kids who hope that knowing the cause might afford a cure.

Another cue is trust. If we trust the people and institutions that are supposed to protect us, we will be less afraid. If we mistrust them, the same warning signal will set off a stronger more protective risk response. In Europe, where Wakefield’s intimations about MMR vaccine took off, they came against a backdrop of Mad Cow disease, controversy over the safety of genetically modified foods, and several other issues that had already begun to shake public trust in science and the public health institutions of government. So since Wakefield, as scientists have tried to explain the overwhelming evidence that refutes the connection Wakefield suggested, the problem hasn’t been the evidence. It’s been lack of trust in the institutions that develop and deliver that evidence.

Lack of trust, and a threat to our kids, were just two of many affective factors that contributed to the response to Wakefield, parts of a survival system that relies on facts and feelings, cognition and instinct. We should be grateful to this system. It’s worked pretty well, so far. But a system that evolved to respond instinctively to threats like guys with clubs, and snakes, and the dark, and which still gives the edge to affective cues over hard facts, can serve us poorly when more complex modern risks like vaccines, or climate change, or mercury in seafood come along. Responding affectively to threats that aren’t as obvious, that require a little more analysis, which involve tradeoffs, can get us into trouble.

Vaccination rates in many places are down, in some places below the ‘herd immunity’ level necessary to keep an infectious disease from spreading. In many places, measles is staging a comeback (and in some places, it’s killing kids). Resistance to many other vaccines has also risen. Tens of millions of dollars has been spent researching what science already knew - and what indeed Wakefield’s paper actually reported - that the link between MMR vaccination and autism that so understandably evokes fear in parents of autistic kids, isn’t there. And the continuing controversy, fueled by a 24/7 “He Who Screams Loudest Wins” media age, feeds a growing mistrust in the scientific community that provides precisely the kind of expertise we don’t have as individuals, and which we need to figure these things out for us.

We can’t undo the affective risk response system. It’s deeply wired into us. But in the name of all our health, we need to understand it better, honestly recognize the harms it can do, and factor an appreciation for the dangers of how we react to risk into the choices we make, as individuals, and as a society. That way those choices will not only feel right, but stand a better chance of doing us the most good.

Why We Can't "Outgrow" War

James Carroll asks in an opinion column in the Boston Globe Monday 1/25 if the human race can outgrow war. http://tinyurl.com/yeek4a2. Accepting his Nobel Peace prize, Martin Luther King said we could, that we should, and that in the face of weapons of mass destruction, we must; “If we assume that life is worth living and that man has a right to survive, then we must find an alternative to war.” (Full speech at http://tiny.cc/T2mv8) But King’s word “survive” captures the main reason why his honorable plea for peace is naïve, and why the answer to Carroll’s plea for reason is “No, we can’t.”

Large scale violence happens for the same reason that most violence does. When we are threatened, we often protect ourselves with physical force. And it’s not something we even think about. It’s instinctive. Whether threatened as individuals on the playground and the streets, or as tribes across larger territories, turning the other cheek is not how we are wired to react to threats. Deep in our neural architecture and chemistry, probably in our very genes, we have a powerful set of instinctive subconscious systems that help us detect and respond to danger, whether it’s a direct physical threat, a threat to our resources, or even a challenge to our basic ideas about social structure. These precognitive systems have evolved to help us survive. They fire up before thinking and reason even have a chance to contribute to our response to risk. And as the threat continues, between cognition and instinctive emotion, the edge definitely goes to the latter.

In nearly every animal known, including the human animal, the first hint of danger triggers the Fight or Flight or Freeze response. (More commonly known as the Fight or Flight response, animals that perceive a threat also instinctively freeze, so I’ve taken the liberty of renaming the phenomenon.) Before thinking even has a chance to get going, we respond to danger by instantly rearranging our bodily systems and metabolism to either fight, flee, or freeze.

One of the things those initial changes do is magnify the power of instinct over reason as our response to the risk continues. We not only use instincts first and thinking second, but in an ongoing risk response, we use emotions and instinct more than reason. Neuroscientist Joseph LeDoux, who helped pioneer the research that identified the amygdala as the part of the brain where fear begins, says of the neural systems that control our response to risk, “While conscious control over emotions is weak, emotions can flood consciousness. This is so because the wiring of the brain at this point in our evolutionary history is such that connections from the emotional systems to the cognitive systems are stronger than the connections from the cognitive systems to the emotional systems.” (p. 19, the Emotional Brain, http://tiny.cc/DeqLG)

Ending war would require that reason conquer these self-protective instincts. That’s not entirely out of the question. We do have the capacity for thinking our way to a non-violent response to threat. And our powerful thinking cortex may yet evolve to become the more dominant contributor to our risk response system, developing smarter and more effective ways to respond to risk than our older hard-wired instincts which, so far, have worked pretty well. But for the foreseeable human future, when it comes to the perception of and response to danger, thinking comes second and instinct comes first. Even King seemed to acknowledge this in his speech when he said “…we have ancient habits to deal with...”

Two other Nobel Peace Prize winners offered their answer to Carroll. President Barack Obama said “To say that force is sometimes necessary is not a call to cynicism - it is a recognition of history; the imperfections of man and the limits of reason (my emphasis).” (full speech at http://tiny.cc/3MMJ4) Obama talked about a “just war”. Which the Prince of non-violence himself, Mahatma Ghandi, also invoked when he said “Fighting a violent war is better than accepting injustice. So, really there is no contradiction in fighting a just war, and believing in non-violence.”

The problem is, what is just to the U.S. feels like injustice, and threat, to radical Islamists. What was just to France and Britain after the carnage of World War One didn’t feel like justice to Germans struggling to survive, so we had World War II. Nationalist tensions in the Balkans, conflict over power among tribes in Kenya, or over whose religion will “win” throughout history…the evidence of how we instinctively fight when we are threatened makes for a long tragic list that will surely grow. Until the time comes when we aren’t threatened by competition over resources, or ideas - and who can foresee that day - despite the attractive rational appeal of peace, our more dominant animal survival instincts insure that violence will continue.

Do we care more for some people than others

The unfathomable devastation and loss of the Haiti earthquake has sparked a huge outpouring of concern. Greater, in fact, than that evoked by natural disasters, including earthquakes, when they happen in places further away. Why does the Haitian disaster evoke so much more concern than massive killer earthquakes or natural disasters in Turkey or Bangladesh or China, people just as poor and powerless as those in Haiti? Shouldn't the same number of people anywhere evoke the same care?
Or are there things that are different with Haiti?

Can it simply be we are somehow more moved because Haiti is closer, which makes those people more "real".

Could it be that we relate more intimately to people, some of whose relatives live in the U.S.?

Could it be that because it's closer, and "our" media can get there, that the greater amount of coverage personifies the risk more. The risk perception literature suggests that when a risk is personified - is portrayed in human terms - it raises more concern than when it's abstract (climate change).

Could it be because the greater coverage has made us more constantly as well as intimately aware? The literature finds that the more readily we can bring a risk to mind, the more dramatically it troubles us.

Can it be that we're more aware of how impoverished Haiti is than poor parts of the world further away? Another finding of the risk perception research is that unfairness - bad things happening to people who can't protect themselves - makes risks seems worse.

The scale of this tragedy is impossible to imagine. But so was the earthquake disaster in Szechaun China that killed nearly 70,000. So was the 1991 typhoon that killed 125,000 people in Bangladesh and left millions homeless. Those tragedies, and others further away, evoked great concern, but nothing like we're seeing now.

It's not just about the numbers. Risk perception never is. Risk is a subjective thing, not quantitative. It's a matter of how things feel, and this terrible tragedy somehow feels especially awful.

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.

Risk Is In the Eye of the Beholder

This May, the dredging of the Hudson River finally began. After nearly two decades of insistence by environmentalists that the PCB-contaminated muck be scooped off the river bottom and hauled off, it’s finally going away. At least, away from the Hudson River. Of course, “Away” to some is “Here” to others. What’s interesting is that this material, which prompts such intense concern in environmentalists in the Northeast, is barely causing a stir in the community where it will end up. Most of the folks near the disposal site on the Texas/New Mexico border who will suddenly be neighbors to millions of tons of PCB-contaminated river bottom don’t seem all that worried. Same stuff. Dramatically different perceptions. Why?

Maybe it’s just the fact that PCBs can do more harm in a dynamic environment like a river than they can in a secure landfill. In the river the PCBs can harm the aquatic environment and get into fish that people eat. In the landfill, which is lined and below which are several hundred feet of impervious clay (and no groundwater below that) the possibility of exposure to the environment, or people, is practically zero.

But try locating a low-risk facility like that near a lot of communities and, scientific realities aside, the answer would be a resounding “NO WAY!” It’s a safe bet that none of the environmentalists in the Northeast who wanted the material dredged out of the river would have allowed it to be disposed of anywhere near their cities or towns. Yet just five miles from the disposal site sits Eunice New Mexico, population about 2,500, only a handful of whom are worried about the sort of place that would have a lot of other people freaked out.

Why is something that stirs such fierce concern in some, not threatening to others? It’s a great example of how the meaning of the word “risk” is less a matter of scientific fact and more a matter of perception and perspective.

To some, the very word “chemicals” evokes fear, and conjures word associations with “danger” “cancer” “toxic” or “deadly”. This is the risk perception phenomenon of Stigma. The word “chemicals” has been branded with sweepingly negative connotations. In addition, chemical risks are for the most part undetectable by our senses, which leaves us feeling powerless to protect ourselves, and that raises our fears. Also, people commonly fear risks imposed on them by others, especially by industry (the PCBs came from General Electric operations decades ago). And many people are culturally predisposed to a “We’re all in this together” communitarian, government-intervention kind of social organization, the kind of social structure required to solve big environmental problems. Subconsciously people feel that environmental issues like the Hudson PCBs, and climate change, are rallying calls that strengthen the way they think society is supposed to work. So they tend to play those risks up.

Then there are folks like those in Eunice, such as lifelong resident Mayor Matt White, with whom I recently spoke. He notes that “chemicals” means something different to people born and raised in a town with 50-60 oil wells, where the “real” risk is hydrogen sulfide gas brought up with the oil that has killed one or two people in the past few decades. They have a familiarity with at least this sort of chemical risk that puts the overall feeling of chemical risks, including PCBs, in a less worrisome perspective. They also depend economically on the health of the oil industry and, indirectly, the chemical industry that buys that oil. So the benefit of the wells outweighs the risk they accept as part of the bargain. The contaminated dredgings will mean an additional 15-20 jobs at the disposal facility, jobs that pay $40-50,000 a year. That’s an additional part of the risk-benefit equation in Eunice, a tradeoff which always colors perceptions of risk.

And Mayor White describes his community as a conservative group of people who have a more libertarian view of government’s role, more independent-minded folks who are less inclined to think government should go butting in all the time. To these Individualists, sweeping environmental problems, including like climate change, call for a social response that cuts against their independent-minded grain, so they often play such risks down.

There is no right or wrong here, just valid reasons why the same risk can look one way to one person and different to the next. Feel one way to one person and feel different to the next. That’s what’s really going on under all those fierce arguments about environmental risks after all. They are battles over perspectives, battles over underlying worldviews. The facts are just the weapons by which the battle is fought. The facts aren’t never the reasons for fighting it in the first place. It’s how people see those facts.

In this case there was no battle. Both perspectives “won”. They got what they wanted. But there is a valuable lesson here for all the times such issues get contentious. “Risk” is in the eye of the beholder. There is no “truth”. The facts can look quite different from different perspectives, and anyone arrogantly claiming that their view of the facts is “right”, is arrogantly denying the valid concerns of the other parties and pouring gasoline on the fire. Solutions will be a lot easier to reach if the parties to these conflicts respect the reasons why people feel the way they do about the issue, and account for those feelings and worldviews in the steps proposed for moving forward.

Uh Oh Nano, Part 2.

(The following essay was written 2 years ago. It is being posted now in connection with research released this week in Nature Nanotechnology showing that people's cultural self-identification also contributes to their perceptions of risk, in this case the risks that may arise from nanotechnology. For a summary of that research and a citation to the original journal article, see http://www.sciencedaily.com/releases/2008/12/081207133749.htm. For an earlier post on nanotechnology, see the second post at http://onrisk.blogspot.com/search?updated-min=2007-01-01T00%3A00%3A00-05%3A00&updated-max=2008-01-01T00%3A00%3A00-05%3A00&max-results=

Nanotechnology, the capacity to manipulate materials at atomic and molecular scales, holds promise bounded only by the human imagination. But if this promise is to be fully realized in ways that respect potential harms to human and environmental health and safety, serious and ongoing consideration needs to be given to the way the public will react to nanotechnology and all its specific applications. For despite it’s benefits, if public apprehension builds, the potential of nanotechnology could be severely limited. The findings of the field of research known as risk perception offer valuable insights into what that public reaction might be. Understanding those potential reactions will allow proponents of nanotechnology to respect public concerns and address them through more effective risk communication, and advance the prospects of the entire field.
The Greek Stoic philosopher Epictetus observed “People are disturbed, not by things, but by the view they take of them.” Indeed, researchers including Paul Slovic, Baruch Fischoff, Sarah Lichtenstein, and others, have found that risks seem to have shared characteristics which, quite apart from the scientific facts and statistical probabilities, play a key role in making us more or less afraid. These affective/emotional characteristics are a fundamental part of how we frame our worries. They essentially form the subconscious backdrop by which we “decide” what to be afraid of and how afraid to be.
Perhaps the most important of these characteristics is the matter of trust. As leaders in the field of risk perception and risk communication have found, the more we trust – the less we fear. And the less we trust – the more afraid we are likely to be. Trust will almost certainly play a key role in the acceptance of, or resistance to, nanotechnologies.
Trust is determined by many factors. It is determined in part by who does the communicating. The facts being presented could be the same, but the trustworthiness of the communicator will help determine how worried the audience will feel. For example, people who learn about nanotechnology from the chemical industry, which is less trusted according to many polls, are more likely to worry than people who learn about it from health care professionals like doctors or nurses, more trusted professions.
Trust is also established through honesty. BSE affords a good example. In Japan, after the first indigenous infected cow was found, the government promised there would be no more. A second cow was found just days later. The government then said they had created a ban on feeding ruminant protein back to healthy cows – which is how the disease spreads – only to have the press learn and report that the “ban” was only voluntary. The press also reported that the government had kept secret an EU report rating Japan at high risk for BSE. These less-than-honest statements by the government badly damaged trust and fueled much greater fear in Japan than in Germany, where, within about a month of the discovery of the first indigenous infected cow, two cabinet ministers were sacked and changes were proposed to make agricultural practices more natural and less mechanical. Beef sales rebounded in Germany quickly, unlike Japan, partly because of the different degrees of honesty on the part of the government.
Trust also grows from an organization’s actions. Again BSE affords an example. In Canada and the U.S., after the first infected cows were found, the governments were able to point out that they had long ago instituted a feed ban and other restrictions to keep the risk low. As much as citizens might not have trusted the government in general, in this matter the responsible agencies had demonstrated their competence in keeping the risk low. This demonstration of competence probably played a role in the relatively minimal impact on consumer beef sales experienced within each country.
Trust is also established when an organization respects the reality of the public’s fears, even though there may be no scientific basis for those fears. In the U.S., authorities withdrew muscle meat from the market that had come from the slaughterhouse that processed the BSE-infected cow. This despite the scientific consensus that muscle meat is not a vector for BSE. The U.S. Department of Agriculture said it was acting “out of an abundance of caution…”. In other words, they were acknowledging and responding to the reality of the public’s fear and doing something that did not reduce the physical risk, but reduced public apprehension. The implicit message in such actions is that the agency was not being defensive, but was being responsive to public concern. That kind of action encourages people to trust such an agency, more than when the message is “There are no scientific reasons for your fears. The facts as we see them says there is no risk. So we are not going to act.” This potentially damaging message has already been heard from a small number of scientists in the area of nanotechnology.
Trust is also established by sharing control. In the case of nanotechnologies, this could include shared control over the writing of public health and environmental risk regulations, or shared control over the development of societal and ethical guidelines. The more that people feel they have some control over their own health and future, the less afraid they will be. The same risk will evoke more worry if people feel they have less control.
Trust is also built by openness. In the development of nanotechnologies, this should include dialogue with various stakeholders, a fully open exchange of scientific data, open government regulatory development, and open discussion of societal and ethical issues, among other areas. The more that people feel they are being deceived, lied to, or manipulated, the more afraid of a risk they are likely to be. Openness reassures them that they can know what they need to know to keep themselves safe. An open process is inherently trust-building.
Trust will be difficult to establish as nanotechnologies develop, because the driving forces behind such development will be principally commercial, industrial, corporate, and government, and the politically and profit-driven sectors of society are, de facto, perceived to be out for their own good more than they are out to serve the common good. So special attention and effort must be paid to establishing trust in everything that a government, a business, or a scientist does while working on commercial nanotechnological research, development or application.
But there are other risk perception characteristics that could bear on public acceptance of, or resistance to, nanotechnologies.
People tend to be more afraid of risks that are human-made than risks that are natural. Nano is almost certainly going to perceived as a human-made technology.
We tend to worry more about risks like nanotechnology that are hard to comprehend because they are scientifically complex, invisible, and not yet completely studied and understood. This could well invoke calls for a stringent application of the Precautionary Principle, and proponents of nanotechnology would be well advised to give serious consideration to such calls until a reasonable amount of safety data is developed.
We tend to worry more about risks that are imposed on us than risks we knowingly choose to take. Nanotechnologies will provide finished materials in some cases, which could appear in the label of a product to alert the consumer and give them choice. But in many cases, nano substances will serve as intermediates or raw materials or catalysts, substances which can not be labeled, and which therefore could evoke concern because people are going to be exposed to them without any choice.
We worry more about risks that are new than the same risk after we’ve lived with it for a while. While carbon black and some nano materials have been around for a while, many nano materials and products are new, with different behavioral characteristics than anything we’ve ever known. And of course the precise ability to manipulate things on a nano scale is new. This too could feed greater public apprehension about this technology.
And we tend to worry more about risks from which we personally get less benefit, and vice versa. For some nanotechnologies, for some people, the personal benefits may well outweigh the risks. But when they don’t – or when the benefits principally accrue to someone else - fear and resistance could rise.
It is important to respect the reality and the fundamental roots of these perception factors. They can not be manipulated away or circumvented with a clever press release, website, or a few open public meetings and dialogue. Human biology has found that the brain is constructed in such a way that external information is sent to the subcortical organs that generate a fear response before that information gets to the part of the brain that reasons and thinks “rationally”. In short, we fear first and think second. No press release can undo that biology. It is quite likely that, because of some of the characteristics of nanotechnology listed above (human-made, hard to understand, imposed, new, lack of trust in industry), that if the first way people hear about it involves some hint of threat or negativity, that the initial reaction many people have will be worry and concern.
Moreover, the brain is constructed such that circuits stimulating a ‘fear’ response are more numerous than those bringing rationality and reason into the cognitive process of risk perception. In short, not only do we fear first and think second, we fear more, and think less.
Again, this suggests the likelihood that first impressions many people will have of nanotechnology will be predominated by caution and concern.
Fortunately, both the biology and psychology of risk perception have been fairly well characterized. Insights from those fields can guide the design of research to find out how people are likely to react to nanotechnology as it becomes more common, is introduced into their lives, and as it gets more and more attention in the press, a trend already beginning in many places. Research that understands how people are likely to react is the first step toward designing risk management strategies, including risk communication, to address public concerns.
It is imperative that such research be done soon, so it can be used to develop risk management and risk communication strategies that will maximize public understanding of nanotechnology, and public participation in the process of its development and implementation. With these steps, the potentials of this remarkable field can be more fully realized while respecting public concerns and insuring public and environmental health and safety.

WORLD DESTROYED!!!

Scientists from around the world are eagerly awaiting the first experiments this summer at the Large Hadron Collider in Switzerland, which will smash subatomic particles together to try to replicate conditions in the universe a trillionth of a second after the Big Bang. Some say the experiments could create a black hole and destroy the earth. Scientists dismiss those fears as irrational. It's a classic collision of the two ways we humans try to sort out the risks we face.



This just in, from Geneva, Switzerland.
The world has been destroyed, consumed in the infinite gravity of a black hole triggered by an experiment at the Large Hadron Collider. All life on earth was extinguished and the earth itself was crushed down to the size of an atom.
However, scientists running the experiment say that, as predicted by the laws of quantum physics, our former world and all life as it existed were instantly replaced with identical copies. “What's the big deal? Nobody even noticed,” said Dr. I. M. Smart, a leader of the science team conducting the experiment. He added "It's just as we predicted. People have to start trusting scientists and stop worrying when we tell them they're safe."
Scientists say the experiment identified a new condition of matter, which they have named the Significant Major Unknown Gyration, or SMUG. “We’re very excited,” Dr. Smart said. “Discovery of Smugness has taught us important new things about the creation of the universe, even if it did require the fleeting destruction of the world. That’s just how science progresses.”
The experiment survived several lawsuits seeking to avoid the destruction that occurred this morning. The plaintiff in those suits, Walter Whiner, could not be reached for comment on the outcome of the experiment. His wife said he disappeared at 4:13 a.m., precisely the moment the experiment began.
Police report that a number of other people are missing. Officials in Cincinnati, Ohio say the entire staff of The Creationism Museum disappeared during a conference entitled “Darwin was a Communist”. Police in Washington, D.C. are searching for Bette B. Scared, founder of “Vaccines Cause Autism”. Australian police say they are searching for Bea Afraid, author of “The Only Safe Risk is ZERO Risk” and a well-known opponent of genetically modified food.
Dr. Smart denies any connection between the disappearances and the momentary destruction of the Earth caused by his experiment. “Under the laws of super strong theory we predict with a 99.99% confidence interval that they should look for these people in Dimension X,” he said. Smart added "We call it The Irrational Dimension. Which isn't so different from where we think they've been living all along.”

Following the momentary destruction of the world, attorneys rushed to file several class action lawsuits. The first was entered at court just 45 seconds after the destruction event by Attorney Sue Everyone of the law firm of Screwem, Ligh, and Profit, who said “This is the most egregious case of arrogant scientists run amok in the history of mankind. It doesn't matter that we may have unlocked the mystery of how the universe was created. My clients, who include anyone on the planet who was alive at 4:13 this morning, were harmed when a nanosecond of their lives was taken away from them." Everyone is claiming infinite punitive damages.

Officials at the Large Hadron Collider say their work will continue. Critics have already filed legal action to stop an upcoming experiment which they say could set the Earth on fire. Scientists say their work is safe. They call the critics irrational. The critics say the scientists are arrogant and aren't taking the risk seriously.
The court hearing on the upcoming experiment will be held next month on Friday the 13th.

The Conflict Between Nuclear Fears and Nuclear Facts

Mark Twain said "I am an old man and have known a great many troubles, but most of them never happened."

We worry about a lot of things in this threatening world, and as Twain suggested, sometimes our worries are based more on our perception of the facts than on the facts themselves. So what's a government to do when people think they have been harmed by something, and they want the government to compensate them, only the evidence says they're wrong.

Well the Japanese have just answered that question with a resounding "Pay them anyway."

This is about the survivors of the atomic bombs dropped on Hiroshima and Nagasaki. They are known in Japan as the HIBAKUSHA, people who lived within about two and a quarter miles of ground zero or visited those areas in the days after the blasts. There are roughly 250,000 of them still alive. Their average age is 64.

HIBAKUSHA rightly get all sorts of special government benefits. Those who suffer from five diseases connected with radiation are also eligible for special medical benefits. In 2001 the government established science-based standards to determine who qualifies, since many HIBAKUSHA, who lived further from the center of the explosions, received practically no radiation dose at all. That science-based approach basically said that the further away from ground zero you lived, the less radiation you were exposed to, and the less likely it is that radiation caused your illness. (Remember, lots of elderly people get cancer, like skin cancer or prostate cancer, and radiation has nothing to do with it.) Under that standard 99 out of every hundred atomic bomb survivors who applied for special medical benefits were turned down.

300 of them sued the Japanese government, and those lawsuits got a lot of attention in the press. Political pressure built on the government. Then-Prime Minister Shinzo Abe was already in political trouble, so he promised a new system.

That new system was just announced and, basically, it says the faqcts don't matter as much as people's concerns. Now any HIBAKUSHA who is sick gets paid, no matter how far they lived from ground zero, no matter if they received any radiation at all. As one member of the government panel that wrote the new rules said "Fear is particularly high about radiation. It's more important to support the HIBAKUSHA regardless of the lack of scientific evidence."

That FEELS good, FEELS fair. But think about it. By that standard governments should be paying people who are worried about electric power lines, or artificial sweeteners, or silicone in their breast implants, or autism from vaccines, or brain tumors from cell phones…or any number of other risks which many of us fear, fears not supported by the facts.

Worrying too much can cause stress, and stress hurts our health. So unlike many of the things we fear, the risk from fear itself is real, and needs to be respected in government policy. But the Japanese policy goes so much further than that. They've basically said that emotions trump science, and in a world in which so many of us are worried about so many things, a policy like that could turn out to be a truly troubling thing.

This is Your Brain on Fear

So I was walking my dogs in the woods the other day and it happened again. There was this long skinny curving line on the ground, and my rational brain said “That’s a root” and my animal brain screamed “SNAKE! SNAKE!”, and the animal brain won. I froze.

This happens to me all the time, which is dumb for three reasons. First, I KNOW it’s not a snake. Second, this is what I study and teach…the way we human animals perceive risk and how to communicate about risk better, so I should be able to overcome this apparent irrationality. And third, every time it happens I tell myself not to let it happen again…but it does. By the way, this DOESN’T happen to my dogs.

The good news is we understand pretty well how this works…how whenever we encounter something that could be hazardous, that information goes first to the part of the brain that sets off a fight or flight response just in case, and THEN it goes to the parts of the brain that can give it a little thought, and send back the message “You did it again you idiot.” By which time, I’ve already frozen.

It doesn’t matter what the potential threat is. It doesn’t matter whether we see it, smell it, hear it, touch it, taste it, or even if it’s just information assembled in our brain…a thought…or a memory. The same thing happens. The information goes to where we fear first, and to where we think, second.

And then, in the ensuing battle between rationality and gut instinct…guess what? Instinct usually wins, or at least it has the upper hand, again because of wiring in the brain.

So there I am on the trail. My dogs look at me to try to figure out why we’re stopping. I ignore this innocent interrogation and move on. And I am reminded once again that talking to people about risk a messy affair. Most risk communication just tries to find really clear ways to explain the facts, to educate. But if just learning the facts was enough, I wouldn’t be freezing when I saw a root on the ground in the woods. If just the facts were enough, we probably wouldn’t be as afraid as we all are about a lot of things…like terrorism (the fear of which helped launch a war) or nuclear power, or industrial chemicals…and we’d probably be more afraid of the things that are much more likely to kill us, like heart disease (it kills 2200 Americans every day), and stroke, and motor vehicle crashes and other accidents.

I find that if I want to help my friends make informed, healthy choices about the risks they face…well, yes, it might help to offer what few facts I can…but I also have to respect their fears, and not just say ”Here are the Facts. Calm Down”. I have to respectfully help them know that risk perception is a combination of facts AND feelings, and though both are valid, sometimes the feelings can lead to behaviors that actually increase the risk. Just knowing that challenges me to think about risks more thoroughly.

Unless, of course, it’s another root in the shadows at my feet. Maybe I should just let my dogs walk ahead of me.

It won't happen to ME!

My wife and I were watching the news the other day about the former governor of New York and she asked me "Why do apparently SMART people take such obviously STUPID risks?"

Well, former Governor Spitzer took his chances for many personal reasons, but he was at least partly a victim of something called Optimism Bias. That's the fancy name for "Yeah I know it's a risk but IT WON'T HAPPEN TO ME." You've probably used that one yourself from time to time. It's what people say to themselves when they smoke. Or they don't wear their seat belts, or they send text messages while they're driving, or they have that rich fattening dessert when they're already overweight. "I won't get caught. I won't get lung cancer. I won't have an accident. I won't get heart disease." IT WON'T HAPPEN TO ME!

Optimism Bias is not just the tool of potential victims though. The flip side of "IT WON'T HAPPEN TO ME" is "IT WILL HAPPEN TO ME." That's the kind subconsciously applied by lottery players, or hedge fund managers, or bank or mortgage executives, or any of us, when we gamble with money hoping to make more. IT WILL HAPPEN TO ME, we tell ourselves, as we fork over five bucks on some scratch tickets…or lend money to people who are not likely to be able to pay it back, or when we buy things on margin…paying only 10% and the bank or broker pays the rest…only if the investment goes bad the bank or the broker calls the loan and we have to come up with the other 90%. Sounds a lot like the credit crisis, doesn't it? There's a reason why the so called credit bubble existed in the first place. The hot air of Optimism Bias helped inflate all that risky financial gambling to begin with.

We all use Optimism Bias, all the time. Optimism Bias is how we tell ourselves it's okay to have that extra beer before driving home from the bar, or to gamble on that chancy mortgage to buy our first home… or to cheat on relationships.

Is this rational? No. But then, perfect rationality is only a myth. We think that because we CAN think, that's how we OUGHT to decide. But our feelings and instincts and ancient needs are also big players in the choices we make and the chances we take. We all have hopes and desires, and Optimism Bias is one of the tools that helps us fulfill them. We ALL use it, not just the apparently smart people we hear about in the news when things don't turn out as optimistically as they had hoped.

CLIMATE CHANGE - What, ME worry?

Anyone interested in climate change paid close attention to the December meetings in Bali, where the world’s leaders worked on how to deal with this unprecedented global threat. The meetings took place under the challenge of the head of the Intergovernmental Panel on Climate Change, Dr. Rajendra Pachauri, who said “What we do in the next two to three years will determine our future. This is the defining moment.”

But as policy makers focused their attention on the Bali meetings, the rest of us were paying attention to the same things we always do; our health, our jobs, our personal budget, our spouses or love lives, the daily commute, etc. The policy makers in Bali considered climate change from their usual perspective, as if looking down on the earth from high above. But we don’t live up there. We live down here. We don’t live on a planet. We live in our homes and our neighborhoods. We don’t live in the climate of the earth. We live in the weather of our daily lives.

That chasm in perspectives, between the global view and the local, could be the biggest obstacle to meeting Dr. Pachauri’s challenge. The things we need to do at the system level will have impacts at the personal. But we may not be willing to accept those impacts, because most of us don’t see how climate change actually threatens us. The wisest policies agreed to in Bali and subsequently will come to little without public support. The leaders dealing with climate change at ’defining moment’ must devise solutions that will work globally, and appeal locally.

Ask yourself this; Over the next 20 years, can you name one specific way that climate change will have a serious, negative, direct impact on you or your family? Most of us can’t answer that question. You probably know that climate change will have all sorts of serious negative impacts, but not how it’s going to impact you directly. A survey of public perceptions of climate change by Anthony Leiserowitz, “Climate Change Risk Perception and Policy Preferences: The Role of Affect, Imagery, and Values” found that while an overwhelming majority of respondents believed that climate change is real and that we should do something about it, only 12% were most concerned about the effects of climate change on them. 50% were most concerned about effects on the U.S. as a whole. 18% were most worried about effects on nonhuman nature. 10% weren’t worried about the effects of climate change at all. Small wonder, then, that the study found the following support in the United States for various ways to deal with climate change.

US Reduce Emissions - 90%
Kyoto Protocol - 88%
Increase CAFE standards - 79%
Regulate CO2 - 77%
Business tax - 31%
Gas tax - 17%


People are ready to support ideas. Fewer are ready to support spending what it will take to make those ideas reality.

Or consider a Globescan survey of 22,000 people in 21 nations released by the BBC in November. 83% said personal changes in lifestyle are needed to help combat climate change. But when asked if they themselves would be willing to make such changes, the number goes down. It’s still large, 70%, but note that it goes down. Fewer still, 61%, agree with the idea of paying higher energy costs. Ask them if they’d be willing to pay higher taxes to combat the problem and it effectively becomes a toss up, 50% saying yes, 44% saying no.

The trend is similar in most surveys. An overwhelming majority of people in the U.S. and around the world believe that climate change is a real threat, but when you ask people what should be done about it, as the cost to them goes up, their readiness to act goes down. That bodes poorly for the prospect of public support for the changes we need to make to address the problem.

Research into the ways humans perceive risk has found that, not surprisingly, we worry more about things that could happen to us than about things which threaten others. The survey evidence makes pretty clear that the “ME” factor is not much at work in most people’s perceptions of climate change. Which makes it unduly hopeful to expect people to give up the benefits of maintaining their current lifestyles? Why would they agree to pay higher energy bills, or gasoline taxes, or more for goods and services whose prices rise because of CO2 trading? The benefits of the comfortable status quo outweigh the minimal risks that we think climate change poses to us personally.

The science and policy communities tend to see the issue through their own professional lenses of fact and science and reason. The science of human behavior, particularly the psychology of risk perception, robustly shows that we use two systems to make judgments about risk; reason and affect, facts and feelings. It is simply naïve to disregard this inescapable truth and presume that reason and intellect alone will carry the day. That's just not how the human animal behaves. Even as potentially catastrophic as climate change might be, if people don't sense climate change as a direct personal threat, reason alone won't convince them that the costs of action are worth it.

There are still too few scientists and policy leaders describing the potential impacts of climate change on a local level. This is an admittedly dicey business because it’s hard to know specifically what changing the climate of the planet is going to do to Denver or Delhi or Dusseldorf. But there is plenty of scientific evidence of the harm climate change might do at the local level. These potential local risks need to be emphasized, in the concrete terms that will give people more of an idea of what climate change might do to them.

The costs of policies to deal with this global challenge also have to be presented in local terms. What will carbon sequestration or CO2 trading do to the prices of the goods and services we buy? What will requiring renewable energy sources do to our electricity bills? How might energy efficiency requirements cost us money, or perhaps save us money?


Many scientists from a wide range of fields have built the evidentiary case for climate change, and identified a range of solutions. But far too little attention has been given to the science of risk perception, and the tools of risk communication, to build a base of support for those solutions. Achim Steiner, head of the United Nations Environment Program, said that the ominous IPCC report released last fall sends a message; “What we need is a new ethic in which every person changes lifestyle, attitude and behavior.” A wonderful goal, but unlikely to happen unless individuals are more worried about how climate change might affect them directly. As the leaders of the world move on in the wake of Bali, they need to remember the real people in the local neighborhoods of our global village who will have a lot to say about whether the policies they choose will succeed.

Cloned Food - "Waiter, my burger tastes like test tube."

Choices, Choices.

Most risks usually involve tradeoffs. We like dessert and fried food so we take the risk of being overweight. We enjoy that nice healthy tan so we're willing to run the risk of skin cancer. We lead busy lives, so we use our cell phones when we drive and dismiss the danger of distracted driving.

But those are all matters of choice. Now comes a new risk-risk tradeoff that could be in our stores soon, over which we might not have any choice at all. We may soon have milk or meat from cattle, pigs, or goats which are clones, copies of the original animal but conceived in the lab, not the uterus. The farmer just has to identify the animals with the traits that produce more meat or richer milk, and copy them, from the DNA up. Those breed stock animals will be used to generate offspring with the superior traits. So what’ll it be, diner? Beef that started out the old fashioned way, or beef from descendants of a cow that never knew its mother...never HAD a mother?

The FDA says this is safe. They studied cloned animals for 6 years before recently declaring that meat and milk from cow A is equivalent to meat and milk from Cow B. But the question of safety isn't just one of lab analysis. Safety is a matter of how we feel. And a Pew Institute study found that 43% of Americans feel that cloned food is unsafe (64% aren't sure). Said one opponent of cloned animal products to the FDA “I would rather pay more for natural processed food (than) have what was cooked up in some science lab.” So show me the company that wants to be the first to bring such products to market.

The problem is, the FDA has not required food produced this way to carry some sort of label. This is just what industry wanted. But it's a big mistake.

Remember, we're less afraid of risks when we have some choice. A risk we take on our own feels less frightening that one which is imposed. No label = No choice. The possibility that there may be something different about one gallon of milk compared to the next, but we won’t know it because the difference won’t be on the label, makes many of us leery. The FDA assures us that cloned product is equivalent to what we eat now. But the Pew survey found that 64% of us aren’t sure, so we want to be able to make that choice ourselves. As the Consumer Federation of America complained, "The products will not be labeled as such and American consumers will have no way to avoid consuming them."

A label to give us choice makes sense, for the consumer and the for the food industry. By giving people choice - good for consumers - labeling will reduce opposition to cloned food products, probably enough to allow them to come to market - good for the food industry. Want proof that this works? Concern in Europe about genetically modified foods went down (not away, but down) after labels appeared telling consumers which foods contained GM products. In the U.S., producers are loathe to use irradiation to sanitize food - also safe and legal - for fear that consumers won’t buy something labeled as irradiated. Yet in test markets where such products have been sold, bearing a label that identifies the food as having been treated with radiation to kill germs, consumers buy these products, in part, they say, because the label lets them choose for themselves.

Will labeling give consumers all the facts they need to make a fully rational information-based choice? Of course not. The GM food label doesn’t. The irradiated food label doesn’t. A label that says something general like “Contains products from cloned animals” is not exactly full disclosure. But it’s enough. Enough to say to the consuming public that our government acknowledges our concerns and respects that we should have the final say about what we eat.

Notwithstanding the science that it’s safe, this stuff is scary to some. The FDA needs to look beyond the science of animal biology to the psychological study of risk perception, which explains why our very real fears often don't match what scientists say are the facts. Requiring a label on food from cloned animals or their offspring could go a long way toward allaying consumer concerns, and allow a food technology that promises more, healthier, and cheaper food to move forward, without being forced down anyone’s throat.