Table of Contents
GETTING RISK RIGHT
GETTING RISK RIGHT
Understanding the Science of Elusive Health Risks
GEOFFREY C. KABAT
| COLUMBIA UNIVERSITY PRESS |  | NEW YORK |
Columbia University Press
Publishers Since 1893
New York Chichester, West Sussex
cup.columbia.edu
Copyright 2017 Columbia University Press
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E-ISBN 978-0-231-54285-2
Library of Congress Cataloging-in-Publication Data
Names: Kabat, Geoffrey C., author.
Title: Getting risk right : understanding the science of elusive health risks/
Geoffrey C. Kabat.
Description: New York : Columbia University Press, [2017] |
Includes bibliographical references and index.
Identifiers: LCCN 2016008208 (print) | LCCN 2016008811 (ebook) |
ISBN 9780231166461 (cloth : alk. paper) | ISBN 9780231542852 (electronic)
Subjects: | MESH: Attitude to Health | Risk Assessment | Negativism |
Risk Factors | Environmental Exposureadverse effects |
Health Educationmethods
Classification: LCC RA776.5 (print) | LCC RA776.5 (ebook) |
NLM W 85 | DDC 613dc23
LC record available at http://lccn.loc.gov/2016008208
A Columbia University Press E-book.
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Cover design: Noah Arlow
To the friends and colleagues who have accompanied me on this journey
The first principle is that you must not fool yourself, and you are the easiest person to fool.
Richard Feynman
What I am saying is that, in numerous areas that we call science, we have come to like our habitual ways, and our studies that can be continued indefinitely. We measure, we define, we compute, we analyze, but we do not exclude. And this is not the way to use our minds most effectively or to make the fastest progress in solving scientific questions.
John Platt
CONTENTS
WHY DO THINGS THAT ARE UNLIKELY TO HARM US GET THE MOST ATTENTION?
The modern world, the advanced technological world in which we live, is a dangerous place. Or, at least, that is the message that, with metronomic regularity, seems to jump out at us at every turn. The news media bombard us with reports of the latest threat to our health lurking in our food, air, water, and the environment, and these messages are often reinforced by regulatory agencies, activist groups, and scientists themselves. In recent years we have been encouraged to worry about deadly toxins in baby bottles, food, and cosmetics; carcinogenic radiation from power lines and cell phones; and harm from vaccines and genetically modified foods, to name just a few of the more prominent scares.
Reports like these have a visceral impact. They inform us that a new and hitherto unsuspected threat has taken up residence in our immediate environment, in our body, or in the bodies of people like us. The impact is similar to coming home and sensing that there is a malevolent intruder in your home.
In the two instances cited above, a quick look at the original studies on which these news items were based would have revealed the crucial point: there are a large number of substantial leapsover many intervening steps or linkagesbetween the putative cause and the putative effect. At each point in the logical chain of causation there is the opportunity for unwarranted assumptions, poor measurement, ignoring crucial factors, and other methodological problems to enter in. Any erroneous link would invalidate the overall linkage that the article is positing and that the news reports trumpet. But, by a mysterious cognitive process, we tend to block out these considerations and accept the validity of what is a tenuous connection that would need extensive buttressing to be worthy of concern. The process of questioning how seriously such results should be taken is an effortful, rational process that cannot compete with the visceral impact of the alert telling us that we are under threat. Even those who are in a position to know better can be unsettled by reports like these.
Our response to such reports is often influenced by another cognitive process that we are usually unaware of. Independent of how solid the underlying science is, the new result may sound true to our ears because it appears to fit in with a broader theme or narrative, which is beyond dispute. Thus any report alleging effects of exposure to environmental pollution may gain plausibility from the incontestable fact that we humans are having a profound and unprecedented impact on the global environment. But, in spite of what seems true, the results of any study need to be evaluated critically, and in the light of other evidence, to see if they stand up. One cannot judge a scientific finding based on whether it conforms to our expectations.
The visceral impact of these scares helps explain how, in different instances, the scientific and regulatory communities, various activist groups, self-appointed health gurus, and the media could all get involved and make their contribution to giving these and similar questionable findings currency.
Although news reports of these threats always make reference to the latest scientific study or measurement, the scares that erupt into the public consciousness often have only a tenuous connection to hard scientific evidence or logic. Many people sense this intuitively, since a report pointing to a hazard is often followed closely by another finding no evidence of a hazard, or even finding a benefit from the supposed nemesis. Furthermore, they sense that people arent dropping like flies from the numerous dangers alleged to permeate modern life. Certainly the periodic reports raising the terrifying possibility that using a cell phone could cause brain cancer have done nothing to slow the unparalleled spread of this technology. And yet this omnipresent noise and the continual procession of new threats to our health take their toll and have real consequences, although these get little attention from those who so vigorously promote the existence of a hazard.
* * *
Information about what factors truly have an important impact on health is a vital commodity that has the potential to affect lives, but the succession of health scares creates a fog that confuses people about what they should pay attention to. People paralyzed, or merely distracted, by the latest imaginary threat may become desensitized to health messages and be less likely to pay attention to things that matter and that are actually within their controllike stopping smoking, controlling their weight, having their children vaccinated, and going for effective screening. Concerning the cell phone scare, in 2008 Otis Brawley, chief medical officer for the American Cancer Society, commented, I am afraid that if we pull the fire alarm, scaring people unnecessarily, and actually diverting their attention from things that they should be doing, then when we do pull the fire alarm for a public health emergency, we wont have the credibility for them to listen to us.
In addition, the exaggeration and distortion of health risks can lead to the formulation of well-intended but wrongheaded policies that can actually do harm. Perhaps the best example of this is the overzealous focus on the presumed benefits of a low-fat diet in the 1990s. Both the federal government and the public health community embraced this doctrine, and the food industry complied by reducing the fat content of a wide range of processed foods. However, something needed to be substituted for the missing fat, and sugar filled this role. This large-scale and dramatic changesometimes referred to as the SnackWell phenomenonhas been credited with making a substantial contribution to increasing rates of obesity.
