risk perception

RECENT POSTS

Don’t Worry, Be Rational: Why Extreme Fear Of Ebola Is Bad For Your Health

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

Let’s face it, Ebola is scary. My kids are scared. The moms at school are talking about giving their children extra multi-vitamins to boost their immune systems in a desperate attempt to do something, anything, to protect their families. But we live in Boston and there are no cases here — yet. Still, that “yet” can make us crazy.

So, in a crisis, who do you call for comfort? The level-headed risk perception consultant: David Ropeik, who spoke with me briefly today about why such intense, prolonged worry and anxiety can backfire, make your body weaker and perhaps even damage your health:

Here, edited, is our short interview:

RZ: So, why is being scared of Ebola bad for your health?

DR: The health ramifications of this are profound. When we worry, that, biologically, is stress — that’s a mini fight-or-flight response going on in the body. When stress persists for more than several days (short-term stress is not the problems), it becomes damaging to our health. Chronic stress raises our blood pressure and increases the risk of cardiovascular problems; it suppresses our immune system and makes us more likely to catch infectious diseases or get sicker from them if we do. It interferes with neurotransmitters associated with mood, and it is strongly associated with clinical depression. Chronic stress interferes with digestion and memory and depresses fertility and bone growth (slows it down).

[The negative effects of chronic stress are widely reported, but Ropeik cites the book “Why Zebras Don’t Get Ulcers,” by the biologist Robert Sapolsky, as a key source here.]

So you think people are overreacting and we’re moving into some kind of widespread nation-wide chronic stress phenomenon here?

We’re on the cusp. It’s like what the fear of SARS did to people in Canada — it freaked [them] out for weeks: “Here it comes again,” is what they’re saying.

How do you see all this evolving?

In the last day and a half the criticism of how health officials have handled things and the mistakes they made in Dallas, real as those mistakes are, have become a focus, and it’s now starting to undermine trust in our health care system.

In a crisis, trust is the pivotal factor for how worried people are. Continue reading

Harvard Poll On Ebola Risk Finds Public Dazed And Very Confused

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

By Richard Knox

Americans are seriously confused about how Ebola spreads. And it’s no wonder.

A new national poll from the Harvard School of Public Health finds that nearly 9 out of 10 Americans think someone can catch Ebola if an infected person sneezes or coughs on them.

Not so, according to all health authorities and 38 years of research on this virus. But maybe people can’t be blamed for thinking Ebola can be spread through the air as they see powerful images day after day of health workers clad in head-to-toe protective coverings and face masks.

And there’s little to no possibility that Ebola will mutate into a virus easily spread by aerosol droplets, like influenza or SARS, for reasons that Laurie Garrett of the Council on Foreign Relations recently pointed out in The Washington Post.

Similarly, all the attention on the imported Ebola case of a Liberian man in Dallas and subsequent infection of two of his nurses (so far) is apparently leading many Americans to overestimate their risk of getting the virus.

In contrast, the great majority (80 percent) think they’d survive Ebola if they got immediate care. That’s probably right — though no sure thing.

(Courtesy of Harvard School of Public Health)

(Courtesy of Harvard School of Public Health)

The Harvard poll, conducted between last Wednesday and Sunday, finds that a little over half of Americans worry there will be a large outbreak of Ebola in this country over the coming year.

More than a third worry they or someone in their immediate family will get Ebola. Continue reading

Curb Your Hysteria: Talking Rationally To Kids About Ebola Risk

A man diagnosed with Ebola this week is being treated at Texas Health Presbyterian Hospital in Dallas. (AP)

A man diagnosed with Ebola this week is being treated at Texas Health Presbyterian Hospital in Dallas. (AP)

By Gene Beresin, MD and Steve Schlozman, MD

On Sept. 30 the first case of Ebola was diagnosed in the United States. The patient, who is currently being treated in Dallas, had recently traveled to Liberia, and was back in this country for a few days before symptoms began.

Understandably, the coverage of this news is pervasive. Although it seemed inevitable that a case in the U.S. would eventually emerge, the story still ignites a fair bit of hand-wringing among just about everyone who has learned of it.

Additionally, our country has experienced some novel infections that have ignited increased concerns in recent weeks. Enterovirus D-68 has made its way across the nation, causing severe cold-like symptoms, and, in some children with conditions such as asthma, the need for hospitalization. There’s also a potentially new contagion on the horizon that appears to cause varying degrees of muscular paralysis, and may or may not be related to Enterovirus D-68.

But, as public health officials are eager to stress, a nuanced and thoughtful approach to these issues has been as necessary as it has been fleeting. Experts agree that our medical infrastructure is well-equipped to handle even a virus as scary as Ebola, and some doctors are quick to point out that viruses like respiratory syncytial virus (RSV) and influenza are much more likely to cause harm than these new ones.

This raises a critical point:

Ebola, as scary as it is, poses a relatively minor threat to the United States; and the current cases of Enterovirus D-68 are far out-numbered by the RSV and influenza cases we experience on a yearly basis. And the currently unknown contagion that appears to cause paralysis has only happened in a very small population of kids.

So why the massive reaction in the media and among worried parents? Intellectually, at least at this point, all indications point to little danger for our children and ourselves. Why, then, do we get so frightened?

Well, let’s start with this confession: We’re frightened.

Sort of.

We know, intellectually, that the threat is minor. But, when has intellect played a leading role in the emotionally driven process of threat assessment? And, especially with regard to infectious disease, when has anyone other than the most statistically driven scientists been able to preserve perspective? We’re not saying that we should massively worry, or even that we’ll be changing our instructions to our kids or our patients on how to behave with these new bugs dancing around.

What we’re saying is that germs, especially new germs, are scary. We have a long and probably evolutionarily derived tendency to fear disease, and when new ones rear their heads, we get alarmed.

Germs In Hollywood

As a society, we think about germs a lot — and nowhere, perhaps, does that play out more than in Hollywood. The 1954 novella “I am Legend” has been made into no less than three movies (“The Last Man on Earth,” “The Omega Man” and the more recent movie of the same title as the written work). You can rattle off other movies as well — there’s “Dawn of the Dead” (in 1978 and again in 2004), “Outbreak,” “Carriers,” “Contagion,” “The Crazies” (in 1973 and again in 2010),

“Quarantine” (and “Quarantine 2”) and most recently “World War Z.” You get the picture. Continue reading

Are Young Women With Cancer In One Breast Needlessly Having The Other Removed?

Are young patients with cancer in one breast, driven by unfounded fears and anxiety, having the other breast removed unnecessarily?

That’s the troubling question implicit in this new survey of women 40 or younger who chose to undergo double mastectomies even though their cancer was only in one breast. The procedure, called contralateral prophylactic mastectomy (CPM), has increased “dramatically” in recent years, particularly among younger women, researchers report.

But evidence suggests that the removal of a healthy breast in a woman with cancer in only one breast does not improve survival rates.

TipsTimes/flickr

TipsTimes/flickr

Still, researchers from the Dana-Farber Cancer Institute and colleagues report that more and more young women with breast cancer are electing to remove their healthy breast to “avoid recurrence and improve survival.”

Specifically, the study found that among 123 women surveyed, 98 percent said they chose CPM to avoid getting cancer in the other breast and 94 percent said they did it to improve survival. (Also of note, 95 percent said they did it for a more nebulous but emotionally potent reason: “peace of mind.”)

If you’ve had breast cancer, or know anyone who has, it’s easy to see why such a subjective, non-data point like “peace of mind” might trump a more rational, just-the-facts approach to treatment. But this paper, published in the Annals of Internal Medicine, points to what it calls the “cognitive dissonance” between what women know to be the facts and what they actually do.

“Many women overestimate their risk for actual cancer in the unaffected breast,” the paper says, concluding that: “Interventions aimed at improving risk communication in an effort to promote evidence-based decision making is warranted.” Continue reading