Map of life expectancy at birth from Global Education Project.

Monday, August 03, 2009

The social amplification of risk

It isn't news that I'm interested in why people worry about unlikely event A more than they worry about more likely event B, when B may be just as bad or even worse than A. I told you that I was going to run a focus group to explore this question, so here are some thoughts based on that experience and current events.

The group consisted of blue collar and middle income white people (the study is focusing on cultural factors in risk perception so we're doing the ethnic groups separately), all of whom live in a densely populated inner suburb. I began just by asking people what they worried about, what fears they had as they went about their lives. The first item anybody mentioned was terrorism -- the government isn't effective in protecting us from wackos who want to blow stuff up. From there, people mentioned all sorts of things: cancer and Alzheimer's disease, basically because they had close relatives who were afflicted; a young man saw his acquaintances get involved with drug trafficking and dropping out of school; a former housing authority employee was worried about indoor air pollution, because she'd had responsibility for public health and she knew all about it (her bosses hadn't kept the properties up to code, BTW, no surprise there); one guy said he didn't worry about much but he was afraid the blight was going to get his tomatoes.

So we had two categories of worry: events people had seen more or less firsthand, and dangers they had seen discussed on television or in the newspapers. Oddly, the woman who was worried about indoor air pollution smokes cigarettes, as does one of the people with fear of cancer. Cancer and Alzheimer's are quite prevalent, but heart disease is even more likely to affect the average person, and no-one mentioned it. Obviously it's impossible to say what the probability of a terrorist attack somewhere, somehow might be, but I think it's safe to say that the probability of terrorism affecting this guy personally, even quite remotely, is extremely small.

There are many factors that influence people's perceptions of risk. One of the most important is whether we have control over them, or at least perceive that we do. That's why it isn't surprising that nobody mentioned motor vehicle crashes, since we feel we are control because we or somebody we trust is driving; and that people can worry about indoor air pollution while aggressively polluting the indoor air, particularly the air inside their own lungs.

But one of the most powerful factors is social amplification of risk. Worries can be contagious, and rapidly infect people within a social group. In modern society, the mass media are by far the most powerful carriers of contagion. We should have learned our lesson from the Summer of the Shark, but no such luck. "Pandemic" influenza has come along to create another misleading, damaging media feeding frenzy.

Are swimmers occasionally attacked by sharks? Is there a novel strain of influenza going around? Yes and Yes. And? What happens in these situations is that perfectly commonplace events or facts, of minor significance, that ordinarily would never be mentioned in news coverage, suddenly become "news" simply because they have some relationship to the fad. This often seems to happen at random but it can also result from an organized campaign by people with a vested interest. The Summer of the Shark appears to have been an instance of the former. The flu frenzy, alas, is not so innocent.

The fact is that the currently "pandemic" strain of H1N1 influenza behaves in a perfectly ordinary way. In terms of pathogenesis it is no more dangerous than the flu viruses that go around all the time; nor is there any evidence that it is more contagious or is likely to cause unusually widespread disease, at least not outside the range of ordinary fluctuations. But you very likely have a different impression.

As the virus first began to spread in the United States, the leading story on the TV news every night was the identification of some number of new cases. I remember quite distinctly one of our local talking heads reporting that three people in New Hampshire had been diagnosed with H1N1 flu, and were recovering at home. Then, of course, if a death was ascribed to the horrificdangerousdeadlyswineflu it would result in screaming headlines and half the minutes on the network news. Supposedly progressive Internet public affairs sites were no better. The swine flu was trumpeted in gigantic red headlines on the Huffington Post for weeks on end, and literally for months, it was the only public health issue ever mentioned on Daily Kos, often with two lengthy posts in a single day.

What nobody bothered to do was to put these events in any sort of perspective. In fact, the incidence of influenza and the rate of serious complications was entirely normal. If we did not have the recently acquired ability to rapidly and cheaply sequence viral genomes, nobody ever would have known that anything identifiable was happening whatsoever. The "news" was generated entirely by the act of labeling ordinary events as significant based on laboratory findings that reified the invisible.

Now as flu season progresses in the southern hemisphere, we keep hearing breathless reports about theaters closing in Argentina and mass panic in New Zealand. But guess what? The flue seasons in those countries have, in fact, been completely ordinary. Influenza has not been unusually common or unusually deadly. It has certainly been unusually disruptive, with people staying away from public places and showing up en masse at emergency departments. But if no-one had ever said anything about it, nobody would have noticed anything out of the ordinary. Some people got the flu, as always. That's it.

So how is this reported in the corporate media? Here's the headline: Argentina Experts See No Swine Flu Mutation -- Yet. So the headline implies that it is nevertheless going to happen, it's just a matter of time. And what does the story actually say?

Argentina has the most swine flu deaths outside the United States, but the virus is still killing fewer people than normal seasonal flu -- good news for a world waiting to see how it evolves in the southern winter. And despite fears that the virus will mutate and turn more deadly, genetic sequencing shows this influenza remains virtually identical to what is circulating in the U.S. and Mexico, making it more likely that a single vaccine can work around the world. With more than a month still to go in the southern winter flu season, swine flu infections have peaked in Argentina. Doctor visits by people with flu symptoms have declined sharply.

They have no vaccine, and yet they have had an event which is short-lived and less consequential than an ordinary flu season. And yet the alarmist coverage continues. A few days ago the WHO and the CDC put out alerts, which were widely covered by the corporate media in dire and alarming tones, to the effect that the H1N1 virus is particularly dangerous to pregnant women. But that is yet another non-event. All influenza strains are particularly dangerous to pregnant women. That is always true: it is not news, it is nothing unusual, it is perfectly normal.

There was another widely reported observation a week or so ago that there had been three cases of encephalitis in young people infected with the flu in Texas. But once again, that is a non-event. All influenza strains occasionally are complicated by encephalitis. This is a well-known, well-documented possibility. It is always true, it is not news, it is nothing unusual, it is perfectly normal. All three of the affected individuals in this case made a complete recovery in a few days with no lasting ill effects.

Now, there are scientists who study influenza, and it is their job to closely monitor the contagion and pathology of all the flu viruses that emerge. They are supposed to be interested in this and follow it closely. That's their job. Good for them. And there are public officials, international, national, provincial and municipal, who have specific responsibility for the response to infectious disease outbreaks who also ought to be following these matters closely and keeping their emergency plans buffed up. The problem is that their observations of routine events, which are not in any way alarming or suggestive of a major international emergency, are all being reported with excessive prominence, in misleadingly alarming terms, by mass media all over the world. That's because the experts who are supposed to be following these matters are exaggerating their importance when they talk to lay reporters whose readers do not have any reason to be so obsessed with this issue and who do not know how to put these facts into perspective.

The result is damaging overreaction. Medical systems are taxed, not because of H1N1 flu, but because people are unduly alarmed about it. Economies are damaged because of irrational travel restrictions and venue closures. People are subjected to abrogation of their freedoms, even mob violence, because of irrational fear.

Unfortunately, among the chief offenders are people who ought to know better, and who ought to be working as hard as they can to oppose this frenzy of disinformation and get people to focus once again on the public health issues that really matter. I sincerely hope that they will think better of what they have been doing and cut it out.


roger said...

oooh look. scary shiny baubles. pay no attention to the little man behind the screen. the best health care system in the universe will save us. don't mess with it or we're all doomed

kathy a. said...

terrorism is so 2001.

Cervantes said...

Yeah, I did think the terrorism thing seemed a little old. But it's still out there, obviously.

kathy a. said...

you know, many of the things people mentioned -- cancer, alzheimer's, kids getting messed up with drugs and dropping out, poor people getting "public aid" that is harmful -- those are serious problems that families deal with all the time. i'm pretty impressed. except for mr. terrorism and mr. tomato blight, it sounds like this group cares a lot about what is actually affecting their families and their communities.

these aren't fear-mongers, nor are they "me-first, to hell with everyone else" individuals. there is reason to be hopeful for humanity. and maybe even universal health care, if that was up to the little people.

Cervantes said...

Yes, it was by and large a pretty sensible group. And I'm sorry to have to say that the tomato blight is real. I've been spared so far but from what I read, I may have the only tomatoes in New England this year.

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