Yesterday I received an intriguing report whose purpose was to point out the very real risks in taking medications as part of a preventative or disease management regimen. The article researched the risks of various ‘voluntary’ activities: non-critical medical therapies, job and transportation choices, and hobbies, and computed the comparative risk of fatality (in annual deaths per 100,000 persons engaging in these activities for an average length of time each year). Some of the data are shown in the upper part of the chart above. These data are global averages, and clearly the danger varies greatly according to your place of residence and work, your age, current health and other variables. Nevertheless, it was an interesting illustration of the degree to which we mentally miscalculate the risks we face in our everyday lives, seeing some things as much safer than they really are (e.g. firefighting) and other things as much more dangerous than they really are (e.g. drowsy driving). I’ve written about this before, reviewing Gladwell’s article on Learned Helplessness, and I concluded then:
So, for example, insurance company stats show your risk of fatality is significantly lower in a convertible than in an SUV, because (a) the convertible is more agile than the clumsy, overweight SUV, so it can avoid accidents the SUV can’t, and (b) since you feel safer in the SUV, you tend to drive more aggressively in it. Nevertheless, people continue to buy SUV’s as ‘safe’ vehicles and shun convertibles as ‘unsafe’.
Since we seem somewhat preoccupied these days with infectious diseases, I thought I would add the comparative data (as best as I can determine it — data for some countries is iffy and diagnoses sometimes overlap and are often wrong) for the top 7 groups of infectious diseases. The results are shown in the lower part of the chart above.
A number of obvious conclusions:
Although bioterrorism risks aren’t on the chart (and throughout history, as deadly as war is, it rarely catches up to disease as a killer) there’s a new book that lists the seven most deadly potential bioterrorism diseases (anthrax, botulism, hemorrhagic fever, plague, radiation poisoning, smallpox and tularemia). That’s because there’s no ready antidote to any of them, and because, if weaponized, they could spread rapidly and be extremely virulent (read Richard Preston’s Demon in the Freezer). Even more deadly (perhaps 100% fatal), but even harder to harness, are the prion diseases (like mad cow and CJD).
It there a real risk here? Of course, but for all kinds of reasons it’s improbable, like the equally potentially catastrophic but low-probability threat of an earthquake on the Eastern North American fault lines. And if bioterrorist activity happens, you can bet it will be an inside job, and probably small-scale. Risk = consequence x probability. Low probability, low risk, no matter how horrific the consequences. We could also be invaded by aliens, or struck by a meteor, tomorrow, but it is foolish to lose sleep over it. When it comes to infectious disease, however, more sizeable threats are the candidates in the ’emerging diseases’ lottery that suddenly emerge or re-emerge every year. Our arsenal against these diseases is dwindling rapidly as we exhaust more and more classes of antibiotics and antivirals — these clever, adaptive creatures can mutate much faster than our science can keep up with them. The size of the candidate list is impressive: dengue, e coli, flesh-eating disease, hantaviruses, hep C, lassa, lyme disease, meningitis, MRSA, mumps, nipah, salmonella, SARS, West Nile, as well as the endemics we currently seem to have under some control: AIDS, influenza, malaria and TB. A little bit of nature’s ingenuity and any of these could evolve into a new, virulent, resistant strain that could jump to the top of the chart above.
If there’s any justification for learned helplessness, it’s these little bugs. If we continue to sit by and allow industry and agriculture to poison us and destroy our immune systems, and continue to help diseases morph in new and dangerous ways by our reckless and extravagant use of antimicrobials, we’ll soon be justified in feeling helpless. That’s why I’m so interested in pandemic preparedness: It’s only a matter of time, and worldwide we know so little and are still so unready. Until then, we have no excuse for learned helplessness — if we really want to live in a world that is healthy and safe, we need to stop the politically expedient and insanely expensive distractions of the ‘war on terror’ and the ‘war on drugs’ and the ‘war on crime’ and focus on the real, and very controllable risks, we create for ourselves: cleaning up our planet, taking responsibility for our own (and our loved ones’ and community members’) health and safety, putting corporate polluters behind bars and shutting them down, and making it easier to eat right, easier to know when we shouldn’t be driving or working, and easier to know when medical treatments are moredangerous than the disease. Category: Our Culture
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You’re interested in pandemic preparedness: It’s only a matter of time, and worldwide we know so little and are still so unready. I wonder what’s your take on this: http://www.newfluwiki2.com/upload/UK%20pan_response2.pdfThere’s a conversation at http://newfluwiki2.com/showDiary.do?diaryId=1240 and the document is being wikified at http://www.fluwikie.com/pmwiki.php?n=Opinion.UKpanResponse
Hi Dave,I like your proactive approach to this complex problem and I agree with your directions for keeping ourselves safe. However, I have a disagreement with the chart – particularly to its relevance, in this era of globalization. What I mean is that, the stats are applicable at a group level – but are no longer relevant at individual levels. Consider this. Our lifestyles have changed and is much more dynamic than ever before. We are no longer doing the same things at the same place, day in and day out. Instead, more often than not, we find ourselves in each one of those vulnerable positions, listed on the chart. So, while there is only a slight chance for any individual to die in an airplane crash – there are many more people flying in many more planes than ever before. And the same people are flying more often than before. Similarly, while people would see strangers probably once in a month or maybe less frequently, a decade or so ago, we are constantly in contact with strangers, even as part of our routine day, in our current lifestyle. In essence, we are more susceptable to any one of those dangers, because we are exposed to all of them, almost on a daily basis. While that is still not an excuse to be paranoid, it is still a cause to be overly proactive in taking preventative steps. Like you, I do believe in letting our body do what it has learned to do best after thousands of years of evolution, and that is to use its own internal mechanisms to protect it.I happened across your website by accident, but am thoroughly enjoying it.Vish Goda