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INTERVIEW //

Should I Be Worried?

Risk expert David Ropeik argues that despite constant headlines, Americans’ health worries are largely misplaced.

By Linda Keslar // Winter 2009
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David Ropeik

Christopher Churchill for Proto

Despite headlines about salmonella outbreaks, the health risks of cell phones and the threat of a flu pandemic, this isn’t a particularly hazardous time for most Americans, says David Ropeik, an independent risk consultant and former television reporter who lives in Concord, Mass. Still, he admits, our anxiety about such threats isn’t surprising, given humans’ highly evolved survival instinct. But unlike our ancient ancestors, who knew when to run from predators and when it was safe to run after them, today we face what seems to be an endless stream of risks we find difficult to assess. Ropeik, who co-wrote the 2002 book Risk: A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You, argues that Americans’ health worries are largely misplaced.

Q: Don’t people have good reason to be worried when there’s a new headline every week about another potential threat?

A: It’s an oversimplification to say people worry too much. But it’s true that the way people assess risk isn’t wholly rational, and as a result we may be too afraid of lesser risks and not concerned enough about bigger ones.

Q: What are some examples of this misperception?

A: The greater the potential pain and suffering, the greater the fear, regardless of the odds. We consider cancer an excruciatingly painful way to go, so we fear it more than heart disease, even though heart disease kills 20% more people than cancer does every year. Feeling that we can exert control over a dangerous situation also matters; it’s why we fear plane crashes more than car crashes, despite the fact that cars are vastly more dangerous. After September 11, many people were terrified to fly and decided to drive instead. During the six months after 9/11, according to studies at the University of Michigan and Cornell, roughly 1,000 more people were killed in motor vehicle crashes than expected in that time period.

Q: Is the media exacerbating our fears?

A: The media is a reflector and a magnifier of human nature, but not a creator; whatever instinctively feels more worrisome to you or me seems like a better story to journalists because greater worry generates more attention. And in turn, when something worrisome is in the news, it’s higher on our radar screens.

Q: You also say it’s simply our nature not to fret about chronic concerns.

A: That’s right. Heart disease, for example, is the result of actions—eating one cheeseburger, smoking one cigarette—that, individually, aren’t especially dangerous but when repeated throughout the years can have deadly consequences.

Q: So if the media can’t change how people react, can the health care system?

A: It can, and must, impress upon the public the danger of the big killers: heart disease, cancer, stroke and diabetes. But the health care system must tackle another major challenge: to communicate more effectively the risks the system itself poses. I’ve had eight surgeries and I find that hospital staff pay woefully little attention to how they communicate. A friend had to take radioactive medication after her thyroid was removed. She was not told that those treating her would be wearing full lead suits or that the big black pill she had to take would be carried to her in a heavy metal canister and would be handled with special tongs. This protocol suggested there was something scary inside that pill, which caused her a lot more worry than the information she had been given.

Q: You’re also concerned about the multiple-page consent forms patients must sign before surgery.

A: Consent forms are the antithesis of good risk communication. They are largely a list of possible negative outcomes, and patients simply don’t read the whole form. The wording should be changed to make the information not only clearer but also relevant to patients’ emotions. A simple phrase such as “As you consider the trade-off between the risks and benefits of this procedure” makes the patient feel that the person who wrote the form is on their side; that feeling could prompt the patient to pay more attention and be more likely to supply correct information, which in turn could reduce medical errors. That is key, because such errors pose an enormous risk: They cause more deaths each year than automobile accidents, breast cancer or AIDS.

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