H
FIVE RISKS
WORTH
THE WORRY
Dr. T.E. Hol T’S
SHor T lIST of
TrUE lIfE-AnD-
DEATH DAngErS
1
OBESITY
More than a third
of U.S. adults are
obese and at
increased risk for
early disability and
premature death.
A low-carb diet and
a reasonable exercise program, along
with an understanding doctor, are
your best allies.
2
He’s a guy in his early 40s, his cholesterol
is through the roof, and he’s telling me, “I don’t want to
take that stuff.” • He has a printout from some website
saying that a drug he’s on—one of the more widely used
cholesterol busters on the market—causes everything
from memory loss to erectile dysfunction. And even
though the evidence behind all of this is less than
robust, he doesn’t know that. He’s just scared. • “Well,”
I say, “your dad had his heart attack at 45. You know
what it’s like to go that way.” • “I know,” he says. “But
do we really have to do this?” • Do we? It’s a great question—one that doctors often skip over in the space
between testing and prescribing. How much of a risk is
his elevated cholesterol? • If I had to tell the truth, I’d
have to say, “I don’t exactly know.” • If there is any single
word that has come to dominate the way we talk about,
think about, and worry about our health, it’s risk. Risk
is the single most important concept influencing the
choices all of us—doctors and patients—make every
day. • To judge by what’s in the news, we should worry
about risk a lot. We should worry about radiation from
cellphones, nitrosamines in cold cuts, electromagnetic
fields emanating from electric blankets. I could go on,
but I don’t need to: You’re already extending the list all
by yourself, from bisphenol A in plastic water bottles to
insufficient zinc in your diet to anything else that happens to be in your personal catalog of dread. Flesh-eat-ing strep, anyone? • But what are the risks, really, posed
by any of the things we’re told will do us in? Despite
most of the headline hyperbole, the honest answer is
that it’s hard to say. A lot of the more popular prophesies
of doom (the Mayan apocalypse is a case in point) are
based on math that’s slipperier than it seems.
MRSA
Antibiotic-resistant
bacteria are here
to stay. What can
you do? Wash your
hands, use antibiotics as prescribed,
and consider avoiding meat and dairy
products from livestock fed antibiotic-laced chow.
3
DEMENTIA
The odds are one
in three that you’ll
lose your mental
faculties. It’s not a
good way to go.
Your best defenses:
lifelong learning;
avoiding alcohol
abuse and head
trauma; controlling
your blood pressure, blood sugar,
and cholesterol.
4
DISTRACTED
DRIVING
If you’ve been pay-
ing attention on the
roads lately, you’ve
probably noticed
a lot of other driv-
ers who aren’t.
Drive defensively.
5
LOSING YOUR
HEALTH-CARE
COVERAGE
The state of things
may improve soon,
but at the moment
you still have about
one chance in five
of living this very
bad dream.
WE’RE ALL TOLD THAT DEATH IS CERTAIN
(and it is), but even with something that ought
to be as clear-cut as dying, it turns out that
numbers are an unreliable guide at best.
What are your odds of dying from any single
cause? You can look them up in tables compiled
from government statistics, like the “Death of
You” chart in this article. It’s a great table, full
of numbers, which most of us assume to be
facts. But these statistics are no better than the
data behind them. And in the case of U.S. mortality statistics, that data is weak indeed.
Much of what we know about causes of
death comes from death certificates. But where
does the information on death certificates
come from? When people die outside the hospital, as most of us do, the cause of death
recorded on the death certificate is often an
educated guess—based on the published statistics about common causes of death. Statistics
derived, that is, from death certificates.
You can already see what kind of trouble
we’re in.
But even if we want to believe that lists like
this are totally based in reality, they’re still
probably wrong, at least insofar as they apply
to you. They’re probably wrong because the
relationship between statistics and any individual is always shaky.
If you live in Oklahoma, for instance, your
chance of dying in a tsunami is considerably
less than it would be if you lived in Japan. People who live in Manhattan don’t drive as much
as Angelenos do, so they’re less likely to die in
a car wreck. Your risk of dying by gunshot
depends largely on whether you have a gun in
the house, and you’re far more likely to be murdered in Texas than in Massachusetts. The
threat posed by pretty much every cause of
death, with the possible exception of asteroid
impact ( 1 in 500,000 odds, claims one website),
varies for each individual, depending on genetics and/or environmental influences.
People are different. Researchers use statistics primarily to overcome this inconvenient
fact, because we’re usually trying to ferret out
some hidden chunk of similarity that might
reveal the fact that, say, balding guys with spare
tires have more heart attacks. But even if we
find evidence to that effect, does it mean your
receding hairline and advancing girth spell certain doom? They spell doom about as well as a
compendium of baseball stats predicts the winner of the World Series. The proposition that
statistics are destiny is ludicrous; if that were
true, every sportswriter in the country would be
getting rich in Vegas. But the most important
fact about statistics has nothing to do with how
predictive they might be. It’s the way we cling
to them in the face of this obvious fallacy.
Why do we do that? Maybe because the
alternative to believing a myth is something
even worse.
I’VE KNOWN HIM FOR SEVERAL YEARS—
a healthy guy with a few minor chronic problems,
too busy with a growing real estate business and
a house full of kids to see me regularly. But he
came in last week because he’d been having dizzy
