more likely. I don’t think my patient has Guillain-Barré syndrome. I think he’s experiencing
pins and needles because he’s hyperventilating.
But there’s another fact that keeps me from
dismissing this man’s fears altogether: Influenza
vaccines do indeed increase the risk of Guillain-Barré—adding maybe another one in 10 million
chance of dying. The difference in these odds is
the reason why getting the influenza immunization should be a no-brainer. But that’s not the
question here: When there’s a chance of somebody dying, even at one in 10 million against,
I can’t ignore it entirely.
It wasn’t Guillain-Barré. And the year after,
when he showed up again for his immunization,
he was able to laugh at himself over his earlier
panic. But as I chuckled with him I couldn’t suppress a brief chill: There’s another, darker question lurking behind this story. I know that the
worry about vaccination side effects is blown out
of all proportion. But still, with the influenza
vaccine as with almost every medical treatment,
we balance the potential for harm against the
good. When the odds are great enough, we recommend a certain treatment, knowing that in a
rare case, instead of saving a life, that treatment
will kill. We accept the sacrifice of the one in
order to assure the survival of the many.
The problem is you never know which group
you’re going to be in. Sure, in this case the odds
are 50 to 1 in your favor. Those are great odds,
but that’s not the same as a guarantee. There are
no guarantees, just as there is no shelter from
our mortality: Your choices are to risk flu or
Guillain-Barré, and no third, safe option exists.
More Than Meets the Eye?
HOLD THIS IMAGE AT ARM’S LENGTH AND
SQUINT YOUR EYES. SEE THE PATTERN?
THERE ISN’T ONE, BUT YOUR BRAIN WILL
STILL TRY TO IMPOSE ORDER ON CHAOS.
174 OCTOBER 2012 MEN’S HEALTH
THE THING ABOUT THAT ECHO CHAMBER
between the medical journals and the world at
large is that it’s dark in there, and some of the
monsters are real. No matter how hard scientists try to shine a light, there will always be
shadows lurking in the corners. We can never
really know—not finally, not certainly—just
what exactly is going on.
You couldn’t find a better breeding ground
for imaginary monsters. As if we needed more.
So what do we do? How do we decide what’s
best, who to listen to, which risks to avoid, and
which ones we must accept? One answer may
be to recognize that risk isn’t entirely a matter
of statistics. It’s also a state of mind.
The psychology of risk perception has been
studied extensively, and reviewing the research
suggests a few things about our reactions to risk
that can help us recognize when there’s something we need to look out for, and when we’re
just being spooked by our own uncertainties.
Several factors hype our perception of risk.
Lack of control is a big one: We feel more vulnerable when we can’t steer. We know that
we’re safer in a commercial airliner than we are
driving down the interstate—but how many of
us take a deep breath every day before backing
out of the driveway, wondering, What if this is
the one that crashes?
Another factor that intensifies our sense of
peril: We don’t trust what we don’t understand,
and we tend to become inordinately alarmed
by what we can’t see. Science and technology
generally scare us out of proportion to reality,
especially when they deal in things invisible
to us. This fear of the mysterious—radiation
from your phone, mad cow disease in your
hamburgers—seems to invoke the same primal
dread as what we can’t control because our
blindness renders us helpless.
Sometimes the only thing that hypes our
fears is hype itself. In the constant churning of
the news cycle, as more and more media outlets compete for our divided attention, the
old front-page logic of “if it bleeds, it leads” is
more powerful than ever. Some research has
suggested that our increased exposure to scary
news is why most of us tend to overestimate
our own risk of winding up as victims in what
we know are actually rare events, like airplane
crashes or acts of domestic terrorism: There is
a publication bias in favor of stories about
these events that gives them an exaggerated
presence in our imagination.
The flip side of these fears is a tendency to
underestimate risk. Anything we understand as
“natural,” for instance, often slips under our
radar. This may be part of the reason why after
last year’s tsunami disaster in Japan we continued to pay so much attention to the malfunctioning nuclear plant (where the radiation
didn’t kill anybody), instead of the aftermath of
the tsunami (which killed thousands).
We’re also less likely to worry about situa-
tions we’re familiar with—which is why driving
on the highway seems so deceptively safe. One
of the most striking findings in research about
how we perceive risk is that certain situations
cause us to deny risk entirely. These tend to be
the really big threats that we feel helpless to
change or where the effort of avoiding them
is high, which may explain why concerns about
global warming have been such a hard sell in
some quarters.
HE’S AN ONCOLOGIST—ONE OF THOSE
guys who wakes up every morning to do battle
with the Reaper in all his meanest forms—and
he’s close to tears. He just lost a patient, and
while that’s always hard, what really has him so
rattled is something else.
“I told him what the probabilities were,” he
says, staring into his coffee. “I told him the odds
got worse with every treatment failure. But he
just couldn’t believe it. He was sure he was going
to be one of the lucky ones.”
My friend glances up from his coffee, but he’s
not looking at me. “Even at 20 to one against,”
he whispers.
WE GENERATE A LOT OF NUMBERS IN
medical research. In the end, what they all
come down to is some estimate of the odds:
chance, not certainty. In the face of the incredible complexity of human physiology and disease, we have no other tool to help guide our
decisions. But these numbers conceal as much
as they reveal. For medical consumers and
practitioners alike, they can blind us to essential realities, foremost among them the limits
of medical knowledge.
We see this in our own use of statistics, how
seductively they lead us to say things like “The
studies say you have a 70 percent chance of
survival.” But the studies don’t actually tell us
this. Statistics tell us nothing about the individual. They can predict the behavior of large
groups, and that’s all.
There’s a 40 percent chance of rain today
over our forecast area, but does that tell me if
I’m going to get wet? Being 40 percent rained
on isn’t an experience any of us has to worry
about. Neither is being 30 percent dead.
What it comes down to in the end is that the
numbers aren’t really the point. Life is, after
all, a series of gambles. How lucky do you feel?
If you’re the kind of guy who wouldn’t bet it
all on an inside straight, then don’t bet your life
on something that might blow up in your face:
Play a cautious game and do the sensible things
your doctor tells you. But remember that there
are no guarantees.
And all that scary stuff you keep hearing
about? It’s tempting to hide in our beds—as if
that were an option. You’re already in the game:
Every time you turn the key in your car, invest
in the market, or fall in love, you’re taking a
chance. Considering how deep you’re in it
already, are you really going to worry about
something with less of a chance than, say, coming up against a hand holding all four aces? Do
you feel that unlucky?
In that case, it might be safer to go back to
bed. But if you do, remember this: The vast
majority of deaths occur in bed. Really. You can
look it up. j
The identifying characteristics of patients described in this essay
have been altered to protect privacy. Any resemblance between such
descriptions and any individual, living or dead, is a coincidence.
