How Ebola Can Help Us Vaccinate Against the Danger of Fear
I'm an Instructor at Harvard, a consultant in risk perception and risk communication, author of How Risky Is it, Really? Why Our Fears Don't Always Match the Facts, and principal co-author of RISK, A Practical Guide for Deciding What's Really Safe and What's Really Dangerous in the World Around You. I run a program called Improving Media Coverage of Risk. I was the Director of Risk Communication at the Harvard Center for Risk Analysis, part of the Harvard School of Public Health, for 4 years, prior to which I was a TV reporter, specializing in environmental issues, for a local station in Boston for 22 years.
The common definition of risk is ‘the probability of an adverse outcome or event’…in other words, the chance of something bad happening; losing your life, your health, your home, your money. The problem is, when most of us wonder ‘what’s the risk of…?” we focus too much on the probability part…the odds…the statistical chance of that bad thing happening. And the problem there is that while the odds may be calculable, “bad’ is entirely subjective, a matter of how the outcome feels, not how likely it is.
As Paul Slovic, a pioneer in the research of the psychology of risk perception, has put it, “risk is a feeling”. And the fear of Ebola is a perfect example. The news is full of dramatic stories about the outbreak in western Africa of this scary disease, The Deadliest Ebola Outbreak in History, even more so here in the U.S, now that Americans working on containing the outbreak have become victims. In the WHO information page about Ebola here’s how they describe the symptoms;
…a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.
You know, like bleeding out of your eyeballs and nose and mouth…while all that other awful suffering is also going on and your skin boils up in horrific pustules…and then you almost certainly die! Ebola is untreatable, and if you get infected, chances are good that you will die. Fatality rates in this outbreak are in the 60% range, but different strains kill as many as 90% of those infected.
Terrible suffering. No control. No hope. How does that feel? Undoubtedly pretty scary. Might it relieve your fears at all to know that the odds that you will get this disease are infinitesimal? Not only would
The chances of that are so tiny that….well, it would be ridiculous for anyone not in that region, or where public health and medical systems are even moderately well-established, to worry about it.
But worry about Ebola we do. And those worries have nothing to do with the odds of dying. The thing that matters is what if would feel like to BECOME dead. It’s the process that’s scary, more than the outcome itself. When Slovic and colleagues asked people to rank the risks they worried about most, the ones that rated highest shared these characteristics…great pain and suffering, and a lack of control. Those conditions make any risk scarier, regardless of the odds.
The problem is…our emotional relationship to risk can be a huge threat all by itself. Fear of flying - we can't control it and dying that way would be horrific - leads to driving, which feels like taking control, but which is far more likely to cause ‘an adverse occurrence or event’.
And some of the things we do to establish a sense of control against the fear of cancer, which despite much medical progress we still perceive to be a diagnosis of death by way of terrible suffering - can also do more harm than good. Women have breast biopsies, or mastectomies, after receiving diagnoses for Ductal Carcinoma In Situ (DCIS), a condition that is not actually breast cancer and sometimes goes away by itself. Men with low grade slow-growing prostate cancer, types which call for only ‘watchful waiting’ and regular check ups, have surgery or radiation treatments that run a significant risk (better than 50% depending on the patient and type of treatment) of lifelong urinary incontinence, bowel problems, or loss of libido. Elderly men go through this even when they have a form of the disease that is so slow-growing that they’ll be dead of old age long before the prostate cancer could kill them. Extensive screening for other types of potential cancers, including lung and thyroid and esophageal, lead to treatments that sometimes cause harm, for conditions that are not cancer at all, or don’t medically require more than monitoring.
The harm of Cancer Phobia is so widespread that in 2013 medical experts proposed redefining several medical conditions to take the word cancer out of the diagnosis, using “indolent lesions of epithelial origin” (IDLE) instead.
We can’t exactly come up with a new name for Ebola, and it wouldn’t do much good. It’s not the name in this case, like the word cancer, that does the scaring. It’s the disease itself, the suffering it causes and the untreatable can't-do-anything-about-it doom a diagnosis brings. But what we can do is use this outbreak to help realize how our fear is disproportionate to the probability of the risk, and realize why, and use that to diagnose another condition from which we all suffer…The Risk Perception Gap, when because of the emotional and instinctive way we perceive risk we fear too much, or too little, and do things that are risky all by themselves.
We can try to vaccinate ourselves against that. And we should. Odds are we’d all be better off.
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