Effect Measure

If your country had thousands of cases of a potentially fatal disease, spread by mosquitoes, would you panic? Not if you lived in the US, apparently. Last year there were over 4200 cases of West Nile virus infections with 177 deaths. I don’t remember panic gripping the nation. So I had to laugh when Canadian public health officials tell their citizens that with a particularly bad West Nile Virus (WNV) season underway south of the border, “There is no need to panic”:

“There’s no need to panic,” Jean Riverin, a [Public Health Agency of Canada] spokesperson, told CBC News. “Many variables need to be taken into account.”

He said that although certain provinces, such as Manitoba, have had a surge in cases in recent weeks, many parts of the country, such as Ontario and Quebec, have to date not reported any.

“It could be a good sign,” said Riverin.To date, there are 25 cases of the mosquito-borne disease in Manitoba and four in Saskatchewan. In 2006, there were 151 total cases in Canada, with 50 in Manitoba, 42 in Ontario, 39 in Alberta, 19 in Saskatchewan and one in Quebec. There were two deaths nationally. (MSN.CBC)

Let’s parse this. If there weren’t many variables to take into account, would this then be a need to panic? If Canada were having a worse season than last year, would there be a need to panic? In fact, is there ever a need to panic? Wikipedia has a serviceable definition of a panic as “the primal urge to run and hide in the face of imminent danger. It is a sudden fear which dominates or replaces thinking and often affects groups of people or animals.” Not a good thing, having an irrational fear replace thinking. It happens, of course. But it is rare. Rare, that is, except in the lexicon of public health officials who have an irrational fear that the public will panic. This irrational notion of public health officials everywhere (not just in Canada, unfortunately), dominates and replaces their thinking, affecting them in groups (called bureaucracies).

Even more unfortunate is the probable source of this irrational fear of irrational fear by public health officials: a reflexive lack of respect for the reasonableness and good sense of ordinary people confronted with a threat properly explained to them. Rather than provide a proper explanation (which the officials are convinced the public can’t understand) and to head of the inevitable panic, the threat is not properly explained, but spun, minimized and conjured away.

Departments of Public Health are misnamed. They should be called Departments of Public Reassurance. Maybe if we put them together with the “homeland security” departments, whose modus operandi is to keep us perpetually scared, we could average them and like Goldilocks, things would come out “just right.”

Comments

#1 anon
July 28, 2007

and who would determine what’s “just right”,
who would measure it when the experts refuse ?
#2 Tom DVM
July 28, 2007

Revere.

A wonderful piece of writing.

Thanks.
#3 writangl
July 28, 2007

An important topic. Peter Sandman and Jody Lanard have written eloquently about it: Fear of Fear:
The Role of Fear in Preparedness …and Why It Terrifies Officials
#4 BG
July 28, 2007

“Even more unfortunate is the probable source of this irrational fear of irrational fear by public health officials: a reflexive lack of respect for the reasonableness and good sense of ordinary people confronted with a threat properly explained to them.”

Hmmm. I would like to bat this one about. Call me a tad cynical, but I don’t have a lot of faith in the “good sense of ordinary people”, primarily because ordinary (i.e., non-science and medicine types) have a horrifyingly poor understanding of the concept of relative risk. Witness the NIMBY phenomenon involving, say, the proposed construction of a nuclear reactor outside Smalltown, USA (OK, it’s an extreme example, since none have been built in years, but it’s good for purposes of illustration). I don’t care how humbly local officials do it, they will never be able to buck the fear which “ordinary” people have that their goldfish will start glowing and their kids will die of leukemia. I don’t believe even the late Mr. Rogers could convince them that their chances of dying in a freeway crash are many times greater than a nuclear accident happening.

And, using the nuclear reactor example, why is this? I suppose one could argue that if the Three Mile Island incident had been handled differently, the nation’s psyche would not reflexively rewind to that moment when any talk of nuclear power is raised, but I think that’s pretty idealistic. I believe that ordinary people have an enormous cultural bias about scientific matters, that it’s the result of many accumulated experiences and negative messages, and it’s not going to be overcome by handling a single, specific concern the right way. This is not to say that the concerns shouldn’t be handled by giving people the straight dope, but I just don’t think that people will react as calmly and rationally as you might hope from this refreshing honesty.

And since I’m on a roll, let me throw out a more recent example which was handled oh so poorly: Andrew Speaker and his MDR-TB infection. I was at a meeting a couple weeks ago and conversed with a number of public health colleagues from years past, and the consensus was that the jittery public has an even poorer understanding now of TB than it did BEFORE the story broke. I will bet you lunch that if you stopped 10 people at random on a busy city street and asked them to rate how frightened they would be of sitting next to someone infected with TB on an airplane, most of them would be quite frightened. Maybe it was reported somewhere, but nowhere, in the midst of the uproar over this fellow’s actions, did I read a clear explanation of the differences between being infected with TB and being infectious, nor was it consistently pointed out that of the 1/3 of the world’s population currently infected, only a small percentage will go on to develop clinical disease. Translation: if they’ve flown even occasionally, the odds are that they’ve already been on a plane with someone infected with TB!

The question: because a fear of TB hasn’t been embedded in the national psyche (I hope I’m not overdoing the Freudian lingo here like that of nuclear power, is it possible that the hysteria over this incident might have been reduced or avoided if some very blunt-talking public health officials had led the charge and gotten this message out from the beginning? I’ll grant that it might have been reduced somewhat, but given the news media’s penchant for wanting to report complex problems in 45 seconds or less, you can’t convince me that “ordinary people” would largely react with “reasonableness and good sense”.

Comments?

BTW, in a small item (buried?) on p.3 of USA Today (July 27), it was reported that Andrew Speaker was discharged from the hospital.
#5 Anne-Marie
July 28, 2007

Out of all the advice I’ve been given in my life, I think the most useful quote, the one I repeat to myself most often, is the phrase that features prominently in the Hithchiker’s Guide series:
“Don’t panic.”
Thank you, Douglas Adams, for saving my sanity many times over.
#6 Tom DVM
July 28, 2007

The foundation of panic…lack of trust
#7 Lea
July 28, 2007

Your second to the last paragraph hit the nail right on the head revere.

It really is simple in my mind. Long, long ago the religious leader’s recognized that fear was great at controlling the masses.
I haven’t read Sandman’s report because again, in my mind, people have the fear reaction so ingrained within themselves through past conditioning, experiences, what the distorted media tells us, religious leader’s lies, and on and on. The mind is extremely vulnerable and easily manipulated and “officials” know this much.
Albeit there is a small group of people who know better, but the key words are small group of people. The majority of people buy right into what the government is feeding them. Again, through past conditioning, the majority of people are lazy and want someone to take care of their every need.

Perhaps deep inside the Public Health Agencies realize they can’t handle a “panic” if it did happen and therefore feel the need to put that particular message out there. Fear is a negative state of consciousness. These people are the ones filled with fear and they project it outwardly to the public. It’s very irresponsible behavior.

Nagging problems, insecurities, anger, fear, and overly emotional reactions begin to disappear when we are told the truth you see.
#8 Wayne
July 28, 2007

I live in a city close to Toronto Canada.Several years ago Toronto was visited by the Sars virus and it was International news. People became sick and some died.During the crisis each afternoon the Health Officials held a press conference and explained what the present situation was and reporters asked questions.There was almost no panic in the city during the crisis.
During the crisis 2 Toronto reporters went to a city in the US to do some person in the street interviews on an unrelated matter.They started to talk to 2 women on the sidewalk but as soon as the reporters revealed that they were from Toronto the 2 women ran away.I guess they were in a panic.If there is a flu pandemic I hope that health Departments keep the population well educated because if they don’t should I be more afraid of the virus or my neighbours?
#9 Charles Roten
July 29, 2007

Rather than provide a proper explanation (which the officials are convinced the public can’t understand) and to head of the inevitable panic, the threat is not properly explained, but spun, minimized and conjured away.

Which sets the stage quite nicely for – you guessed it, panic.

I don’t see too many examples of self-fulfilling prophecies, but this one sure fits the definition.

You start lying to people, people in the mass, about something that is capable of killing them, and it won’t take much to start them stampeding.

What you have, in effect, is a supersaturated solution of perfectly justified mistrust. When it goes through its phase change, that mistrust precipitates out. The only thing that the panicked masses know for sure is that they have been lied to. Because they know that, for sure, but nothing else, they overestimate every danger. By orders of magnitude.

The foundation of panic…lack of trust

Bingo.

Ever wonder why American conspiracy theorists are as thick on the ground as crabgrass?

I think it may be because Americans have been systematically lied to by the authorities and by the press for, literally, generations.

Conspiracy theory is a subacute form of the mass psychological disease we call “panic”.
#10 Charles Roten
July 29, 2007

During the crisis 2 Toronto reporters went to a city in the US to do some person in the street interviews on an unrelated matter.They started to talk to 2 women on the sidewalk but as soon as the reporters revealed that they were from Toronto the 2 women ran away.

The amount of misinformation in the Seattle area was nothing short of stunning. The rumor mill was cranked up to full blast.

The prostitute press was hyping the SARS story, presumably because “if it bleeds, it leads”. Nobody was telling people about the real demographic extent of the epidemic, which was utterly trifling. Even in Guangdong Province, which was its epicenter.

But in the popular imagination, people were dying of this stuff right and left.

This wasn’t a failure on the part of the public. This was an utter and shameful failure on the part of the news media, whose job it was and is to keep the public informed about matters like this.

I guess they were in a panic.If there is a flu pandemic I hope that health Departments keep the population well educated because if they don’t should I be more afraid of the virus or my neighbours?

Correct.

An uninformed population will multiply both the risks and the societal damage to the point where it dwarfs the actual impact of the virus.

But this country’s ruling elites embrace barbarism like a lover. So you can pretty confidently expect that this is exactly what will happen.
#11 Tom DVM
July 29, 2007

“What you have, in effect, is a supersaturated solution of perfectly justified mistrust. ”

Charles:

This has to be the most perfect description that I have seen. It is exactly and absolutely true.

Thanks!!
#12 Lea
July 29, 2007

An uninformed population will multiply both the risks and the societal damage to the point where it dwarfs the actual impact of the virus.
But this country’s ruling elites embrace barbarism like a lover.

Everything you said rang a bell inside and sent a shiver up the spine Charles Roten. Well said and appreciated.
#13 M. Randolph Kruger
July 29, 2007

Now you know that even as an NGO I trust them as far as I can drag a B727 full of supplies. No guarantee that there will be any supplies for me and my people to distribute but they are going to pay me a lot of money for nothing if there isnt.

Roten got this one right for sure. It will be a surrealistic world we live in if it crosses 5%. Bodies will literally be stacked up. Tennessee would have 56,000 and it would take 3 years to bury them individually working 12 hour shifts, 365 days a year. Push that on up to 30% and there wont be anyone to bury them at all.

Panic? Panic? We dont need no steenkin’ panic.

Indeed, I think that the panic will set in on the first day and be full fledged riots by the time the second week rolls around. Small communities will survive far better than the cities. Complete breakdown of civil authority in some places will occur as it did in Katrina. The looting alone will require shoot on sight orders and who knows how long it will last?

The last thing they want to do is inform the public about panflu. If they did then there would be a demand for a response on a biblical scale and that demand would have some real teeth in it. Either a chemical or nuke strike could be used to “control” it. We have obviously the nuke capabilities, but chem weapons would have to be persistent agents for them to work.

Would they use them on US citizens? The first conspiracy theory was launched by Truman when FDR and others closed him out of the loop. So they made him VP and then kept him out of the loop. Cant have a conspiracy if you are part of it. No one blinked a bit about the stolen money after we had the bomb. Nope, not one. Some called it immoral but no, nothing about the dough. And they’ve been lying to us ever since.

To quote William Jefferson Clinton, “It all depends on what is, IS.”
#14 Lea
July 29, 2007

The government solution to a problem is usually as bad as the problem.

by Milton Friedman

Therefore we are fortunate to have these blogs and other sites to educate those who are paying attention.
#15 Jody Lanard
July 31, 2007

Revere, I love the way you parsed West Nile “panic.”

Writangl — Thanks for your nice words about our “Fear of Fear” article.

Unfortunately, that is one of our pretty long ones…

I’m going to indulge myself and suggest two shorter ones that make some of the same points:

“Panic Panic” and Fear of Fear
http://www.psandman.com/handouts/AIHA/page24.pdf

Tsunami Risk Communication: Warnings and the Myth of Panic
http://www.psandman.com/col/tsunami1.htm