Yesterday I received an intriguing report whose purpose was to point out the very real risks in taking medications
as part of a preventative or disease management regimen. The article
researched the risks of various 'voluntary' activities: non-critical
medical therapies, job and transportation choices, and hobbies, and
computed the comparative risk of fatality (in annual deaths per 100,000
persons engaging in these activities for an average length of time each year).
Some of the data are shown in the upper part of the chart above. These data are global averages, and clearly the danger varies greatly
according to your place of residence and work, your age, current health
and other variables. Nevertheless, it was an interesting illustration
of the degree to which we mentally miscalculate the risks we face in
our everyday lives, seeing some things as much safer than they really
are (e.g. firefighting) and other things as much more dangerous than they really are (e.g. drowsy driving).
I've written about this before, reviewing Gladwell's article on Learned Helplessness, and I concluded then:
This delusion of danger, and the illusion that something can or
has to be done, that someone -- British cows, Canadian farmers, Chinese
cats, Firestone, Saddam Hussein -- must be brought to account in order
to give us back control, is literally making us all crazy. It causes us
to believe we cannot let children out of our sight even for a moment.
It causes us to wildly change our diets, to avoid visiting whole
countries, to fingerprint whole nations of visitors, to suspend civil
liberties, to put barbed wire around our communities, to drink only
bottled water, to wear masks, to introduce five levels of increasingly
hysterical 'threat' to everyone's safety.
So, for example, insurance company stats show your risk of
fatality is significantly lower in a convertible than in an SUV,
because (a) the convertible is more agile than the clumsy, overweight
SUV, so it can avoid accidents the SUV can't, and (b) since you feel
safer in the SUV, you tend to drive more aggressively in it.
Nevertheless, people continue to buy SUV's as 'safe' vehicles and shun
convertibles as 'unsafe'.
Since we seem somewhat preoccupied these days with infectious
diseases, I thought I would add the comparative data (as best as I can
determine it -- data for some countries is iffy and diagnoses sometimes
overlap and are often wrong) for the top 7 groups of infectious
diseases. The results are shown in the lower part of the chart above.
A number of obvious conclusions:
- The chances of dying from any of these things (unless you commute to
work by motorcycle) is very small, at least in affluent nations.
Worldwide, you are twice as likely to die of cancer (ten times as likely if you live in an affluent nation) and twice as likely
to die from heart disease (ten times as likely if you live in an affluent nation) as from lower respiratory infections, the #1
infectious disease group.
- The
chances of dying from murder, war or
suicide varies enormously between demographics, from near the top of
the list (for a few geographic areas and age groups) to negligible (for
everyone else). As most of us know, if you are murdered, it's almost
certainly by someone you knew well and who you considered very capable
of murder, rather than by some crazed suicide bomber or terrorist. The
US has spent, in recent years, a trillion dollars in a futile 'war on
terror', ostensibly to reduce the risk of terrorist attacks on the US.
The amount it has spent on the the much higher risks in the chart above
is paltry by any standard.
- In struggling nations, or if you're poor, the chances of dying from
the infectious diseases above rises dramatically, by a factor of 10 or
more.
- As I said yesterday, don't take medications you don't have to.
- You have a lot more control over the risks you face than you think.
Alert driving (i.e. not driving when you're sleepy; not using a
cell-phone or fooling with your radio or mp3 player while you drive;
not being distracted by others in the vehicle) reduces the risk by at
least 75%, far more than any combination of safety devices. Most of our
learned helplessness is illusory, and plays right into the hands of
politicians, preachers, fearmongers, marketers and corporatists.
- It is no accident that we have no idea where to put very profitable
(politically and/or economically) hazards on this chart, because the
data is unavailable: consumption of foods, medicines and cosmetics full
of toxins and untested ingredients, the toxins we use in our homes and
yards, chronic exposure to air and water pollution, staying in an
abusive family etc. If we could isolate these data, I'm sure they would
rank near the top of the list. But if we found that most cancers, heart
diseases and immune system related deaths were due to agricultural and
industrial toxins (picture a bar at the top of this chart twice as long
as the motorcycle commuter one) what would we be prepared to do about
it?
Although bioterrorism risks aren't on the chart (and throughout
history, as deadly as war is, it rarely catches up to disease as a
killer) there's a new book that lists the seven most deadly
potential bioterrorism diseases (anthrax, botulism, hemorrhagic fever,
plague, radiation poisoning, smallpox and tularemia). That's because
there's no ready antidote to any of them, and because, if weaponized,
they could spread rapidly and be extremely virulent (read Richard
Preston's
Demon in the Freezer). Even more deadly (perhaps 100% fatal), but even harder to harness, are the prion diseases (like mad cow and CJD). It
there a real risk here? Of course, but for all kinds of reasons it's
improbable, like the equally potentially catastrophic but
low-probability threat of an earthquake on the Eastern North American fault lines. And if bioterrorist activity happens, you can bet it will be an inside
job, and probably small-scale. Risk = consequence x probability. Low
probability, low risk, no matter how horrific the consequences. We
could also be invaded by aliens, or struck by a meteor, tomorrow, but
it is foolish to lose sleep over it.
When it comes to infectious disease, however, more sizeable
threats are the candidates in the 'emerging diseases' lottery that
suddenly emerge or re-emerge every year. Our arsenal against these diseases is
dwindling rapidly as we exhaust more and more classes of antibiotics
and antivirals -- these clever, adaptive creatures can mutate much
faster than our science can keep up with them. The size of the
candidate list is impressive: dengue, e coli, flesh-eating disease,
hantaviruses, hep C, lassa, lyme disease, meningitis, MRSA, mumps,
nipah, salmonella, SARS, West Nile, as well as the endemics we
currently seem to have under some control: AIDS, influenza, malaria and
TB. A little bit of nature's ingenuity and any of these could evolve
into a new, virulent, resistant strain that could jump to the top of
the chart above.
If there's any justification
for learned helplessness, it's these
little bugs. If we continue to sit by and allow industry and
agriculture to poison us and destroy our immune systems, and continue
to help
diseases morph in new and dangerous ways by our reckless and
extravagant use of antimicrobials, we'll soon be justified in feeling
helpless. That's why I'm so interested in pandemic preparedness: It's
only a matter of time, and worldwide we know so little and are still so
unready.
Until
then, we have no excuse for learned helplessness -- if we really want
to live in
a world that is healthy and safe, we need to stop the politically
expedient
and insanely expensive distractions of the 'war on terror' and the 'war
on drugs' and the 'war
on crime' and focus on the real, and very controllable risks, we create
for ourselves: cleaning up our planet, taking responsibility for our
own (and our loved ones' and community members') health and safety,
putting corporate polluters behind bars and shutting them down, and
making it easier to eat right, easier to know when we shouldn't be
driving or working, and easier to know when medical treatments are more
dangerous than the disease.
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MADE IN CANADA
trust your
instincts 
