MRSA is a worldwide problem. In the U.S. alone at least 19,000 people die every year because of it. 100,000 more become infected with a disfiguring, disabling, life-altering MRSA-caused disease. And studies in the U.S. and Canada show the problem increased 17-fold over an 11 year period beginning in 1995. Yet neither government nor the public seems concerned. Why is that?
Daniel Kahneman is a 77 year old Israeli psychologist. He won the Nobel Prize in Economics in 2002 for explaining the wayward thinking that is behind poor economic decision making. He was presented with the American Psychological
Association’s Award for Outstanding Lifetime Contributions to Psychology in 2007. And his life’s work was turned into his 2011 New York Times best-selling book Thinking, Fast and Slow.
Our problem, says Kahneman, is that we “think” too emotionally and quickly and as a result we get important things wrong: often times it is the fear factor at work. That explains why we are afraid of certain kinds of well publicized but low probability risk but indifferent to more objectively dangerous but less probable ones. Murder, accidents, and terrorism get headlines. Diabetes and asthma don’t. So you are more likely to be afraid of the first 3 despite them being far less likely to affect you. Studies show that people judge deaths by accidents to be more than 300 times more likely than deaths by diabetes, but the true ratio is 1:4. And while death by disease is 18 times more likely than accidental death people judge the two as being about equally likely.
Kahneman calls this the “availability heuristic.” It means that we assess the relative importance of issues by the ease with which we can think of examples of them. Therefore the more dramatic an event, the more vivid the imagery associated with it, the more it’s attached to celebrity, and the more it’s replayed in the media, the easier we can retrieve examples from our memory. The most recent example of this is Asiana Flight 214 that crash-landed in San Francisco this past Saturday morning killing 2 and seriously injuring dozens more. Such a remarkable event, easily retrieved from the memory bin, is what causes us to grossly exaggerate the frequency and dangerousness of events – like travelling by air. Importantly, it’s not just the public that falls prey to this kind of thinking, our government decision makers do too, and perhaps no more so than in the context of terrorism.
We are more likely to drown in a bathtub than we are to die from a terrorist attack. However, since 9/11, life in the United States has been turned upside down, including the way in which the federal government allocates funds in an effort to deal with this perceived risk. There was a shift of tens of millions of dollars of federal research money since 2001 away from pathogens that cause major public health problems to obscure germs that the government fears might be used in a bioterrorist attack. So much so that according to a 2005 report in the New York Times, 758 scientists including 2 Nobel Prize winners petitioned the U.S. Government’s National Institutes of Health saying grants for research that cause anthrax and 5 other diseases that are rare or non-existent in the U.S. have increased 15-fold since 2001. Over the same period grants to study bacteria not associated with bioterrorism including those associated with tuberculosis and syphilis have decreased 27 per cent. One of the petitioners, Sidney Altman, a scientist at Yale, who won the Nobel Prize in chemistry in 1989, said that while a risk of bioterrorist attack existed he considered it “a very minor factor” among all the risks faced by the nation.
So given all of this, what chance does MRSA and its cousin pathogens have of capturing public imagination and government health care dollars? On the face of it not a lot, however, there is an important precedent in the history of infectious disease that suggests otherwise.
In 1981 another then unknown disease was making its way into the United States: HIV/AIDS. The Centers for Disease Control dubiously labelled it the “4H disease” because it affected Haitians, homosexuals, heroin users, and hemophiliacs. The stigma resulted in horrific behavior towards a suspected carrier: they’d be subject to compulsory testing, mandatory quarantines, and violence. If you had it you were scared to tell anyone, health care workers quit their jobs rather than risk infection while treating someone who had it, and government treatment programs and research dollars were virtually non-existent. The word AIDS became a code word for any shameful malady. And if you got it, you died. Yet today, HIV/AIDS is no longer a death sentence. People have it and lead full lives. There is much more public understanding and acceptance, and there’s government support for programming and research.
There are several reasons for the turn-around but one event in particular drew the attention of University of Central Florida social scientist Philip Pollock: In 1991 Magic Johnson told the world he was HIV-positive. What had been stigmatized as largely a “gay disease” now had a very different face. Pollock wanted to know if Magic Johnson’s public acknowledgement mattered. This fit nicely into Pollock’s interest in how you go about changing the public’s perception of issues. What he found was that immediately after the announcement and again 10 months later the public “constructed” their view of AIDS more positively, and that included a 15-point increase in support of AIDS spending. Pollock says that intense, public, value-laden communications, or “critical moments,” are of key importance in changing public awareness and opinion of issues.
This is exactly what Kahneman is saying. The flip side of dramatic personal testimony constantly played out in the media is marshalling statistics about obscure-sounding Latin-named pathogens. No matter how strong the numbers are the public and our representatives in government can’t “hear” them: that’s just human nature, says Kahneman. As he puts it, “the world in our heads is not a precise replica of reality.” In other words, it’s not just the pathogens that we have to confront it’s also the flawed way in which we think about them.
It’s only a matter of life and death.