Risk Perception and Probability

Each day, when you take your morning shower, you face a 1 in 1,000 chance of serious injury or even death from a fall. You might at first think that each time you get into the shower your chance of a fall and serious injury is 1 in 1,000 and therefore there is very little to worry about. That is probably because you remember that someone once taught you the famous coin-flip rule of elementary statistics: because each toss is an independent event, you have a 50% chance of heads each time you flip. But in this case you would be wrong. The actual chance of falling in the shower is additive. This is known in statistics as the “law of large numbers.” If you do something enough times, even a rare event will occur. Hence, if you take 1,000 showers you are almost assured of a serious injury—about once every 3 years for a person who takes a shower every day. Of course, serious falls are less common than that because of a variety of intervening factors. Nevertheless, according to the CDC, mishaps near the bathtub, shower, toilet, and sink caused an estimated 234,094 nonfatal injuries in the United States in 2008 among people at least 15 years old. In 2009, there were 10.8 million traffic accidents and 35,900 deaths due to road fatalities in the United States. The CDC estimates a 1-in-100 lifetime chance of dying in a traffic accident and a 1-in-5 lifetime chance of dying from heart disease. But none of these realities affect our behaviors very much. We don’t take very many (if any) precautions when we shower. We text, eat, talk on the phone, and zone out while driving, paying little attention to the very real risk we pose to ourselves (and others) each time we get in the car. And we keep eating at McDonald’s and smoking cigarettes, completely disregarding the fact that these behaviors could eventually affect our health in extreme and fatal ways. On the other hand, there is zero proven risk of death as a result of the diphtheria- tetanus- pertussis (DTP) vaccine.

Conspiracy Theories

Conspiracies are mysterious. We think it is reasonable to say, even without any data to support it, that most people have never been part of a conspiracy or even known a person who has. It seems that in ordinary life getting even a moderately sized group of people who all agree on something together, finding time to meet, and then planning and actually implementing a secret operation over a long period of time would be fairly difficult. Getting a few people together to plan a surprise birthday party and keeping the plans secret until the actual event is difficult enough. Many of us believed at one point or another as we were growing up that our parents were conspiring against us, but today’s parents rarely have the time or energy for even that much underhanded activity. Nevertheless, we are routinely asked to believe that large, well-organized, and focused conspiracies exist that, in order to maximize their profits and scope of influence, have as their goal the destruction of our health and well- being. Every charismatic leader we will describe in the next chapter claims to be the victim of at least one such conspiracy. In the health and medical fields, the alleged conspirators usually include some combination of organized medicine, mainstream academic science and public health, the government, and large pharmaceutical and other companies. Even Wayne LaPierre, the leader of the National Rifle Association with its vast economic resources and ties to the gun manufacturing industry, portrays himself as the victim of a conspiracy of left-wing politicians, the media, and the federal government, all of whom, he would have us believe, are intent on denying Americans their Second Amendment rights, thereby exposing us innocent citizens to bands of marauding, well-armed criminals. According to the leaders of conspiracy theory groups, “Most conspiracies are … invisible to the vast majority of sheeplike citizens who go grazing through the pasture of life, never suspecting the evil wolves lurking behind the rocks of everyday oc¬currences” Therefore, the conspiracy theory leaders tell us, they themselves are indispensable for our very survival.

Avoidance of Complexity

Every day scores of scientific articles are published that report on the results of studies examining the causes and treatments of diseases. Each of these articles usually has five sections: 1. Abstract: an overall summary of what the paper is about 2. Introduction: an explanation of what the problem is and why the present study may offer new insights 3. Methods: a detailed account of exactly what the investigators did, usually including a statistical section in which the authors explain what mathematical tools they used to decide if their results are meaningful 4. Results: the data collected during the study (full of numbers, tables, and figures) 5. Discussion: the conclusion, in which the scientists explain the significance of their findings, what shortcomings their study had, and what should be done next to further understanding of the field in question It is hoped that other biomedical scientists and clinicians will read as many of these papers as possible so that they can keep up- to-date on the newest information. We expect that our doctors are on the cutting edge of medical science. But of course no individual can approach reading all of these papers, even if he or she narrows the field down by reading only the most relevant topics. Furthermore, scientific papers generally do not make the most gripping reading. Although editors of scientific journals expect the papers they publish to conform to proper spelling, grammar, and syntax, they place a premium on conveying scientific accuracy, not on producing page-turners. So at the end of a long day in the laboratory or clinic, what parts of a paper do scientists and clinicians actually read? The first thing to be ignored is the Methods section. A typical Methods section is full of technical details about who or what the subjects of the study were, what measurements were made, how the data were collected and stored, how informed consent was obtained if human subjects were involved, and what kinds of statistical analyses were done. Of course, this is the most important part of the paper.

Causality and Filling the Ignorance Gap

There is an old adage: “What you don’t know can’t hurt you.” In the science denial arena, however, this adage seems to have been recrafted to something like: “What you don’t know is an invitation to make up fake science.” Before it was dis¬covered that tuberculosis is caused by a rather large bacteria called Mycobacterium tuberculosis it was widely believed to be the result of poor moral character. Similarly, AIDS was attributed to “deviant” lifestyles, like being gay or using intravenous drugs. When we don’t know what causes something, we are pummeled by “experts” telling us what to believe. Vaccines cause autism. ECT causes brain damage. GMOs cause cancer. Interestingly, the leap by the public to latch onto extreme theories does not extend to all branches of science. Physicists are not certain how the force of gravity is actually conveyed between two bodies. The theoretical solutions offered to address this question involve mind-boggling mathematics and seemingly weird ideas like 12 dimensional strings buzzing around the universe. But we don’t see denialist theories about gravity all over the Internet. Maybe this is simply because the answer to the question does not seem to affect our daily lives one way or the other. But it is also the case that even though particle physics is no more or less complex than molecular genetics, we all believe the former is above our heads but the latter is within our purview. Nonphysicists rarely venture an opinion on whether or not dark matter exists, but lots of nonbiologists will tell you exactly what the immune system can and cannot tolerate. Even when scientific matters become a little more frightening, when they occur in some branches of science, they register rather mild atten¬tion. Some people decided that the supercollider in Switzerland called the Large Hadron Collider (LHC) might be capable of producing black holes that would suck in all of Earth. Right before the LHC was scheduled to be tested at full capacity, there were a few lawsuits filed around the world trying to stop it on the grounds that it might induce the end of the world.

Confirmation Bias

One of America’s greatest scientists summarized confirmation bias well when he quipped, “I wouldn’t have seen it if I didn’t believe it.”That scientist was the great Hall of Famer and New York Yankee baseball player Yogi Berra. How do we know Yogi Berra said that? One of us once heard someone say that he did, and it sounds like the kind of thing that has been attributed to him. Of course, there are those who say that Yogi didn’t say many of the things attributed to him and that there are actually perfectly logical explanations for some of the seemingly nonsensical statements he allegedly did utter. But we don’t care about any of that. We love the line, it makes our point well, and we are going to stick to the Yogi attribu¬tion no matter what kind of disconfirming evidence crops up. As Yogi might have said, “When you come to a piece of evidence that doesn’t agree with what you already believe, tear it to shreds and then ignore it.” Confirmation bias refers to our tendency to attend only to information that agrees with what we already think is true. Notice that we did not simply say that this bias involves ignoring evidence that is incompatible with our beliefs but rather that it is an active process in which we selectively pay attention to those things that confirm our hypotheses. Confirmation bias is responsible for not only a great deal of denial of scientific evidence but also the actual generation and maintenance of incorrect scientific information. That is, scientists, doctors, and public health experts are as prone as anyone else is to “seeing what we believe,” making it especially difficult to help people sort out what is true science from the mistakes and outright fabrications. As we will see, confirmation bias is strongly rooted in primitive needs and emotion and therefore not amenable to correction merely by reciting facts. Although confirmation bias is irrational in the sense that it does not take into consideration evidence, it is still frequently adaptive and even necessary.

Conclusion

We have argued throughout this book that there are complex psychological, social, and neurobiological underpinnings of resistance to scientific evidence. We have also argued that many of these tendencies are in many ways completely adaptive, healthy, and essentially human. The challenge that remains for those of us interested in maximizing population health and at the same time helping individuals to make scientifically informed health choices is to figure out how to address the tendencies that lead to false scientific belief without completely insulting or, worse, attempting to repress these tendencies. Not only does telling people not to be emotional fail, but we also strongly believe that it is in no one’s best interest to suppress this side of the human brain. So we propose a multipronged method to help guide people toward the evidence without dismissing the importance of their humanity. In the end, we don’t want people to scramble for a story when they should be paying attention to statistics. But at the same time, we wouldn’t want a society full of people who see only percentages and probabilities in place of showing empathy for the individuals around them. We just want to help people better tease out when their natural psychological tendencies are protecting them and when they are actually harming their health. We will begin by citing the core principles that we believe any reader of this book should take from reading it. Then we will show how these core principles translate into our recommendations for better strategies for communicating and dealing with people who do not believe the science. We call this the Gorman- Gorman method. Guiding Principle #1: It is not simply uneducated people who make irrational health decisions. We have seen multiple times throughout this book that making rational health choices is not particularly correlated with intelligence. There are abundant examples of people with illustrious academic training, including in the sciences, who have embraced unrealistic and irrational beliefs about important topics such as the relationship between vaccines and autism and the cause of AIDS.

Charismatic Leaders

In this chapter, as in the last, we explore the ways in which skeptical science beliefs are formed in social environments. This time, however, we focus specifically on the leaders of anti-science groups, people we call “charismatic leaders.” While behavioral economists and cognitive psychologists have spent much time analyzing the ways in which individual shortcuts and cognitive errors cause irrational beliefs, here we turn to social psychologists to inform us about how being in a group affects the way we process risk, the way we understand complexity, how we decide to whom we give credibility, and how we determine what is true and what is false. We will see that in some cases, people in groups make decisions or hold beliefs that do not resemble decisions or beliefs they would hold on their own. In this way, groups can be said to have transformative capacity. The formation of cooperative groups was foundational in the evolution of the human species. Groups are essential for success¬ful human society. In this chapter, however, we explore the ways in which anti- science groups form around a particular type of leader. Although groups have many important and interesting dynamics, the role of the charismatic leader is a central feature of science denial groups in particular. We will look at several such charismatic leaders in this chapter: Peter Duesberg, Andrew Wakefield, Jenny McCarthy, Gilles- Éric Séralini, and Wayne LaPierre. We will also look at the ways in which our brains and minds work in social settings and how exactly we are persuaded. Indeed, some of the features that make us most human, such as our ability to empathize using our imaginations and our desire to be accepted and integrated into social groups— indeed, some of the very things that enable our society to function— are also some of the features that render us most irrational and most prone to the wiles of the charismatic leader. Before we discuss the figure of the charismatic leader, it is important to examine what factors enable leadership success in the first place. In many ways, leadership is actually created by followers.

Introduction

On October 8, 2014, Thomas Eric Duncan died in a Dallas hospital from Ebola virus infection. From the moment he was diagnosed with Ebola newspapers all over the country blared the news that the first case of Ebola in the United States had oc¬curred. Blame for his death was immediately assigned to the hospital that cared for him and to the U.S. Centers for Disease Control and Prevention (CDC). By the end of the month a total of four cases had developed in the United States: two in people— including Duncan— who acquired it in African countries where the disease was epidemic and two in nurses who cared for Duncan. Headlines about Ebola continued to dominate the pages of American newspapers throughout the month, warning of the risk we now faced of this deadly disease. These media reports were frightening and caused some people to wonder if it was safe to send their children to school or ride on public transportation— even if they lived miles from any of the four cases. “There are reports of kids being pulled out of schools and even some school closings,” reported Dean Baker in the Huffington Post. “People in many areas are not going to work and others are driving cars rather than taking mass transit because they fear catching Ebola from fellow passengers. There are also reports of people staying away from stores, restaurants, and other public places.” An elementary school in Maine suspended a teacher because she stayed in a hotel in Dallas that is 9.5 miles away from the hospital where two nurses contracted the virus. As Charles Blow put it in his New York Times column, “We aren’t battling a virus in this country as much as a mania, one whipped up by reactionary politicians and irresponsible media.” It turns out that Thomas Duncan was not the only person who died in the United States on October 8, 2014. If we extrapolate from national annual figures, we can say that on that day almost 7,000 people died in the United States.