The Culture of Precaution
Are all risks worth avoiding?
Posted Aug 26, 2015
The concept of risk has had quite an impressive run in the last decade. The word ‘risk’ has found its way into the vocabulary of every field, spanning from politics, to economics, education and even healthcare. The need for certainty and stability is something that is deeply inscribed in our culture. Every day, people take steps to avoid hazards that are far from certain. We try not to walk in moderately dangerous areas at night, we exercise, we have smoke detectors alarms, we watch our diet and we buckle our seatbelts. We make these decisions to insure safety. In many ways, by striving for safety, we have set up a culture of precaution that has reached its present point with governments, institutions, companies and people constantly attempting to counteract the risks that threaten them. So what could be more logical than to set up safety guards by way of more tests, better technology or more rigorous analysis of the future. While it is true that our knowledge and experience has given us the possibility to solve an almost unimaginable range of problems, is it also possible that the massive outgrowth of safety guards is an overkill and can lead to dangers? Are we living in a culture of precaution?
Key medical specialties are subject to precautionary practices, reflecting aversion to risk. Quoting the headline of a recently published article in the Wall Street Journal: “Pregnant Women Get More Ultrasounds, Without Clear Medical Need,” tends to indicate the heavily unacceptable societal tolerance for health related risks. This is especially true of those risks affecting children’s health. This comes as no surprise given the high rates of malpractice suits against physicians, and according to CBS news report – obstetrics and gynecology being one of the top specialties to get sued the most. As a result, medicine has grown into a practice of precaution, providing test after test to patients, with little regard to the ironic possible risks of such practices.
Consider the following choice. Would you rather definitely lose ten dollars or a one percent chance of losing 1000 dollars? Perhaps not surprisingly, people would much prefer to lose the 10 dollars, than run a small risk of a large loss. Why? For the same reason that we buy homeowners insurance, take precaution to look both ways before crossing the street and check our appliances before leaving the house. Prospect theory - an influential account of human behavior - emphasizes people’s aversion to significant harm that has a low percent chance of occurrence. The willingness to experience sure loss, in preference to a low probability harm of a higher valued loss, explains why the culture of precaution exists.
The clearest evidence for the current culture of precaution comes from the German psychologist Dierrich Dorner, who has designed experiments to see whether people can reduce risks. Participants were asked to reduce risks faced by people of various regions of the world. Examples of some of the risks involved included pollution, insufficient water or excessive hunting. Many initiatives to solve the problem were available (i.e. drilling more wells, strict hunting laws, etc.) Once study participants chose a particular initiative, a computer projected what is likely to happen in the region based on choices made.
Dorner’s experimental results produced a number of calamities long-term based on choices made by study participants. They did so, because the subjects fixated on isolated problems and did not see the complex, system-wide effects of specific interventions. For example, many appreciated seeing the benefits of drilling more wells to provide water, but did not anticipate the energy and environmental effects of the drilling on food supply. Unfortunately, only few participants were able to see several steps down the road and understood the multi-layered effects of certain interventions.
In the spring of 2013, two Chechen brothers orchestrated a terrorist attack exploding two pressure cooker bombs during the Boston Marathon, killing three people and injuring an estimated 264 others. Each of these murders and injuries was a tragedy, but the actions of these terrorists affected thousands of others as well. Many were afraid to attend public groupings of any kind, with the idea that they could be next. Fear gripped the nation. Behavior changed dramatically. People took to wearing body armor while out on the streets or shielding themselves with car doors while pumping gas. It was hard to know what to do for our public safety.
Boston Marathon Bombing was highly publicized, undoubtedly leading many people to think that the risk of the next terrorist attack was great. However, for people in the area, the bombings only caused a minuscule increase in risk, far lower than the risks associated with many daily activities about which people do not express even the slightest concern. The extent of alarm could not possibly be justified by the extent of the risk. Why, then, did so many people feel fear and alter their behavior in the midst of these bombings?
In many high visibility cases with low probability of danger, such as shark attacks, kidnappings or terrorist attacks, the mass media focus on the risks spreads fear and concern to the general public. The culture of precaution focuses on elements in which the schools, governments or institutions failed to regulate harm, demanding safe guards to be in place for the future. Visibility fosters fear and fear breeds precaution.
Among doctors dealing with risks, a commonly observed phenomenon is the “cascade.” Most doctors rely on the previous works of their colleagues to administer a particular type of treatment. Thus an article in the prestigious New England Journal of Medicine cites the “bandwagon disease,” in which physicians push certain treatments primarily because everyone else is doing the same. Unfortunately, cascades can lead to mistaken directions, such as the overuse of ultrasounds in pregnant women based on research from the early 1980’s.
So what can be done to change our culture of precaution?
First, we have to manage our fears with uncertainty through education, information and acceptance. Cost-benefit analysis is an exceedingly helpful tool, simply because it provides an understanding of the stakes, of what is to be gained and what is to be lost in a bigger systemic sense. Second, we are first and foremost people, not consumers, and our judgments do not always have to track cost-benefit balancing, but face potentially catastrophic risks that come with life. Third, fear is an inseparable part of human life. Often, it points us in the right direction. But often, also, fear only serves to ensure that we take precautionary steps to avoid risks that may or may not protect us against dangers.
In this regard - live life with the idea that you are living in a risk society and understand, that some risks are worth accepting for the very reason that avoidance of those risks can actually lead to more harm than good.