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Vol. 109 March 15, 2014 “Misfearing” – Misperceptions of Health (and Other) Risks

In current events, drugs, evidence-based medicine, Pediatrics on March 15, 2014 at 9:45 PM

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“Heart Attack Three Times as Likely With Drug A.”

We are all familiar with headlines like this, sometimes not as dramatic, but still attention-getting. It’s enough “to strike fear into your heart”.  As we read on we see the actual numbers, often buried more than half way through,  “ 1000 patients were given drug A and 3 of them had a heart attack. 1000 similar patients were not given the drug and only 1 of them had a heart attack.” 3 is 300% more than 1, but look how low the risk is: an increase from 0.1% to 0.3% risk invokes a lot less fear. By reporting the relative risk percentages rather than the absolute risk percentages the article nurtures “misfear” ; instinctive fear rather than factual fear.

When women are asked what they think the number one killer of women is, most respond, “breast cancer”.  The correct answer is “heart disease”. Clearly women fear breast cancer more than they fear heart attacks.

Which is a greater danger to a child, a gun in the house or a swimming pool?
Each year in the U.S. one child is killed by a gun for every 1,000,000 gun owners. One child drowns for every 11,000 residential swimming pools. Residential swimming pools are much more dangerous to children, but they won’t get the headlines until perhaps a whole birthday party drowns in one. It is less expensive to take steps at home to safeguard guns than it is to build a fence and install alarms around a swimming pool.This raises the issue of cost-benefit analysis in risk assessment. Does the cost of prevention efforts result in a significant benefit? Do we spend a lot of money to try to reduce small risks and little or nothing to reduce big risks? (2)

Sex Offenders
Our current policy of publicly identifying names and addresses of past sex offenders is based on two specific cases (3): an 11-year-old boy kidnapped by a masked gunman in 1989 and never found and Megan, a seven-year old raped and killed by a neighbor in 1994.  “Megan’s Law”  requiring states to publish personal information about sex offenders was passed by Congress in hopes of helping people to protect their children and prevent such crimes. Unfortunately that has not been the result. Two 2008 studies found no decrease in such crime rates and concluded that public notifications “tell the public nothing about the actual risks of a sex crime.” The resulting “misfear” may lead to all sorts of school bus stop, day care drop-off, shopping mall, etc. regulations which may do nothing to reduce risks. In addition such notification may be harmful by making it harder for the “ex-con” to reintegrate into society, find a job, and avoid harassment of fearful neighbors.  In my town such a discharged sex offender killed an adult neighbor with a baseball bat during an afternoon argument on the neighborhood street. As the story unfolded, the dead victim, who had no young children, was described as the only neighbor that had not accepted the presence of the discharged and publicly identified offender, and who was reported to have repeatedly disparage and verbally harass him.

“One in 7 Young People Solicited For Sex Online” is enough to start a moral panic about the internet. The actual report that on which this headline was stated that nearly all of the solicitations were from teens’ peers and other young adults, and that most teens did not find such encounters as upsetting. (4) “Misfear” has led to numerous attempts to regulate the internet “to control sexual predators” rather than fund programs to help vulnerable youth. Statistically such sexual victimization is more likely to occur through school or church participation than through the internet.  One expert decries the blooming of this “misfear” into a general distrust of adult strangers which can blunt “the teenager’s exploration and learning of the world.”

Examples of past “misfears” include - (5)
Elevator Sickness (1892): Scientific American reported that the new 600 feet per minute elevators (that made skyscrapers possible)  could cause “dizziness, irregular sleep, a constant desire to void, and motion sickness” through the herky-jerky motion of internal organs. The elevator was also feared as a spreader of contagious disease through shared conveyances, the originator of the concept of claustrophobia, and  a source of psychological stress about new kinds of “stranger etiquette”. (6)

Bicycle Face (1890): “Nearly all bicyclists have an expression either anxious, irritable, or at best stony… due to the nervous strain of balancing on two wheels.” Now “joggers face” is something I can believe in. I have never seen a jogger with a smile on their face.

Television Neck and Legs (1950): ‘ Viewing your favorite shows too intently could permanently limit the range of motion of your head.”  The AMA warned teens not to sit too long watching TV lest they develop “lack of flexibility” below the waist. That “misfear” of “lack of flexibility” has been translated by modern statistical research into the real fear of childhood obesity.

Examples of present “misfears” include:
Drinking bottled water: More than half of the parents studied chose bottled water for their children believing it was safer, cleaner, and more convenient than tap water. Several other studies have shown that except for increased convenience, those reasons are not true. Besides noting that the average cost of $23 a month for the bottled water, public health experts decry its use because of its lack of fluoride to improve pediatric oral health. (7)

Lice: The launching of the “Lice Protocol” by schools and day care centers currently rivals the launching of the “Concussion Protocol” and the“Bullying Protocol” in terms of drama and “misfear”-mongering. Lice do not cause any disease, hardly ever cause any symptoms except some mild itching, are spread only by direct contact, but are the subject of wide-spread fears and treatments. Such “misfear”, perhaps bolstered by the yuck factor, has spurred development of $200 per visit home delousing services (NitWits, Lice Aunties, Desperate Lousewives) (8)  The Academy of Pediatrics recommendations state,  “Head lice are the cause of much embarrassment and misunderstanding, many unnecessary days lost from school and work, and millions of dollars spent on remedies. Because of the lack of evidence of efficacy, classroom or school-wide screening should be strongly discouraged. No healthy child should be excluded from or allowed to miss school time because of head lice. “No nit” policies for return to school should be discouraged.” 

Wind Turbine Syndrome: Much too long and complicated a subject for this brief blog. Maybe in the near future, if it turns out to be the result of “infrasound” rather than going the way of elevator sickness.

References:
1. “Misfearing”,NEnglJMed 370;7 Feb. 13, 2014, p.595, Lisa Rosenbaum, MD
2.  “Avoiding the Cost of Needless Fear,” BosGlobe Ma.r 6 2014, pg. K6, Cass Sunstein, Prof. Harvard law School)
3.  “Follow Evidence, Not Gut Feeling, on Sex Offenders”, BosGlobe August 28, 2011, Gareth Cook, p. K9
4. “Parents, Forget the Online Bogeyman”,Bos Globe Mar 9. 2014, pg.K10, David Finkelhor at the Crimes Against Children Research Center.
“Its Complicated: The Social Lives of Networked Teens.”, Danah Boyd, Microsoft Research, in press
5. Bos Globe Feb. 19, 2012, p.K12
6. Bos Globe March 2, 201, p.K1, Leon Neyfakh, Daniel Levinson Wilk, Assoc Prof of History at Fashion Institute of Technology, NY.
7. ArchPediatrAdolesc Med 2011 Jun 6
8. “Cleaning Up With Lice Treatments”,Bos Globe May 27, 2011, p. B5, Jenifer McKim

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