Risk

An easy-to-read chart, intended for posting in physicians’ offices, has been recently described, comparing the odds of death in the coming 10 years for different ages and diseases. It was even suggested to have similar charts to be placed in the waiting room of every doctor’s office.

Risk, indeed, is a difficult concept, often mixed with emotion and mathematics. We humans tend to fear some diseases more than others. Some fears we exaggerate, others we underplay. Many women, for instance, worry breast cancer far more than heart disease, although five times as many women die of heart disease. The amygadala (a pair of almond-shaped emotional control centres within our brain's primitive core) sends more neural projections up to the cerebral cortex than it receives, as brain researchers noted. That makes it easier for our feelings to hijack our thinking than for our thinking to rule our feelings. Well, this sounds a little primitive for we genius humans, but it is really the case. In the forest, our ancestors – and probably me too - jumped at the sound of rustling leaves, leaving the cortex to decide later whether the sound was made by a predator or just by the wind.

Yesterday afternoon, medication incidents related to drug allergy were high on the agenda in my hospital, where people discussed the ways to curb the incidents of giving ampicillin (by mistake) to patients with known allergy to penicillin, for example. To my open-mouthed astonishment the Prime Minister proposed to stop keeping antibiotics at all the medical wards. This courageous move would theoretically force the doctors to prescribe and order medication from the pharmacy, which then scrutinizes the allergy list before sending the drugs to the medical wards. That being the case, you might ponder, it should help to save life. Great move? Let's step back and think. Think of the thorny delay in getting the antibiotic for an elderly hospitalized for pneumonia, in particular with the really long "boarding time" for our patients waiting for a bed in the emergency room nowadays. Of every 100 patients with pneumonia and delayed administration of antibiotic (say, after four hours), an extra patient will die, according to numerous published studies. Such inherent risk of delayed drug administration, as you can see, looms large as compared to the woefully meager benefit in double-checking the drug allergy by another human. I cannot help thinking about the metaphor of denying young people the availability of condom merely "for the sake of safety."

Alas, intuition (or hysteria, if you wish to call it) gone awry defeats rationality.