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February
2004
Feeling Safe or
Being Safe?
“Facts are stubborn things; and whatever may be our wishes,
our inclinations, or the dictates of our passion, they cannot alter
the state of facts and evidence.” So said John Adams in his
incarnation as a trial lawyer. “Facts are stupid things,” said
President Reagan in a botched allusion.
Both may have been right, judging from newspaper, magazine and
journal articles I have been reading lately.
Not only are facts stubborn,
people are, as well. Among the most stubborn are owners of SUVs,
according to Malcolm Gladwell, writing
in The New Yorker recently. Despite overwhelming evidence of the
vehicles’ danger to their drivers and to other motorists,
their owners are psychologically hooked on false feelings of security — that
bigger is actually safer. As the author concluded: “Feeling
safe has become more important than actually being safe.”
In the field of politics or advertising, perception is reality.
In the field of medicine, perception, without reality, can be hazardous
to your health.
Recent articles in the New
York Times and Washington Post chronicled
controversies over how much cancer screening is necessary. The
implication was that at great economic cost, screening may not
make as much difference as we hope and sometimes might lead to
unwise interventions: a case of wanting to feel safe rather than
be safe.
Even though we know
that some radiological abnormalities are best left alone, fear
of cancer, even slow-growing tumors that pose
no real threat, is such that a study in the Journal of the
American Medical Association found 87 percent of adults believe routine
cancer screening is almost always a good thing, even though 38
percent of them had already experienced a frightening false-positive
result. The authors conclude, “This enthusiasm creates an
environment ripe for … placing the public at risk of overtesting
and overtreatment.” Again, feeling safe is seen as better
than being safe.
A new study in Minnesota
found that the rate of sexually active junior high school students
more than doubled in the three schools
where “abstinence-only” was taught. But the federal
government continues to fund abstinence-only sex education. Thus,
feeling protected apparently is better than practicing protection.
American
Demographics magazine reports that 55 percent of people in a large study said
they were overweight. That is good news because
it is one point lower than the previous year, but it is also about
10 points lower than what national statistics suggest is the truth.
For some, feeling thin is enough; they don’t actually have
to be thin.
In a sea of information
about health, people will navigate their own course haphazardly,
with science acting only as a small rudder
against the gale force of convenience, preference, impulse and
inertia. The challenge for capturing the value of health research,
then, is to help people make better use of stubborn facts that
science produces to help people chart a safer course toward good
health.
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