Too much emphasis on disease, not enough on managing risk

Every once in a while, I swing by Wal-Mart (yes, you liberal readers, I go to Wal-Mart!) and use the machine there to check my blood pressure.  I don't take one measurement.  I take three. And, of course, I walk away with a smug relieved feeling that I am doing ok.  (Btw, it turns out that these machines typically report numbers that are higher than the ones when the nurse checks using the old style sphygmomanometer.)

I have been doing this for a number of years now.  It is because of a deep-seated conviction that physical health includes a great deal of personal decisions on managing the risks that are within our control.  One of the risks that I (and you, too!) need to manage is blood pressure. Periodic measurements then gives me an idea of that particular risk.

Once, when I told my daughter about this practice of mine, she warned me that I stand the risk of crossing over the dark side and obsessing about personal health. So, I don't tell her this anymore ;)  Well, she has a valid point there, and I am hoping to stay clear of the line that separates the light from the dark.

I worry, however, that we are increasingly living lives where we don't pay enough attention to managing risk.  The sedentary population ignores it as much as the overly active population overlooks the risks. Years ago, I asked my doctor whether he thought that people who jog and run a lot could affect their knee joints more than people who only walk a lot (like me!) because we humans are, after all, not designed to run like cheetahs but to only wander around like cows on meadows.  At least that is my risk management reason for not jogging--what's yours?

Only rarely can we truly eliminate risks, and those are often in the contexts of infectious diseases. Otherwise, it is all about managing risks.  Prevention of diseases, as the old saying goes, is immensely less expensive than curing them later on.  The expense of dollars as well as the expense via a diminished state of health.  But, could we also go overboard with this preventative approach?

Maciej Zatonski writes in the latest issue of Skeptical Inquirer (not online yet?) that a major problem with modern medicine is that it needlessly treats "everyone's "abnormal" findings" that results in:

Treatments are often expensive and can make previously healthy people feel sick--both physically (from side effects) and psychologically (due to their changed perception of their own health.

Why?  Simple: "The closer we look, the more "diseases" we find."

We scan, screen, and diagnose more and more individuals using the most advanced technology. But are we always helping our patients? Who actually benefits from early treatments? How many suffer complications? How many are harmed, physically or emotionally?

My mother has a long-running case of anemia. Recently, when father suggested that she undergo more tests, she flatly refused it, based on her own estimates of benefits and costs related to this risk management, given her age and the life expectancy at this stage of her life.  Father made the mistake of asking for my opinion--he was not happy that I supported mother ;)

Zatonski concludes:

My impression is that we need to redefine our conception and definition of health and disease and introduce the concept of "risk management of possible future health benefits."

Absolutely.

Your teenager troubles you? Read on ...

It was an inconsequential, and yet a serious, chat with "S" about parenting and children.  Coming from different backgrounds and age didn't seem to matter at all when he and I speculated that the troubling adolescent behavior is coded somewhere in the human genes only to ensure that the child will wean away from the parent.  Else, given the unique ways in which humans take care of their young, well, this split might not happen--in an extreme case--and that could threaten the propagation.

Hey, every casual conversation doesn't have to be about politics, you know.

Speaking of which, did you catch this beauty from Bill Maher on the allegation in the book that Sarah Palin did cocaine?  Maher said, “Sarah Palin doing cocaine? That’s ridiculous. That stuff can make you yammer like an imbecile.”

Ok, stay focused here. Adolescent behavior. No, for the final time, this post on adolescent behavior is not about Palin :)

One of the typical adolescent attitude is towards risk--they seem to care less about actions that we older folks might think are way too risky.  

Teens take more risks not because they don't understand the dangers but because they weigh risk versus reward differently: In situations where risk can get them something they want, they value the reward more heavily than adults do.

Interesting.  I had always worked with the assumption that the teenage behavior is framed by the context of inadequate information about the risks.  But, if they are aware of the risks, at levels comparable to adult understanding, then it has tremendous implications for public policies too, right?  Ok, I am getting ahead of myself.  The researchers add:

"They didn't take more chances because they suddenly downgraded the risk," says Steinberg. "They did so because they gave more weight to the payoff."
Researchers such as Steinberg and Casey believe this risk-friendly weighing of cost versus reward has been selected for because, over the course of human evolution, the willingness to take risks during this period of life has granted an adaptive edge. Succeeding often requires moving out of the home and into less secure situations. "The more you seek novelty and take risks," says Baird, "the better you do." This responsiveness to reward thus works like the desire for new sensation: It gets you out of the house and into new turf.

Risks and the high that comes from novelty, which are further enhanced in the company of peers.  Gets them out of the parents' shadows:

The move outward from home is the most difficult thing that humans do, as well as the most critical—not just for individuals but for a species that has shown an unmatched ability to master challenging new environments. In scientific terms, teenagers can be a pain in the ass. But they are quite possibly the most fully, crucially adaptive human beings around. Without them, humanity might not have so readily spread across the globe.

A painful aspect in parenting.  But, a critical part of the remarkable success we humans have had as a species.

Hmmm ... so, "S" and I were really on to something in that casual chat; maybe I should forward this to him.

Toyota recall: much ado about nothing?

The deaths and various levels of unfortunate experiences are horrible, indeed.  There is no denying that.

But, are we over, over emphasizing the risks associated with this?  Robert Wright, always the sober and rational person, writes:

it worries me that this Toyota thing worries us so much. We live in a world where responding irrationally to risk (say, the risk of a terrorist attack) can lead us to make mistakes (say, invading Iraq). So the Toyota story is a kind of test of our terrorism-fighting capacity — our ability to keep our wits about us when things seem spooky.
Passing the test depends on lots of things. It depends on politicians resisting the temptation to score cheap points via the exploitation of irrational fear. It depends on journalists doing the same. And it depends on Americans in general keeping cool, notwithstanding the likely failure of many politicians and journalists to do their part.

Wright correctly points out that the odds of dying from a car-related accident are much, much higher:

your chances of being involved in a fatal accident over the next two years because of the unfixed problem are a bit worse than one in a million — 2.8 in a million, to be more exact. Meanwhile, your chances of being killed in a car accident during the next two years just by virtue of being an American are one in 5,244.

So driving one of these suspect Toyotas raises your chances of dying in a car crash over the next two years from .01907 percent (that’s 19 one-thousandths of 1 percent, when rounded off) to .01935 percent (also 19 one-thousandths of one percent)

One of the best comments to Wright's piece is this:

Nobody understands risk. Smokers will complain about the dangers of Toyota software.