Societies often are poorer because of the irrational ways we react to uncertain events. Monday’s Pioneer Press brought that home.
News of the devastating tsunami filled the front page. Inside the paper, thoughtful articles examined the longer-term ramifications of taking drugs such as Celebrex off the market. In both cases, humans are reacting to situations of risk. Tsunamis occur infrequently. Only a fraction of drug users are harmed. In our emotional reaction to such news, though, we don’t quantify probabilities very well.
In Asia, wealthy nations will rush aid to hundreds of thousands of people hurt by the tsunami. Thousands have died, and suffering is widespread. Providing such assistance is the right thing to do. This aid in a highly publicized natural disaster contrasts, however, with diminishing support for everyday foreign aid.
Time has demonstrated that well-targeted health, sanitation and nutrition programs from foreign aid can prevent millions of premature deaths at surprisingly low cost. But politics is shrinking appropriations for such assistance, even though our per capita incomes are far higher than when we gave substantially more aid.
The deaths of thousands by drowning catch our attention and motivate us to give. Deaths of millions from malnutrition and easily preventable diseases do not.
Deaths as a side effect of some drug also draw more attention than day-in and day-out deaths from other causes. When we learn that some drug such as Vioxx or Celebrex may increase the risk of stroke or heart attack, our impulse is to ban it and punish the profit-thirsty incompetents who foisted an unsafe drug on the public. We ignore Dear Abby’s sage counsel to ask whether we “are better off with this drug or without it.”
The even more important question is: Can we manage how and to whom we prescribe this drug so as to keep most of its benefits for many while minimizing the probability of harming some?
Of course, some drugs are so dangerous that the harm they cause clearly outweighs their benefits. It is not obvious, however, that Celebrex, or even Vioxx, falls into this category. A story in Monday’s paper cited scientists who had explored indications that these drugs may have significant benefits in reducing various cancers. Their research was halted by fears about the adverse side effects of the drugs even though the statistical evidence of harm was small. Countries banned Thalidomide when it was found to cause birth defects. It since has proved to be an effective leprosy treatment, but the stigma from side effects four decades ago continues to limit its availability in countries where that disease is still a problem.
Irrationality in the face of uncertainty is a natural human reaction. But we are better off as we manage to overcome it.
© 2005 Edward Lotterman
Chanarambie Consulting, Inc.