Sunday morning breakfast – a croissant, a coffee, and a stress-free morning.
But wait a minute…
I wonder how healthy all that butter is? When did I last have my cholesterol levels checked? Were they high? Will my crisp, moist butter croissant push me into a French pastry-coronary?
And how about the coffee? Didn’t I hear that caffeine gives you cancer? Maybe that was just the Daily Mail on another cancer scare spree.
But there’s no smoke without fire…
Bother – what am I going to do? I can already feel the panic rising!
Hang it all, I’ll just head out to MacDonald’s for a Sausage Egg and Cheese McGriddle, with a couple of hash browns on the side. After all, didn’t someone say it’s healthy to start the day with a good breakfast?
Okay so I’m not really sitting down to croissants and coffee (more’s the pity), and I’m not going to rush off for a MacDonald’s breakfast. But it is a Sunday morning, and with my brain in weekend mode (i.e. slow, relaxed, prone to roaming, uninformed speculation…), I found myself ruminating over something a friend said in an email a few days ago…
It concerned apparent resistance to having H1N1 flu shots in some quarters – an issue that is still bubbling away in the news.
I’m not going to write about the H1N1 vaccine directly – that would be irresponsible given my limited knowledge and my Sunday morning torpor. But the issue does raise an interesting question of what happens when we are forced to consciously make decisions we might usually take for granted.
Martye’s email came on the tail of the latest poll from the Associated Press and GfK on people’s intentions to be vaccinated against H1N1. The poll suggested that people were more wary of the new vaccine than “normal” flu vaccines, even though each year’s batch of flu vaccines is tailor made for that year’s prevalent virus strains – something that Martye had witnessed himself anecdotally.
He wondered how this played into people’s trust of science, scientists and government, and the role of mis-information in the decisions people make.
Because this is a Sunday morning, and there are important Sunday morning things to do (like find those croissants), this is a question that will have to wait until another day. But it did get me thinking about the degree to which too much information, or a particular focus on an issue, can create a quandary by shifting the decisions we make from the subconscious to the conscious level.
As a species, we’re pretty adept at letting the subconscious parts of our brains do the heavy lifting when it comes to making decisions. Just imagine how tedious life would be if we needed to analyze the pros and cons of every move or decision we made – much like the coffee and croissant illustration above, we would become paralyzed by indecision. But we’d also more than likely end up making decisions that were more based on what we were comfortable with, rather than what was good for us.
This raises a real dilemma though, and one I don’t have a good answer to. A major thrust of what I do is advocating for and enabling informed, evidence-based decision-making. It’s something I believe in strongly – that in a science and technology-driven society, people should be enabled to make the best possible decisions for themselves and their society based on good evidence and strong scientific principles.
Yet it seems that where the decisions people need to make are far from black and white, forcing them to think about things could end up leading to choices that are more harmful than helpful.
The H1N1 flu vaccine seems to be a case in point. If it was rolled out as just another annual flu vaccine, many people would have accepted it without question – the decision-making would have been at the subconscious level.
But because the issues of its importance and possible downsides have been raised explicitly, people are being forced to make a conscious decision whether to have it or not.
And kicking up the decision-making process from the subconscious domain to the conscious level has led to confusion and indecision.
So what should we do? Should complex decisions be left in the hands of “experts?” Should information – evidence – be withheld from people who don’t have the ability to process and use it? Should we just accept that others are more informed than we are – and trust them?
At this point, every bone in my body is screaming that transparency, access to information and personal decision-making autonomy are moral obligations in a mature society, and that a hierarchical technocracy is not the way to go. Yet, if this is the case, we need to face the fact that more information isn’t necessarily a good thing on its own. We need to develop the social tools to use it wisely, empowering individuals to make decisions that benefit themselves and society without leading to undue paralysis and harm.
This is a tough task. I’m sure there are mountains of scholarly works that address it. But I’ve yet to see any clear routes forward emerge.
Yet if we are going to cope with new challenges in a world where information spreads like wildfire, it seems more important than ever to work out how to empower people to make responsible and informed decisions on risks and benefits, without becoming paralyzed, or forced into relying on comfortable but possibly unhelpful decision-making shortcuts.
It seems that too much choice could be bad for the health. But I suspect that not enough choice – and a lack of help, guidance and other tools for making informed decisions – will be worse for the health in the long run.
But that is most definitely a Monday morning problem.
Now, back to that croissant and coffee…
Well, not a ‘this Monday’ decision anyway, since it’ll be Thanksgiving in Canada and Columbus Day in the US. A week Monday perhaps.
Last week I got embroiled in an extremely unsatisfying discussion on another blog relating to vaccinations in general. I pointed out that not even the concept of ‘herd immunity’ is currently understood by the general public, although, having minimally researched it, I’m seeing oblique references to it in statements made to media by public health officials in an attempt to persuade all Canadians to get the H1N1 vaccine. The point I tried to make on the other blog was that, if you want 90% of any given population to do something, you’re either going to have to persuade them or you’re going to have to introduce legislation to force them to do what you want them to do. (And yes, I do realize the ‘herd immunization’ level varies from virus to virus, and that it can be achieved by getting the virus as well as via vaccination.)
I’m also seeing various polls of and interviews with ordinary Canadians who are very torn about whether to get the H1N1 vaccine or not, and I certainly understand their dilemma. They’re going through the same process as you with the croissants vs the McGriddle: looking at the info and asking themselves if they’re in a high risk group or not, evaluating precautionary measures and determining whether they’re too onerous for them to implement while trying to figure out how bad it would be if they got swine flu, trying to weigh the odds of their getting seasonal flu and whether they’ll increase if they get the swine flu vaccination. There is an undercurrent, although it’s been unstated, of trying to evaluate one’s civic duty in this situation as well, given the H1N1 virus’s quite long contagious period.
I think what perturbs me most about what’s surfacing is another unstated belief that seems to permeate the developed world these days, which is that we shouldn’t ever get sick, and if we do as a result of a virus, the ‘system’ has let us down. That coupled with a work ethic in North America that implies you’re slacking if you’re not available 24/7 or have the temerity to actually stay home when you’re sick – and that the number of sick days you take will be used against you in an uncertain economy – are extremely disturbing.
I don’t think a decision-making aid process would be such a bad idea, really, as long as it was comprehensive, and included some tough questions like, ‘Are you prepared to remain in quarantine even if you get sick over the festive season?’ ‘Do you have anyone to look after you if you do get swine flu?’ and ‘Can you afford to take a week’s sick leave?’ as well as, ‘Do you have health insurance in case you have an unknown underlying condition that means you end up in hospital with swine flu?’
Thanks Ruth,
I’m afraid I opened a can of worms with a deceptively trite post – many of which you’ve dug out and aired a little more thoroughly 🙂
Dealing with information, risk, and personal and social decision-making is not easy. There’s a large academic and popular literature out there, which I conveniently ignored in the post. But the bottom line is that, although there’s a lot of talk about the problems, I don’t see too many practical solutions!
The SOULTION had already been provided:
Prioritize everything in life!
What is important and urgent is #1 priority, what is important but not urgent – #2, and the rest of the stuff to do in life can go directly to the trash box in your mind just like in your e-mail account: there is a fodler for the important and the folder for the junk that you simply avoid considering 99% of the time.
Hey Ruth, Ben Goldacre very much shares your view re the expectation we don’t get sick and that it’s a failure of the system/profession when we do, He was more subtle at a meet earlier this year; summary: “shit happens”.
LOL, Tim – that’s precisely the kind of subtlety I expect from the good doctor.
Interesting post. It makes me think about how my field of work/study influences my trips to the grocery store. I consciously veer away from the snack aisle, read those zillion fine-print labels on everything to make sure they don’t have hydrogenated vegetable oils or high-fructose corn syrup or MSG or preservatives/chemicals I can’t recognize. All these extra steps make my grocery trips almost as much of an information-overload as the most recent graduate seminar in the department.
In fact, when I am running short of time, my groceries consist of almost entirely fresh produce (that don’t have any labels on them that I might be tempted to scrutinize). I think its funny that, to avoid the tedium of agonizing over unproven disease-exposure links while I am grocery shopping, I have unconsciously made a choice of just getting things that are somewhat uncontroversial — well, almost.
Ha – thanks Zeeweed!
Clearly the solution is to label nothing 🙂 No information – no hard choices!
(I’m being facetious, of course…)
Interesting to consider whether the scholarly works you mention (incl. I guess products of theoretical discussions going on in academic circles) on the topic of informed publics, engagement and decision making have actually informed this topic in any practical sense.
I wonder too if there is too much aversion to prescription in these matters of guiding folk how they might deliberate over information and formally quantify risk / relativities.
Consider a hypothetical engagement focused website that makes a deal of asking users whether the site itself is doing the right thing, providing the right information or level of information. That approach can appear super-democratic and involving; but can also be seen as nervous, inexpert, and ducking of responsibility. ‘First round’ content can surely be put out with some confidence following focus group type activity?
I guess I’m thinking the most effective techniques for dealing with information are not themselves as subjective as the decisions they inform, and should be presented as such – as tools.
Also, that the ‘public’ can be forgiven for expecting professional engagement specialists to propose some solutions to the questions like the ones you raise here – without having the issue thrown back at them. (That’s not a reference to your post here I should add!). ‘Authority’ and ‘expert’ are not dirty words and will be respected where they are convincingly demonstrated.
I think that’s an important point that, while decision-making based on information is typically complex, the tools don’t have to be – and there’s a danger of confusing the two and getting in a knot.
There was a recent paper in Nature Nanotechnology talking about risk research that seemed to do something similar – confusing public engagement with quantitative risk-based research. Both are valid, but they are complimentary – one isn’t a substitute for the other.
You might find this Ted talk interesting.
http://www.ted.com/talks/dan_ariely_asks_are_we_in_control_of_our_own_decisions.html
Thanks for the link Handre
These thoughts have being doing my head in for the last year when deciding about http://www.nanoandme.org. So what does information like this do for anyone, except give them yet another thing to worry about that they didn’t have before. Could it inflame debate and undermine further people’s trust of nano, or science or technology or companies? Is that ‘deserved’ so important to shine the light? What trumps what?
I came to the conclusion that rounded, thoughtful information which seeks to explore the issues at reasonable length, whilst remaining easy to understand and relatively fun to interact with may be better than nothing. People are going to hear others, ngos, businesses, scientists, media telling them what nano is and isn’t. So trying to give them a reference point which creates a more rounded picture and lots of links to other places for a more detailed view is perhaps a useful contribution.
Tim Jones’s point about whether one is being nervous and inexpert or expert and consultative is very tricky. With Nano&me I was trying to get the balance of authority and consultation, and had no cash for focus groups. The current ‘expert’ consultation was supposed to do that job, and was to include direct requests to those members of the public who had participated in UK nano dialogue type initiatives who virtually all said they wanted more information. Unfortunately data protection legislation meant all their email addresses had been chucked away, so we have now to find another way to consult!
Also the point in theory of genuine consultation being that you haven’t got it sorted already, which is why you are asking, so their views can inform the debate makes it trickier!
But as no-one will now fund any communications outreach for the general consumer then perhaps I’ll stop worrying, as no-one will see Nano&me anyway!
Your point re genuine consultation is well taken, Hilary. I would say that until the turn of the 21st C in North America anyway a form of ‘cookie cutter consultation’ designed to ensure the success of corporate strategies for growth was the norm. Given the tremendous cost of doing a consultation, I was always vehemently opposed to that notion. Consultations, whether mandated by law or freely entered into, are tremendous opportunities for learning. During the year-long community and stakeholder consultation I was involved with, we learned a tremendous about issues that were brewing that had nothing to do with the corporate strategy that was the subject matter of the consultation, as people vented in the spirit of, ‘while I have your attention, there’s another matter I’d like to discuss.’ What I learned from the whole process was that people want to be listened to. They don’t necessarily expect – or want – to have their point of view adopted, in the same way that people don’t necessarily exercise their right to vote in a democracy. But take away the right to vote – or to express their views – and you run the risk of opposition consolidating and becoming an actual organized ‘movement.’
Given the lack of funding, perhaps the way forward is to ask communities to organize opportunities for consultation themselves, and merely provide access to the experts? Or perhaps create a web-enabled consultation process that doesn’t involve travel, signage, renting halls, refreshments, etc.
Yes, you are right Ruth. I was rather hoping to take the easy way out. Now have to try a bit harder, but as you say, it may be better in the long run!