Risk and reason
To live any active kind of existence without occasionally risking life and limb is not possible. Wherever we live, and however we live, hazards are never far from us. This is a situation we have to accept, but a degree of caution does not come amiss. However, in our nanny state today we may well place too much
emphasis on risk. It is difficult to judge this risk, since statistics regarding
it are notoriously misleading and inaccurate. At the same time, the current
passion for human rights has produced a climate in which recourse to legislation
and legal proceedings is increasing our tendency to discard reason in favour
of advocacy. If someone has been warned that a certain pattern of behaviour
might increase the chance of suffering a disability, and the warning is conveyed
by expert professional advice, the onus for taking heed or otherwise surely
rests with the advised. In practice, things are not so clear cut.
Unhealthy habits, however clearly recognised by their critics, may go unheeded
by some who practise them. For example, there is overriding evidence that smoking
tobacco and drinking excess alcohol carry serious health hazards, perhaps not
for many years but, in the end, almost inevitably. Overeating, particularly of
the wrong kind of foods, will end in bodily disorder of one kind or another.
Failure to take adequate exercise may carry disaster in the long run. Plenty
of statistics exist that establish the risks. Yet most individuals who practise
such unhealthy habits seem impervious to warnings.
On the other hand, some hazards tend to be overrated in the face of statistics.
People fear for their health if they discover signs or symptoms suggesting disease,
and it is often impossible to dismiss their fears. In The Lancet for 27 September
Mike Fitzpatrick describes the effect of the publicity given to breast cancer
from time to time, which drives frightened women to rush to their general practitioner
to request investigations that may often be unnecessary. The statistical picture,
he points out, does not support some of the figures for incidence given by campaign
propagandists, which may be exaggerated. Nevertheless, a precautionary approach
remains important and must not be discounted.
In its issue of 27 September the BMJ carries several articles in which the issue
of communicating risk in the clinical field is discussed. As several writers
point out, risk is not something that is approached rationally. It is too subjective
for that. In the business of doctor-patient communication, doctors today need
to build trust in their judgement and advice when they confront a patient who
is worried, as most are. They have to contend with an increasing number of alternative
sources of medical information regarding treatments and outlooks to which their
patients have ready access. Pharmacists, too, in their interactions with patients
who ask their advice, should remember that they need to balance evidence and
discount baseless rumours concerning the risks and effectiveness of drugs and
treatment in general. And they need to remember that what is obvious to them
may mean something less obvious to a patient, particularly when it refers to
a risk.
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Purple robes for the ancient Greeks and Romans were a mark of dignity, and were adopted by emperors, kings, magistrates and military commanders.
The so-called Tyrian purple, notably produced in the seaport of Tyre
from shellfish of the genera Buccinum and Murex by a process of fermentation,
became a symbol of luxury and power. Various combinations of shellfish
and processes yielded a range of different hues.