Old Lad

There seems to be more anxious people about than when I was younger – or perhaps that’s just the rose tinted spectacles of old age! However I do think that now that we have 24 hour rolling news, multi media churning out scare stories, and a type of journalism that does not believe in treating news in measured tones, its not surprising that people are generally more anxious. Or as my Gran would say – “On top Note”! Open the daily paper or watch the news on TV and you will believe that the country is going to hell in a hand cart. For example according to today’s paper we are heading for civil disturbance, nuclear conflict, penury from financial mismanagement and the effects of eating and drinking the wrong things!

A notable feature of life as I have grown older has been the rise of Risk Management. One of my annual delights is to dress up as Santa Claus and be driven round the streets on a sleigh by my local Rotary Club. It delights children as we roll up outside their door and we collect a fair bit of money for charity. Now however this simple activity has to be preceded by a written Risk Assessment document. So this contains such gems as Santa being asked to hold a baby for a photograph. Perceived risk – Santa drops baby. Mitigating factor – no holding babies, parents to stand next to Santa with Baby! And so the document goes on identifying the most unlikely outcomes and gradually squeezing the joy out of the event. Who demands this – why the Insurers of course. In the public sector and particularly the NHS Risk assessments abound but they don’t seem to contribute to notable improvements in service. But the risk assessments provide a comfort blanket for managers.

One area that has increased is in producing risk measurements for individual diseases. This of course is based on the mantra that Prevention is Better than cure. The problem here is that much of this practice is based on the science of epidemiology, which looks at overall populations rather than individuals. Let me give you an example. The population of Finland has generally lower levels of heart disease and this has been attributed partly to genetic factors and partly to a diet rich in oily fish like herrings. So the message promulgated from the research in Finland is that a diet rich in oily fish may prevent you from getting a heart attack.. However the sting in the tale is that if you stuff yourself with oily fish there is no guarantee that you will not have a heart attack. If your whole village ate lots of oily fish then the overall number of heart attacks might fall but its not possible to know if you will be one of the lucky ones. The only areas where prevention works tend to be where there is a direct individual risk. So stopping smoking will prevent lung cancer because we know that the carcinogens in tobacco will induce cancers to form. Also the various screening programmes such as bowel screening will improve early diagnosis and prevent deaths.

Journalists of course love reporting medical research that purports to show a link between certain activities or treatments and the chances of disease or death. What you need to know when making a calculation of what this means for you is to look at how the risk is being described. Which is where I jump on my hobby horse about the difference between relative risk and absolute risk. Lets take an unlikely example. Researchers decide that there is a problem of people developing brittle finger nails. Say the rate in the population is 5% of people having brittle nails – i.e. 5 in a hundred. The research shows that those who use a certain brand of nail varnish have a 7% chance of brittle nails – i.e 7 in a hundred. The relative risk will be reported as a 40% increased risk(2 being 40% of 5) but the absolute risk is actually an extra 2 in a hundred – i.e.2%. You can bet your bottom dollar that the press will report the 40% figure which of course sounds alarming to women rather than saying you actually only have a 2% extra chance of having brittle nails. So which figure do you think generates the anxiety? It happens all the time. So next time you read a story about the risk of this disease or that or which wonder drug is being introduced see if you can find the absolute risk.

The thing that becomes apparent as you become an Old Lad is that life is a risky business and the best we can do is just relax and be careful, and not get anxious about things we cannot do much about. I suggest the Winnie the Pooh approach. There is a story that Piglet and Pooh are wandering through the woods and a storm is brewing with high winds shaking the trees. Piglet who is naturally nervous says to Pooh – “Oh dear, suppose the wind blows over a tree and it falls on us, whatever will we do”. And as they walk on Pooh says in his laid back way – “Well suppose it doesn’t”!