Live & Learn; Is Anything Safe?: Living Realistically in a Risky World

Well Doc, I want to say thanks. My shoulder is just feeling tons better, that physical therapy just did wonders. Well Scott, I'm really glad you're doing much better and I expect you can get out into that great big garden and what is it, 15 acres out there in the country? It is and actually I've been feeling enough better. I was out last couple of weeks just trying it out a little bit and my shoulder is doing fine but you know, the most curious thing happened. In spite of how cold it's been, I got a couple of mosquito bites out there and I thought that was kind of odd and then I got thinking about the fact that my neighbors got horses and you know, all that news this last year about West Nile virus and it just had me kind of worried a little bit. What do you think about my risk of that West Nile stuff where I am? Well you do have a real risk being outdoors like here or what, 6, 8, 10 hours a week? Oh easily. Yeah, are you using a bug repellent like deep? Well that stuff kind of stinks, I don't do too much of that.

Well there's an option for you, it will cut down your risk. But now that you mention it, I'm glad you're thinking about personal risks. Now I've been your doctor some 10 years now. Let me just reflect and I'm going to ask you some questions, you don't need to answer them but I just want you to think about how they relate to your personal risk. Sure doc. First of all, are you still smoking? Well yeah. And you put a lot of time on rural roads, are you still going without your seat belt? Yeah, you know, those kind of confine you. Yeah, well and I'm not putting you on to the spot so just think about these risks. That 8, 10 hours out there in that big beautiful farm out of yours, are you wearing a wide room hat and are you wearing long sleeve shirt? And I know you love to go hunting in fishing and I'm just wondering, are you keeping those guns and that beautiful collection of antique guns properly stored and the ammunition away

from the boys there? That's a ton. And you've got lots of farm equipment and you've got a nice shop out there. Are you using eye protectors and hearing protectors? What? And let's see now, I bet you, if you're like most guys, you're doing more of your lawn mowing and you're gardening on the seat of a tractor than on your feet. So I just want you to think of some of those risks. I bet you they are bigger than West Nile virus for you personally. Wow, well you sure give me a lot to think about. Maybe we better do a little bit of that. Let's do some thinking about some of that. Before we get into our talk today, I just want to mention a thanks to Dr. Woolley for even

being here and doing this with me right now. His daughter Abigail has just won the McGregor scholarship from WSU, very prestigious scholarship and so he's missing the press conference announcing that as we speak today. So just wanted to mention that to you and thanks to Doug for hanging in there and still helping me with this today. We are being inundated about news of risks that are all around us. In according to the report released today, coffee can cause depression and twins as that's the latest. But you know whether it's television or newspapers or whether it's get-togethers with friends at the office cooler or family gatherings over the holidays, we are inundated by reports

of what's the newest risk. In fact I was just looking at our newspaper The Eagle this morning and you'll see that there's an article in there on the second page about safety of burning a pulporee in your home that you could burn your house down burning pulporee. And then if we go to the next section, there's a piece on the fact that lab tests confirm it that the KU campus does indeed have a cougar roaming about. So your risk of being bitten by a mountain lion or worse is for real on the KU campus now. Yes, somewhere else in there it says, now if I add danger, it dangers to pound while you're walking. I've known that danger for a long time. Yes, I can attest to that very fact.

Yeah, there are some of us that should not walk and talk at the same time. Yeah, exactly, thank you. I've got quite a support section where you can tell. Many of you may have been aware of the news release from Reuters yesterday that a draft advisory board of the FDA and the EPA cautions pregnant women, nursing mothers, young children and women of child-bearing age to limit their intake of tuna. So if you're having tuna fish sandwich today, it's supposed to be 12 ounces a week. They said in that section, and then on down, and it says the advisory says mercury levels in tuna can vary. Fresh tuna steaks, for example, have a higher mercury level than canned light tuna. But then it says women can safely eat tuna on a weekly basis, but those at risk should eat no more than six ounces a week. So here, even in the press release, it's pretty confusing about how much tuna can I have.

If you take Newsweek, just this last week and Newsweek, there was one of the headlines, the top 10 health stories of 2003, and they've got a section on breast implants and continue to be cautious. I just love this statement. This October, an FDA advisory committee voted 9-6 in favor of lifting the ban against breast implants, silicon breast implants, silicon, excuse me. And soon after, however, the committee's leader announced that he opposed such a move and urged the FDA to ignore his committee's recommendation. So I thought, well, that tells us a lot, doesn't it? Or another one of the lead articles for 2003, of course, was on the SARS outbreak, and they make this comment at the end of that section. One thing China hasn't learned from its SARS experience is that eating habits, particularly

the taste for freshly killed meat, might have to change. Scientists found that civets, a cat-sized creature, and local delicacy, can harbor the SARS virus. Chinese authorities banned sale of the animal in April, but reversed themselves in August after farmers and restaurant tours in Guangdong objected. From a safety standpoint, says WHO's Beckadam, we think it was premature to put it back on the menu. This winter, the battle will be shaping up between China's tradition and the world's safety, so more to come. And then yet another one, spending thousands for hearing help is nuts. Oh, wait a minute, that's an advertisement. Okay. As you go through the magazine, you can hardly tell the difference sometimes between what's in the news and what's in the advertisements.

Okay. So we are certainly surrounded by this kind of stuff, and in fact, I don't know if any of you noticed, but when they ran the little blurb for a Doug and my presentation last Friday on NPR, right after the little thing where Carla introduced us, I reflato came on and talked to did a piece on all the dangers of Christmas time. Did you catch that? It was like, oh, I had to stop my car and write down notes as Ira is giving his little thing because it was just perfect in terms of what we're talking about today. And he was talking about the toxicity of point setters and mistletoe and he finished off by making sure, discouraging or wanting you to be sure to not drop the fruit cake on your foot. So it was very much ingest, but it was just perfect for what we're talking about today. So we want to, something that Doug and I had noticed in our practice and in our personal

lives, is that even though we are living longer and healthier, this just points out what's been happening with our life expectancy, whether it's at birth or at age 65 or even at age 85, that it is increasing for both men and women in this country and has been steadily for the last 50 years. Even though we're living longer and better than we ever have in history, it seems like we seem to fret and worry and be anxious about more and more risks and dangers that are around us. And of corollary or secondary part of that is that oftentimes we find that people fret over very trivial kinds of risks and yet they remain oblivious to very real immediate threats to our health and our safety and our well-being. And so what happens from that then is we make some very poor even stupid decisions about

our health. And so that's the issue that we want to address with you a little bit today. We want to define some terms and concepts that are related to risk and safety in order to help you better filter the news and we want to offer you some action steps that you might consider in order to live a healthier life yourself in what we will accept as a risky world. Now a couple of disclaimers before we go any further, Doug and I are not epidemiologists. We are family dogs. And so what we're going to share with you today is we're going to try to personalize the statistics a little bit but we don't claim to be grand epidemiologists in that. And the second thing is that the statistics we'll share with you today, we have referenced them as best we can. But they are approximations and sometimes even lots of uncertainties and some contradictory

kinds of statistics that are out there. And so we will address that as we go along but what we're giving you is the best information that we could find. Okay. Well now some risks in life are either silly or quite obvious. I mean, you know, the mistletoe that I inflato talked about, you don't really worry about the toxicity of that as long as you've got it hanging somewhere where the kids and the dog aren't going to eat it, right? Okay. The real risk with mistletoe is who you kiss, okay. All right. And for motorcycle riding without a helmet, I mean, I don't have to tell you that's risky, right? In medical circles we call those people organ donors, okay. And they are pursuing some kind of either a death wish themselves or they just don't have any brains to protect, okay.

I don't know what it is, but you already know that that's a high risk of behavior, all right? And you also know that the danger of cell phones is not from the radiation exposure to your ear of using them, it's the fact that you're distracted while you're using them and you are at high risk of some kind of accident, especially if you try to do that while you're driving a car and you've heard lots about that. So cell phones are quite risky and especially if you try to do it while you're driving. But the risk isn't the issue of how much radiation you're delivering to your ear. But some risks may not be quite so obvious. And so we've put together a little quiz to start off our time today and to get some sense of what these risks are. And if you're used to using powerful, you're all set, if you're not, I'm going to explain a couple of things before we start on some of the questions we have for you. You've got an answer pad there and I will read through the questions and make sure that

you have plenty of opportunity to get your finger on the right button and find it on the answer pad before we start the timer. But then you'll need to press one of your buttons when the timer starts. Now you will not be embarrassed as far as I'll be able to point out exactly who voted what way. But what will show up here is how you voted as a group, okay? And so for the first question, living in Wichita, Kansas, you are, now there's not necessarily just one right answer on this particular one. You are more likely to be killed by a tornado than by choice number one, a motor vehicle crash. Choice number two, a pedestrian traffic accident. Choice number three, lightning. Choice number four, a drive-by shooting. Choice number five, drinking contaminated water, okay? So as everybody chosen your one, don't press it yet. Let me get my act together here, okay? Go ahead and vote now.

Okay, time's up. All right. So you're more likely to be killed by a tornado than by contaminated drinking water. Most of you gave that as your answer. That's correct in spite of how it tastes. That really is not a significant risk in Wichita. And actually you are more likely to be killed by a tornado than by a drive-by shooting. And on the lightning, you are probably a little more likely to be killed by a tornado than by lightning, but it's right on the same order of magnitude. So either one is risky and actually dying from a flood is more risky still than either of those, okay? And of course, pedestrian traffic accidents and motor vehicle crashes are much more common than getting killed by a tornado. And so watch out.

But we all know that because of Wichita's streets in general, okay? Next one. All right. If you get killed by a gunshot wound, the bullet most likely came from. Number one, your own gun intentionally, in other words, you're trying to commit suicide. Number two, your own gun unintentionally. So a gun-cleaning kind of accident or the kid's playing with your guns in the home. Three, someone who knows you intentionally, as in a homicide, four speakers. Yes. Ouch. Oh, man. Do you see that blood stain right there? Okay. Four, someone who knows you unintentionally, so a hunting accident. Five, someone who doesn't know you, but intentionally, so like a drive-by shooting, are finally from a police officer. Okay, everybody, fingers on your voter pads there and go ahead and vote. Okay.

So most of you said your own gun unintentionally. Actually, that's not correct. The most likely by far is your own gun intentionally, suicide, is by far and away the greatest risk. And unintentional accidents either from your own gun or someone you know is quite uncommon. And that is, and that lags behind some kind of homicidal intent. And most of the homicide is someone who knows you and doing it intentionally. Drive-by shooting is quite rare. Does happen. And we hear about that in the news all the time, but that's exceedingly rare.

And that is even rare than getting shot by a police officer. But that is, that those are much more rare than number one is suicide, number two is intentional homicide. Okay. Next one. The most dangerous cleaning item in your home is your iron, bleach, washing machine, your vacuum sweeper, or window cleaner. Okay, get ready to vote, go ahead and vote. Okay, looks like the majority of people said bleach. And bleach is number two. So if you voted for bleach, you're close. Number one is actually your washing machine. Yeah, so people leaning over and getting themselves tangled up, I think, I don't know, loading and unloading while it's still running or something.

I don't know. But anyway, washing machines the biggest bleach is second, and your clothes iron is third. And of course, most of them with the clothes iron are minor burns and dropping it on your foot. Okay. And I don't know where vacuum sweeper and window cleaner are, just made those up to make it interesting. Okay. All right. Next question. Airbags reduce your risk of fatal auto injury by about 20%. How much additional benefit do you get from properly buckling your seat belt? Just one more percent, or about 10%, about half, or greater than 79%. In other words, you reduce your risk of a fatal accident by over 99% overall, okay? So get ready. Go ahead and vote. Okay. Most people thought that you reduce it by over 99% overall.

I wish that were the case, folks. The answer is 50%. And so you do, and the point, the take home point here is that airbags do work, seat belts work better. The combination works best, but by no means is it 100% or even near 100% effective. But okay. Next question. The safest mode of travel. Bicycle, train, private auto, taxi, commuter airplane, or a major carrier airplane. Are you ready? Go ahead and vote. Okay, people say major carrier airplane. You're close. That's second. The very safest one is the train, number two. And that's very interesting because if even one person gets killed in a train accident,

it makes national news, doesn't it? But the most dangerous one up there on the list is your bicycle, I'm afraid. And next is automobile. And I really don't have statistics on taxi. You have to decide for yourself, are you safer than the taxi driver? But automobile is, by far and away, much more dangerous than either a train or an airplane. Commuter airplanes are several times more dangerous than major carrier airplanes. But they are still much, much safer than going by private auto. Okay, the most dangerous pest. And now you have to take into account both severity and frequency of bider sting from these pests. Fire ants, tarantulas, scorpions, black widow spiders, and honeybees. Okay? Get ready to vote. Okay, you got that one nailed, it's the honeybee.

And why is that? Well certainly they are some of the most common on the list there, but also then the anaphylaxis or life threatening allergic reaction is also fairly common with honeybee compared to any of the others. You can substantially lower your exposure to chlorine and chloroform by drinking bottled water. We know that chlorine in your water turns to chloroform as a known carcinogen. So true or false that you can substantially lower your exposure by using bottled water instead of tap water. Go ahead and vote. Okay, most of you figured out that that must be false or I wouldn't have bothered to put it up there.

And that is correct. In a brief shower a day, you absorb through your skin and breathe in as much chlorine as drinking two quarts of bottled water. So bottled water is not your safety valve for limiting your exposure to that at least individual known carcinogen. Well, if you drink it for taste, that's one thing. But if you're drinking it for safety, that's my message. Okay, at this point Doug is going to define some terms and introduce some concepts regarding risk and safety. Thank you Scott. Well, in order for us to be able to well be well armed to understand what's happening in discussions of risk and risk reduction that we hear so much about in the media, we

need to be familiar with terms. And as Scott showed you, practically every day in the newspaper and in our weekly news magazines, we're going to have significant discussions of risk and risk reduction. So anyway, what is risky? With anything that might be hazardous or might do harm, we can call risky. And when we talk about what is the risk of something, what is the risk of exposure to something? We're really talking about four terms. We're talking about the probability that exposure to a hazard will lead to a harm. So these four words that we want to review are probability and exposure and hazard and harm. Well, sometimes as Scott mentioned, harm is very clear. For instance, writing your motorcycle without a helmet or Dr. Rogers writing a motorcycle at all.

I told her I'd do that. Sometimes harm is not clear at all. For instance, how long was it in the history of man that we didn't know that exposure to lead was very harmful? Or how long in modern history did we not know that exposure to radon in certain parts of the country, like in the basements in Pennsylvania where I used to live, that's very potentially risky over long haul? And talking about harm with exposures to something is really quite complicated, like exposure to alcohol. It's been well demonstrated in many modern studies that a modest amount of alcohol ingested regularly can reduce the risk of coronary artery disease. And yet we know that with some people, even exposure to a little bit of alcohol leads them to seek out settings for more exposure. And then their health and their family's health and that of the community is very harm. So, and even a little alcohol may increase the risk of esophageal cancer or some other

cancer. So, harm is very difficult sometimes to define. Exposure is another term we have to look at and think about when we are reading the articles like Scott reviewed with us. Scott exposure varies with people and over time dramatically and the impact of certain exposures can be very different. For instance, even a minute amount of certain toxins in the prenatal period and in particularly in certain vulnerable parts of the prenatal period can lead to a disaster in the development of the fetus. Whereas an exposure to the same hazard later on in life, even at much greater amounts will have no apparent impact at all. So, remember that exposure varies over the hazard of an exposure, can vary dramatically

over a lifetime. And what is the exposure that you may have can be very hard to measure, very hard to define and quantify. And what certain exposure does to some people is very different than exposure will do to other people as is very evident to you when you think of what the hazard of a given exposure of sun will be as a health risk to a northern European versus someone of African ancestry. Very different, same exposure, very different risks. So, now we need to talk about probability and this can be a little difficult at times. When we talk about probability of a specific event occurring with a specific exposure to a known hazard, we don't know what the exact outcome is going to be.

But we do know from in many exposures to hazards, a pattern of outcomes with many similar exposures is somewhat understood. So we have some understanding of what might happen and how often it might happen if this event recurs over and over and over again, but by no means can tell you what will happen to you with a specific exposure to a specific hazard. And so that inherent concept is difficult at times to grasp. Now, when you hear statements about probability, you're going to be hearing phrasing that expresses how often a particular harm will happen given a particular level of exposure to a specific hazard.

And here's some of the examples. For instance, two deaths per 100 cases. And this would apply, for instance, to the mortality rate in West Nile virus. But I have to mention to you that if you're either young or very old, that doesn't apply to you at all. The risk is going to be much higher. We might hear a phrase that goes like one in 10 women over a lifetime. For instance, what applies to the diagnosis of breast cancer in your lifetime? Or one in a hundred per year. That's your risk of dying in any one year on average. And of course, it's a little higher with newborn infants and very, very much higher with folks over the age of 75. But if you're 40, you tend to be at the lowest level of risk. Now then, as you're reading through your article in the newspaper or listening to something on radio or TV, you'll hear a risk statement.

And it may or may not include a statement of the population that is under consideration. But you need to listen for that very carefully. What is the population that's being discussed? Is it the entire population, in which case you have to ask yourself, how do I differ from that population? Is it a special population, for instance, smokers or diabetics or aged people or a specific gender? So every time you come across a statement of health risk, ask yourself, as a population mentioned, and how do I differ from that population? How do my circumstances differ? So earlier, we heard that one in 4,000 chances of having your house flooded. Now when you hear that, you ask yourself, well, do I live in the flood plain of West Wichita, or do I live east of Hillside? And as you think through how that statistic applies to you, you ask yourself those questions.

Now this might be the most difficult concept to talk about of the whole discussion. And that is the difference between relative risk and absolute risk. Now you might hear this statement made about three different treatments. This treatment reduces the chance of blank by 50%. For instance, this treatment reduces the chance of needing a knee replacement by 50%. Or this treatment in diabetes reduces the risk of coronary artery disease death by 50%. Now does each of those treatments reduce risk the same? And do they have the same impact on risk reduction for the population? And the answer is by no means. For instance, this treatment reduces the chance of needing a knee replacement by 50%.

Well, that only applies to folks with arthritis. But only one in 50 people who has significant arthritis will ever be considered for a knee replacement. And so this particular treatment would benefit only one in a hundred of the people at risk, which is a small, a small-ish part of the population. The next statement, this treatment reduces the risk of a soft-legal cancer by 50%. Well, the population discussed there is the general population. But only one in 500 people will ever have a soft-legal cancer. So this reduces the risk for or benefits one in a thousand. The next one, this treatment in diabetes reduces the risk of coronary artery disease by 50%. Well, if you're diabetic, you have a 50% chance of dying of coronary artery disease. So this treatment benefits one in a quarter or one in four of the people at risk. So it has a very high impact on the at-risk population.

But if you just take the statement as given, this treatment reduces risk by 50%, you may not realize how very different the impact of risk reduction those treatments have. There are specialists who look at risk reduction and the impact of risk discussions on the general population. We have in the references at the end of our talk an excellent internet site for you to go to is the Harvard Center for Risk Assessment. People like that look at what the discussion of risk does to us psychologically. And they've come up with an understanding of how we really don't process the discussions of risk have impact on us very different than the real risk of the hazards. In other words, psychologically, we are not well equipped to process risks accurately.

And here's why. We tend to be significantly more concerned about risks that are new to us than old ones that we know, even if those new risks relatively speaking are much smaller. We tend to be very much more attuned and worried about man-made risks than natural risks, even if the man-made risks are much smaller. So the risk of radiation from a cell phone may be thought much more significant than risk of radiation from the sun, whereas the opposite is very much true. Radiation risk from the sun is much higher than electronic radiation risk. We tend to accept chosen risks much more easily than imposed risks. So smoking or motorcycle riding, we tend to accept much more than if a high power line is close to our house.

We tend to tolerate risks that have benefits like living in California on the beach. Even though we might discover that our house burns up or is flooded out, much more than those that are without benefit. And we tend to be much more concerned about scary risks than those that are not scary. For instance, the risk of dying in the teeth of a shark versus the risk of drowning. We accept risks that have control much more easily than we accept even far lesser risks that we have no control over. So we tend to accept driving risks more than natural disaster risks. We tend to be much more vulnerable to publicized risks than unpublicized risks. Even if the real risk is very much bigger for the unpublicized one, we're much more bothered

by unknown risks than familiar ones. And we're very much more bothered understandably by risks that our children face even if they're very small compared to big risks that we might face. And to illustrate how we tend to, one of the reasons that we tend to focus on some risks more than others, has to do with where we get our information. Most of the time, we're getting our information about risks from news media. And the news media doesn't necessarily give equal time to equal risks. For instance, we'll hear lots more about toxic agents and motor vehicle accidents and other personal accidents than we hear about tobacco. And yet, as far as a risk that has a high impact on the community, tobacco is dramatically

greater than toxic agents or accidents or illicit drugs. And the same thing can be said for causes mortality, we're much more worried about. And much more interested in taking steps to reduce mortality that is spoken of more in the media. And that's not necessarily the mortality that we most likely face. Now why would we want to talk about risks and mortality as a community? Well, over the last 50 years, discussion of risk has actually had a significant impact on relative risk and on absolute risk, for instance. Now, before I go into that, I just want to show you this is a graph that you might see in a publication like Newsweek or in a scientific publication.

And it features the relative risk or the change in risk to us over the last 50 years of some very significant issues, heart disease, cancer, stroke, unintentional injuries and diabetes. Happily some of these are going down relatively dramatically. Heart disease, stroke, in particular, and thankfully since 1970, unintentional injuries. They look like relatively modest changes though. But does anybody spot on this graph an issue that is difficult to detect, but if you understand it, you understand that for instance the decrease in heart disease is dramatically greater than might be represented by this graph. Look over on the y-axis here, up top it says 1,100 and 10. This is a log scale and this is an example of how sometimes the portrayal of statistics

can inherently bury some very important things for those of us who don't look at them carefully. That log scale means that a risk here is 10 times greater than a risk down here and a 10th the risk up top. So heart disease has dramatically decreased over the last 50 years. That scale, if it was a regular scale, would look something like this, as would stroke and unintentional injuries. So this graph shows trends for folks between ages 45 and 65. This one shows the trends for folks over the age of 65. And remember we talked before about risks for different ages and genders can be very different. Who would like to point out the dramatic difference between this one for 45 and 65 and this one

for folks over 65? The scale is a bit different, that's true, but there's a color on this graph, it's not on this graph. Influenza and pneumonia, a major killer of old folks. So when you hear general statistics about risk, be sure you understand what is the population that's being discussed and risks for folks over the age of 65 and particularly 75 are dramatically different than those over the age of 65. Here's another graph to just illustrate to you how your risks will dramatically change over age. Now as we hear about risks, we really need to put the size of that risk into some perspective.

And so for the next few minutes, I'd like to illustrate for you some of the risks that you face that are very high, moderately high, modest, low, and almost imperceptible. So and it's very hard for us to process some of the numbers that are involved. So the scientific community is looking for ways to be able to communicate to people so that they can really process it in real terms what these numbers mean. Well if you live in a household where you've never had measles before but somebody in the home develops measles or chickenpox, what's the likelihood that you are going to end up with the infection? It's 50% or greater. In other words, both measles and chickenpox are extremely contagious. So the hazard is the infection, the exposure is the household, the probability is very

high, and the harm for the most part is modest. What's the lifetime risk of death due to heart disease? Well still, even though we saw it dramatically decrease is still very high, one in three. How about for your children and grandchildren, if they take an errand step, what's the chance of their teenage lover having a sexually transmitted disease, it's very high? How about the teacher's lifetime risk of an assault by a student? That's kind of scary. Okay, so these represent relatively high risks, greater than one in tan, but be careful, remember the denominators are so different. Per exposure, some risks like this one, per lifetime, like this one, and this one, and per period of exposure, this one.

Relatively high risks. You can see these in your own handouts, gastrointestinal side effects of antibiotics, or serious crime in a lifetime, death by car crash over a lifetime, or injured in motor vehicle crash this year. Moderate risk, and this is between one in a hundred and one in a thousand. Death all natural causes age 40, one in eight hundred and fifty, and you remember earlier I mentioned that taken for the whole population, it's one in a hundred. Low risk, in other words, between one in a thousand and one in ten thousand, the lifetime risk of death due to plane crash, or driven from your home by a flood in a year, relatively low risk. Now you have to start to ask yourself, what's my definition of high risk versus low risk or very low risk, because people's inherent tolerance of risk is definitely different

and different under certain circumstances. Very low risk, in other words, between one in ten thousand and one in a hundred thousand, poisonous snake biting you this year, one in forty thousand, well if you live in a high rise apartment in New York, I think it'll be a little lower, however if you go hiking in Appalachia it's going to be very much higher. Minimal risk, in other words, likely to happen to only one in a hundred thousand to one in a million people exposed. In associated polio it gets a lot of press but it's very low risk. And almost negligible risk, in other words, fewer than one in a million people will experience the harm if exposed. Lifetime risk of death due to rabies, well if you're a farmer on the Mexican border in

Texas that might be a little higher. Here you're a death in a single trip on an elevator, well if you're acrophobic who knows. All right, so how do we communicate those vastly different concepts of risk so that we have some way of responding appropriately to them? Here's one way, just a graphical illustration. One in one is on the top, all the way down to one in a thousand. That might help you emotionally wrestle with the difference between these two risks. To see a thousand little boxes versus one. Now Dr. Moser, who is very good at it, is going to start talking about the unknown. And we put this slide in as a reminder that a lot of the risks we do not know very well. Even very close ranges on what kinds of risks we have.

The real temptation then when you're faced with uncertain risk is to just pretend it's not there or to rationalize about it and not do anything. So we want to focus on as we come toward the end of our presentation is to talk a little bit about some specific action steps that you might consider. In face of all of our discussion about risk today. The first one that I want to point out here is oftentimes I get this approach by people about, well why should I quit smoking? I've already, I'm already at bad risk. There's no point. And let me just say that if you smoke, why do we keep harping on that? Well the point is that if you smoke, then all the other risks in life are pretty minimal by comparison to that risk that you're taking right now.

And so I think it's a good index case or problem for us to address here. But even after a single day of quitting, your risk drops for sudden cardiac death. After just two days, your sense of smell and taste begin to recover. And after just a few weeks, you start getting better circulation. After a few months, you stop coughing so much and you have less respiratory infections and fatigue. After a year, your risk of heart disease, coronary disease drops by half. And after five years, your risk of the main cancers due to smoking long and mouth cancer also drops by half. So you can see that taking action whenever it is in your life can make a significant difference on your risk. All right, other kinds of things get smart, educate yourself. You've started that process by showing up for this today.

We've included some resources available to you both online and in the live local library that you can explore this some more if it interests you. Next, throw out that myth that we live in particularly risky times. We don't. The fact is that we are living longer and healthier than man has ever lived in history. Now, that doesn't mean that there aren't still real risks all around us. But what I'm saying is that put that in perspective as you hear about the risks. Also reject the myth that there is somehow some kind of medical suppression of the truth going on. This is often espoused by people who have various kinds of alternative approaches to care. And the reality is that if there's a true miracle drug out there, you can't suppress it. I mean, when Penicillin was discovered, the world knew about it immediately. And that's the truth about true miracles.

Also reject the myth that there is really any such thing as, quote, safe. If you stay in your house all day long, you will avoid the risks of sun exposure. You're not likely to get run over by a car. But you also lose the benefits of sunlight, being outdoors, getting exercise, et cetera. So whatever you choose to do, they're going to be risks and benefits associated with that. Also don't be fooled by when we in science talk about a significant risk. That's a statistical term. It doesn't necessarily mean that it's important. Dr. Woolley pointed out to you some of how, especially when we talk about those relative risks, that just because it's a significant difference doesn't mean that it has any great importance to a population or to you individually.

Have a healthy level of skepticism when you hear new reports. Is there some reason, does this person that's trying to alarm you have an agenda? Do they have something to gain by alarming you about this risk? Very often there is an agenda that they have. It may just be improved TV ratings for their company, all right? Or it may be a political agenda or whatever. But ask yourself, is there some kind of gain that this person is getting from this? And remember that there is no substitute for moderation and discipline. Say if you eat too much, if you exercise too little, if you rest too little or irregularly, if you participate in bad habits, if you continue in a relationship or a job where you're chronically angry or unhappy or anxious, it will catch up to you sooner or later. In spite of the fact that your uncle Jake, smoked like a chimney, drank like a fish and

lived to be 103. Okay. I mean, those things do catch up with you. Okay. Okay, further action steps, number one, drop a will. And you say, man, why is he saying something like that? The point is that oftentimes when we are so overwhelmed by all these different risks, our tendency is to pretend that we're going to live forever. And the reality is that the risk of death for every one of us is 100 percent, right? And we can talk about when or when or what the cause is going to be, but we're all mortal. And so it's amazing to me how many people think they can pretend that they're immortal and somehow that's going to help them live longer and that ain't the case. So first of all is getting in touch with your own mortality and a good way to do that is to drop a will. Secondly, limit your TV exposure.

Now why do I pick on TV more than any other media, medium? And there are a couple of reasons for that. First of all, it's the most graphic of all the media in terms of grabbing our attention. But it also has to do with the fact that there is not really an opportunity to reflect or to give the whole story. When you have print media, you can go into some of these nuances and explain things a little more clearly. TV tends to be those brief little sound bites or clips and you get this psychological impact but you don't get an opportunity to reflect on whether it's significant or not. So one aspect has to do with its impact on us that way. The second reason I say to limit TV is there's excellent evidence that the more TV you watch, the more your body turns to mush and the more your brain turns to mush. And so the more time you spend doing that is less time you're spending doing things that

are better for you. And so that's why I pick on it. Number three, perform an honest self appraisal of your risk. And there are lots of ways to go about this. Perhaps just reflecting on some of the things we've shared today will help you in that regard. There are tools available to do that. You've given you the website for one that I tested out myself at that www.ufers.com. If you do a Google search, you can find a lot of these but some of them, you're giving some pretty personal information. And even this one, you have to leave an email address but you don't have to leave your name or some other personal information. So you want to be a little careful. But some of these tools are very useful in terms of the kinds of questions they'll ask you and an opportunity for you to take a little risk inventory on yourself in terms of addressing it.

The next one then is as you have performed that kind of an appraisal, then take a look at the big known risks and avoid those. But as you do that, let the small risks take care of themselves. And finally, my re-emphasis of we'll do something because the great tendency is for all of us just to not do anything about it. And in regards to that, some further self-assessment questions that you could ask yourself, number one, is there some risky behavior that I'm involved in now or some risk I'm taking that I ought to stop? So in spite of all these uncertainties, there are some knowns, all right? And my guess is that it's so easy to rationalize with all that uncertainty, but you know good and well that there are some of those things we do know that aren't good for us. And so the question is, is there some kind of risk that I know I should stop? And then the question is, well, what's keeping you from doing that, all right?

The next one is, is there some kind of healthy habit that I know I should start, all right? And is there some reason that you haven't started that? And is that a realistic excuse? Is there a worry that you have that isn't? And some of our discussion today, is there something that you've been fretting about that you've realized that's really not a realistic worry? And finally, is there something fun that you have always dreamed about doing but you've never done? That question about, well, if you knew you just had six months to live, what would you do that you aren't doing now? And what's stopping you? Well, it might be for very good reason, okay? I'm not, I don't want you to walk out of here today and say, well, most are told us, we ought to all go, you know, skydive because I've always wanted to do that, okay? That's not the appropriate response to what we're saying today. But I am saying that oftentimes those unrealistic fears keep us from doing things that would add

a lot of fun and enjoyment to our lives so that we don't look back on our lives in a few years with a lot of regrets, okay? Because in spite of all these risks, we know life is risky, but also life is to be lived. And so that's what we wanted to leave you with and we've got some resources for your further interest if you want to. So thank you very much. We'll take an opportunity for some questions. And as you're thinking about your questions, I'd like to ask you one. Think back to the vignette of Scott in the doctor's office and reflecting on the discussion we've just had, what are some of the things that the fellow who lives in rural Kansas close to Wichita, but is worried about West Nile virus, what are some of the things he should

be doing and some of the things he shouldn't be doing? If we follow, if he follows Dr. Moser's recommendations, all right, yeah, he should be out there wearing a wide-roomed hat because he looks like he has northern European ancestry, maybe a little sun-volverable, yeah, use a seat belt. We saw the statistics, 50% increase, wow, that's a pretty big impact, no pun intended. What else? Maybe the horse, huh? Yes, stop smoking. That is the one single biggest risk reduction step that he could take and everything else is insignificant in comparison. So I tell my patients, if you never come, I tell my patients who smoke, if you never come through another doctor's office door again, but stop smoking, you'll be ahead of the game

compared to showing up every month and worrying about something. Other things that this fellow ought to do. Go for it. Go for it. Well, you know Larry, that is controversial, don't drink what and how much you plan. So I'm not sure. The pest is the date, the pest is the date? Yeah, that would be a good thing because he really does face a real risk, somewhat bigger than those of us who are outside for 10 hours a day in rural Kansas. So that does make sense. So I didn't poo poo it, and I just said, wait a second, let's put those in perspective. Okay, now how about your questions?