It has been said that we fear that which we do not know and do not understand. But all too often, we engage in behavior known as “misfearing” – the term used to describe the human tendency to fear instinctively rather than factually. Misfearing is pervasive in our culture, and its consequences on our collective health are staggering.
In February, Dr Lisa Rosenbloom touched on the subject of misfearing with regards to women’s health in a perspective piece in the New England Journal of Medicine. A cardiologist by trade, Rosenbloom took an informal poll of her patients, asking them which health condition they thought was the number one killer of women. Many of her female patients accurately reported heart disease to be the leading cause of death for women. A fair number incorrectly said breast cancer. One of her patients, a woman with high blood pressure and high cholesterol, said “I know the right answer is heart disease, but I’m still going to say breast cancer.”
The truth is that heart disease takes the lives of more women each year than all types of cancer combined, that it is in many ways preventable, and that despite what many women believe, multivitamins and antioxidants do not reduce the risk. However, all the facts in the world cannot sway the opinion of a person who misfears, who determines their sense of risk based on not fact but feeling. Certainly, there is some amount of ignorance involved, some amount of misunderstanding from patients or a general lack of knowledge. I’m not implying that patients are not intelligent human beings, but rather physicians historically have done a particularly poor job of educating their patients. But with more and more information available to patients at their very fingertips in the nanosecond or two it takes to use Google on a smartphone, where has our collective misfearing come from?
For breast cancer, the availability of that information may be the very problem. As a society, we are constantly bombarded by health messages, and women in particular are assaulted by advertisements from groups like the Susan G. Komen Foundation, which seems to have trademarked the color pink. Women are constantly hearing about breast cancer and the importance of screening mammograms. Many physicians view a woman at age forty as beginning her “right of passage” by obtaining the first screening mammogram. There is no doubt that the message out there solidly directed at American women is to fear breast cancer, a message so pervasive that when the US Preventative Services Task Force recommended decreasing the frequency of mammography, there was a public outcry among doctors, women’s health experts, and women themselves. Rosenbloom goes on to discuss how pervasive the fear of breast cancer is in our culture, asking
Have pink ribbons and Races for the Cure so permeated our culture that the resulting female solidarity lends mammography a sacred status?
Rosenbloom goes on to create a greater argument surrounding misfearing, culture, and personal identity with breast cancer as her prime example, but misfearing is far more prevalent than only women’s health issues. Decades of research on risk perception have revealed the factors that feed our misfears, including those that are big, dramatic, memorable, or constantly on our minds. Misfearing is the reason that many of us horde guns to protect ourselves from random, senseless acts of violence that the media portrays as widespread, while we simultaneously fail to protect ourselves by buckling our seat belts. Similarly, misfearing is to blame for those who refuse to fly for fear that the plane may crash but do not realize they are far more likely to die in a car accident on the way to the local grocery store. We fear terrorists attacks and yet 15 percent of our population smokes regularly, misfearing our risks of heart disease, cancer, and stroke.
Perhaps the best example of misfearing comes from the controversy over autism and the belief that vaccines are to blame. The rising anti-vaccination movement has concluded that the dramatic increase in autism diagnoses is directly linked to childhood vaccines, citing evidence that is dubious at best and has been discredited by every respectable scientific and medical society. The same anti-vaxxer movement has been blamed for a rise in outbreaks of disease like measles and mumps, diseases that were considered eradicated in the recent past. How did this come to be? Simply put, diseases like measles and mumps have left our nation’s collective consciousness due to the incredible effectiveness of vaccines. Unlike our parents and grandparents generation, who grew up in a time when childhood disease like measles, mumps, and polio had devastating, if not deadly consequences, a new generation of parents has been immune to the highly contagious infectious disease of our not so distant past and have instead come to fear autism’s devastating diagnosis. Despite the evidence that vaccines do not cause autism yet protect children from deadly disease, parents continue to make the utterly baffling choice to refuse vaccines anyway. The culprit here? Misfearing – and it’s leading to a deadly public health threat.
Rosenbloom laments that there isn’t much we can do about misfearing. We can educate individuals to change the perception of their individual risk. We can craft laws and regulations based on fact rather than feeling. But while education and regulation in the world can sometimes nudge us toward behaviors that promote our health, they unfortunately cannot tell us what to believe. Before we can reduce our own risk, we have to believe it exists in the first place.