Health care doesn’t need more money — it needs better knowledge. Such is the sobering message in a new report by German psychology professor and director of the Harding Center for Risk Literacy, Gerd Gigerenzer.
In the report, Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020, more than 40 authors from different fields of research and professions argue, that doctors and patients are “statistically-illiterate.” Doctors and patients (and journalists and politicians…) are unable to interpret the meaning of numbers and statistics, the authors say, and this causes serious wasted spending in health care — public as well as private.
“Wasted spending includes panic reactions that happen when patients are frightened by things they do not understand. A well documented example is the contraceptive pill-scare in the U.K. when women were told (by the Committee on Safety of Medicines, ed.), that if they were to take the new generation of contraceptive pills they would increase the risque of potentially lethal thrombosis with 100 percent. The women panicked and stopped eating the pill which led to an increased number of unwanted pregnancies and abortions. They never learned that 100 percent in this case meant the risque had increased from 1 in 7000 to 2 in 7000. This is just a very simple example of a basic statistical conflict. You have a relative risque (big numbers) which scares the women and an absolute risque (small numbers) that is never known by large parts of the public and this leads to unnecessary harms to the women and increased spending in the health care.”
The following year, the total number of abortions in England and Wales rose by 13,000 while expenses in public health care went up by 4-6 mill. due to the pill scare, says Gigerenzer.
PSA-screening and mammography are good examples
According to Gigerenzer, risk-illiteracy is a huge problem in the health sector. It affects the medical guidance that physicians give to their patients, the information found in health pamphlets about potentially life changing treatments, the way medical information is covered in the media and it has a big say in the way public spending is prioritized in the health care, he says.
Take statistics associated with breast cancer screening as an example.
Recently, a group of Danish scientists claimed that mammography (breast cancer screening) had had no effect on reducing the number of women who die from breast cancer in Denmark (link in Da.) This was troubling, they said, since the Danish public had been informed that the technique would reduce the number of deaths with a full 20-30 percent.
Such findings are important. But the interesting part about Gigerenzer’s report is that it explains how both of these seemingly contradictory statements — no effect and 20-30 less deaths — can, in fact, both be correct at the same time.
Another way to explain the effect of mammography is to say that 5 out of 1000 women die from breast cancer in regions without a screening policy. And that 4 out of a 1000 women die from breast cancer when screening is implemented on a large scale.
With a better statistical understanding with journalists, the public and with doctors, in other words, Danes could have known all along what those 20-30 percent actually meant.
Pros and cons
Saving 1 out of a 1000 patients is still saving a patient’s life. And you can’t put a price on that. But what are the potential harms associated with mammography?
That is another topic that is left out in most pamphlets and the media, says Gigerenzer.
According to Gerd Gigerenzer’s interpretation of the available evidence, 50-200 out of 1000 women are subjected to unnecessary biopsies when screening is implemented on a large scale. These are painful and causes severe psychological stress to the women and their families because both doctors and patients generally underestimate the number of false-positives associated with the technique.
Moreover, he says, it is estimated that 2-10 out of 1000 women have their breast removed partially or completely due to the discovery of cellular changes in the tissue that would have never made a difference to the patients’ health had the changes gone unnoticed.
Benign tumors detected at this early stage, to reiterate, are seldom given the benefit of the doubt but are treated as potentially malignant tumors.
- If you’d like to read more about Gerd Gigerenzer’s findings on risk-illiteracy — or if you would like to read about it in Danish — you can check out this article I wrote for Dagens Medicin (Daily Medicin.) This blog post is my personal take on the issue and should not be confused with Dagens Medicin in any way.
- If you wish to continue on your own or do not speak Danish, I would advice you to check out this site and download the first chapter of the book by Prof. Gigerenzer and J.A. Muir Grey (also available in Ge.) The topic of risk-illiteracy reaches much farther than panic-reactions and mammography (think about how much public spending is wasted in a modern administrative society that doesn’t understand statistics!)
- You should also check out the web page of the Harding Center for Risk Literacy (Harding-Zentrum für Risikokompetenz) at the Max Planck Institute in Berlin. There, or here, you can learn more about mammography and see how the Harding Center would present statistics on mammography to the public in a way it argues is transparent.
Before you go anywhere, however, there is something else you have to see. Please watch American Greg Powell land the world’s first Special Flip!
There can be no misunderstandings there.
“Mad A/S” is a Danish counterpart to the U.S.-produced, “Food Inc.” But Christina plans for the documentary to become more than “just” a movie.
“The movie project is a seed for cultural change,” she says.
By opting for a bottom-up approach where parts of the funding is reached via micro-donations from individual contributors, Kirstinesgaard hopes the Danish population will feel as stakeholders in the finished documentary. Hopefully, she says, this approach will inspire a feeling of ownership with the viewers that will increase the movie’s impact when it hits the cinemas and when it moves on to its political, deliberative and educational afterlife.
“Mad A/S” is produced in collaboration with a research panel consisting of medical physicians, professors and PhDs, and will be distributed free-of-charge to Danish educational institutions upon completion.
Below is the full interview. Please feel free to leave questions, ideas or concerns in the comments section above.
Christina Kirstinesgaard: Right now, there are so many things going on in the industrial farming — everything from animal abuses to humans falling ill from eating the food. So, together with the group, I wish to shed light on the subject, communicate the truths and point to alternatives — there are many. The story will be full of hope and told with a bit of humor.
E&S: “The title, Mad A/S,” is a direct translation of the American documentary, “Food Inc.” Is it possible to do a similar documentary in a country like Denmark with no Monsanto or Smithfield Foods?
CK: “MAD A/S” is inspired by “Food Inc.” But it will be focusing on the problems in Denmark. Denmark is usually following the American lead with a delay of 10 years or so, but that’s no longer necessary. It’s more fun to plan ahead than it is to do damage control. Unfortunately, Monsanto is already very much a presence in Denmark — they’re already present at approximately 10 experimental plots with GMOs [Genetically Modified Organisms, ed.]
E&S: How would you characterize the creative forces behind this movie? Are you activists, journalists, consumers or producers?
CK: We’re a good mix of all those people. We have an incredibly skilled, professional director with many years of experience with documentaries and who, as the first Dane, has won an EU prize [The European Parliament Journalism Prize, ed.] for best documentary. We have many skilled and “professional” consumers, we have a research panel with professors, PhDs and physicians and we have 100 individuals who’ve contributed with donations ranging from 50 kroner to 10.000 kroner [approx. 10-2.000 USD, ed.]. We have about 1000 members on Facebook who support us and have faith in the project. This is a movie that simply HAS TO and WILL happen.
E&S: “Food Inc.” presents organic farming as a solution to the problems with conventional farming. What is your take on this?
CK: There are big issues that we wish to deal with. Obviously, organic/biodynamic agriculture are solutions as they’ve been proven to produce foods that don’t contain traces of poison, but we also want to talk about permaculture, CSA [community-supported agriculture, ed.] and the philosophy behind Frie Bønder [Free Farmers, link in Danish. Ed.] who believe farms should be smaller in size.
E&S: “Mad A/S” is partially funded from bottom and up. What have been the pros and cons with this financial model?
CK: The dream is to be able to say: ‘It’s the Danish population who has asked for this movie.’ That would create a very special impact — on the public as well as on politicians. And, by the way, who can sue the Danish population? Unfortunately, micro-funding is a rather slow process — 50 kroner hither and thither sums up to large amounts, but only slowly and in waves. We still hope and wish for something grand to happen.
E&S: Who else are contributing financially?
CK: We’ve received 15.000 kroner [approx. 3.000 USD, ed.] from an organic foundation. We’ve applied for funding at larger foundations and are still working on it. But you have to be brave to support this project! That’s another reason why micro-funding appeals to us — it gives us a chance to be brave together.
E&S: Lastly, when can we expect to see the movie in the theaters?
CK: Our initial goal was to release the movie this spring and everything is ready. But it takes time to raise 1.5 mill. kroner. We’ve been invited to the film festival in Copenhagen this fall so we need to be ready by then. If we really push it, our director can have the job done in about 7 months from when we’ve got the funding.
E&S: Is there something you’d like to add?
CK: This is not ‘just’ a movie project but a seed for cultural change. First thing is to screen the movie in Danish cinemas. Then we’ll follow up with a series in the media, free educational CDs for all of the 2.5000 educational institutions in Denmark, debates, an active research panel and a constant follow-up. Movies are great at touching people and affecting our attitudes towards life, but afterward you’ll quickly disappear from people’s everyday life and the good initiatives are forgotten. But with a long follow-up and by repeating the message you can get the movement continuing in the right direction.
Below is a short clip from the much loved and equally lambasted American documentary, “Food Inc.”
Mad A/S. The title of a new Danish documentary is inspired by the American documentary, Food Inc. (2008), that sought to expose the powers wielded on U.S. farmers by food company behemoths such as Monsanto, Tyson Foods and Smithfield Foods.
Now, with Mad A/S, Danes will get a chance to see if a similar critique can be brought to the Danish agricultural scene.
While still in its developmental phase, Mad A/S looks like it could turn out to become an important and relevant film. When I first heard of the movie, I was worried that it would become yet another activist flick — uncritically confirming existing prejudices. But this doesn’t appear to be the ambition — far from it. Instead, it seems the premise should read something like this:
There are a ton of opinions and beliefs out there about the food we eat and the ones who produce it. And sometimes we get carried away by our emotions. But what kinds of documentation can we actually find and how does the food industry view the situation?
- (paraphrase based on Mad A/S’s informational material.)
Another interesting thing about Mad A/S is that it will be funded largely via micro-contributions — from bottom and up. This means the movie won’t happen unless its viewers want it to (more or less). And, I believe, it could create a strong communal base that will later go on to support the educational efforts that are intended to follow the movie as well as the public debate it’s meant to spur.
Mad A/S will be distributed free-of-charge to Danish primary schools for educational purposes and if more people have a personal asset in the movie, then maybe the following debates and educational efforts will inherit some muscle and heart and represent the demographics of Danes more than just producers or activists.
That would be very food 2.0.
I will try to get an interview with the film’s producer, Christina Kirstinesgaard, to post here on Earth & Science.
Ever wondered how scientists actually measure the amounts of CO2 in the Earth’s atmosphere? Or why they can guarantee that the increase in greenhouse gasses is caused by humans?
If the answer to that question is ‘yes,’ I suggest you read this fascinating post by Tom Yulsman on his blog, CE Journal. The story is a great chance to dive down under the surface of hard news headlines and get your hands dirty with the actual science. And, in my opinion, it’s a fine example of a “healthy” meeting between writings about science and the actual complicated and messy world of science that doesn’t really fit into any front page thoughts.
Yulsman is an associate professor at University of Colorado’s School of Journalism and Mass Communication, and he is co-director of the Center for Environmental Journalism.
The story was crafted for Climate Central and can also be read there.
In a recent press conference at Davos, Georg Kell, Executive Director of UN Global Compact, responded to a question similar to the one I posed here on Earth & Science in a previous post:
Is there a risk that WindMade can get into a battle with solar?
Kell answers by calling WindMade a “pathbreaker,” an initial label and initiative that may clear the way for a more general label in the future. He suggests the name, NatureMade.
Below is the clip:
Referring to sustainable energy as NatureMade may sound good but it doesn’t make a lot of sense. Coal and oil are also very natural — they are just releasing a lot of CO2 that was (naturally) stored in them in the past.
So I still think CleanMade would be a better, more accurate general term. It also sounds nicer: “Clean,” don’t you just smell the country air?
Recently, I also wrote an e-mail to GermanSolar asking them what they thought of the label name, WindMade. Christoffer Ovesen, Sales Manager at GermanSolar’s Danish Branch has promised me an answer but was vacationing until today. I’ll post his answer here when I receive it.
Below is a second clip from the conference where Ditlev Engel, CEO and President of Vestas, goes over his hopes for the new label. Nothing new under the sun there.
Sorry, I meant blowing in the wind.
But the clip is still worth watching. Please note Engel’s distinction between poor countries — defined by heads of states. And poor people — defined by people. I thought that was a good way of looking at the potentials of a bottom-up approach such as WindMade.
To many, the Shinmoedake eruptions that started on January 26, 2011, are first and foremost a natural disaster. So far, hundreds of residents have fled the 1,421-meter volcano, belching lava and ashes for the first time in 52 years.
But from a purely aesthetic point of view, the massive eruptions are also examples of great natural art.
Below is a photo and link to a Reuters collection of photographs. Click the photo to see the full slide show on the Reuters website. The photo displays volcanic lightning above Shinmoedake.
Below is a quick breakdown of the process leading to lightning. The walk-through is pretty basic, but if you’ve never thought about why lightning occurs, it might be a good first place to look.
Lightning for beginners
How lightning is formed is still a debated issue and that’s even more true for volcanic lightning. But According to Geology.com, a website created by Hobert M. King, Ph.D. and contributors, it can be explained as a process which ideally occurs in four steps.
The first step of lightning formation is the starting stage. Here, particles in the air are still in a neutral electrical balance.
In the second step particles collide which leads to charge separation — a phenomenon where charges in the air’s particles are driven apart. This is referred to as the electrostatic induction hypothesis, and is — as far as I understand — still a process that lacks a generally accepted explanation.
In the third step of lightning formation the negatively and positively charged particles are sorted, most likely via the aerodynamic “currents” in the atmosphere. At this point one section of the cloud will be more electrically negative than another.
Finally, in the fourth step, lightning occurs. This happens as the clouds even out the electrical imbalance between them. At this point the charge separation has reached a certain critical stage when the electrical imbalance between the clouds has become too strong.