risk abatement options (response to Tschaeche)

["Karam, Andrew" <Andrew_Karam@URMC.Rochester.edu>]

Dear Al,

Another approach might also prove of interest to you.  Taking Tammy Tengs'
paper on the cost-effectiveness of over 500 types of life-saving
interventions, you can make a very good case that spending, say, $100
million to address a "problem" that will affect only a few people is not
effective and will actually cost lives.  For example, there are many
programs (including childhood immunization programs) that operate at a net
savings to society because these people require fewer emergency room visits
and miss less work.  Putting $100 million into safer roads in the community
will also save more lives, as will using it to upgrade emergency response
vehicles or any of a number of other areas.  In addition, other work cited
in the New England Journal of Medicine has shown that every (about) $10
million in costs distributed across society results in one additional death
because that is money taken from taxpayers (or ratepayers, or whatever) that
is not available for, say, new snow tires, better foods, vitamins, and so
forth.

Putting these together, I have argued that, by insisting a large amount of
money be spent on reducing a very small risk, these funds are being removed
from other, better uses that could save many more lives.  By insisting that
radiological risk reduction be pursued at all costs, in my opinion, the
"radiophobes" are also insisting that people are going to die who could
otherwise have been saved or helped.  And this is all based on LNT.
Postulating a threshold (which I tend to feel is more appropriate) or
hormesis effects, the argument becomes even stronger.  Unfortunately, as has
already been pointed out, many people are particularly immune to logic in
such matters.  Therefore, while I always hope for the best, it is not unlike
religious conversion.

I realize, of course, that there is not a general "risk abatement pool" of
funds from which money can be distributed at will.  However, I also know
that our budget is not limitless and that money spent in one area
necessarily means that it is not available to any other program for any
other purpose.

Something else that many do not seem to grasp is that being born is the
riskiest thing we do because the chance of death is 100%.  By necessity,
reducing risk in one area will result in increases in risk in all others.
Since we have greatly reduced infant mortality, death from infectious
disease, starvation, and wild animal attacks, we see an increase in other
forms of death, including cancer.  Personally, I view the relatively high
cancer rate as a sort of backhanded compliment to the success of our medical
system - we're living long enough to develop it.  However, many obviously do
not see it that way and feel that every cause of death must be eliminated,
forgetting that this is not possible.  I have often wondered what the
regulatory world would look like in a world in which cancer did not exist or
could be cured.

Finally, I must admit that I have not been following this thread closely.
If I have repeated someone else's statements, please accept my sincere
apologies.

Sincerely,

Andy

Andrew_Karam@URMC.Rochester.edu
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