Worry vs. Reality: The Real Risks You Face

When weighing risks, don't let your heart overrule your head.

From the WebMD Archives

Woody Allen defined major surgery as "anything being done to me."

When it comes to evaluating medical risk -- or risk of any kind, for that matter -- it gets very personal, and when we're weighing threats to ourselves or to others we care about, we tend to think with our hearts rather than our heads.

As Seen on TV

A sobering example of emotions overcoming reason when weighing personal risk came in the aftermath of Sept. 11, 2001, when many people who were frightened by images of airplanes crashing into buildings took to the roads instead of flying. But according to the National Safety Council, your lifetime odds of dying in a car accident are 1 in 242, compared with 1 in 4,608 of dying in all "air and space transport" mishaps combined. Take the bus, and those odds shrink to about 1 in 179,000.

One picture can indeed be worth a thousand words, and public perceptions about risk are often shaped by television news, which has immediacy and visceral impact, but might not provide careful reflection or thoughtful analysis.

Cause of Death

Lifetime Odds of Dying*

Car crash

1 in 242


1 in 1,028

Plane crash

1 in 4,508

Lightning strike

1 in 71,501

Bitten or struck by dog

1 in 137,694

Venomous spider bite

1 in 716,010

*for someone born in 2000
Source: National Safety Council

"In my opinion, it has a lot to do with the way the media handles the reporting of it. I think there are times when the media tends to overstate certain issues especially when it comes to medical problems. Obviously the media is very helpful in disseminating information, but if things are overstated, then they can result in people overreacting," Michael I. Greenberg, MD, MPH, editor-in-chief of The Journal of Medical Risk, tells WebMD.

What You Don't Know Can Hurt You

Remember the SARS (severe acute respiratory syndrome) panic of 2003? According to the CDC, there were161 possible cases of SARS in the United States, and out of that number a total of eight were confirmed as having SARS; the remainder were classified as "probable" or "suspect" cases, and there have been no SARS-related deaths in the United States to date.


In contrast, every year approximately 36,000 Americans die from the flu, which is far more common than SARS, and just as easily transmitted. So why do stories about flu outbreaks only occasionally make headlines or lead the evening news, while small threats such as SARS capture all the media glare?

One reason, says David Ropeik, director of risk communication at the Harvard Center for Risk Analysis in Boston, is that when it comes to risk, familiarity breeds concern.

"Fear has intuitive characteristics which are more powerful than the probabilities and the scientific facts. For example, cancer kills us in a dreadful way, and the nastier a way it is to die, the more afraid of it we are likely to be. That is our perception of what to be afraid of," Ropeik tells WebMD.

The American Heart Association has struggled with this problem for years. That's why it recently launched its high-visibility "Go Red for Women" campaign to coincide with the release of heart disease prevention and treatment guidelines. The AHA points out that cardiovascular diseases -- heart disease and stroke -- kill nearly half a million American women every year, accounting for more deaths annually than the next seven causes of death (including breast cancer and all other forms of cancer) combined.

Cause of Death

Heart disease

1 of every 2.6 deaths

Heart disease (women)

1 of every 2.5 deaths


1 of every 4 deaths

Breast cancer (women)

1 of every 30 deaths

Sources: American Cancer Society, American Heart Association

"Unless a woman perceives herself to be vulnerable, she's not going to heed a preventive message. It only resonates when you realize there may be a personal risk," Nanette K. Wenger, MD, professor of medicine at Emory University School of Medicine and chief of cardiology at Grady Memorial Hospital in Atlanta, tells WebMD.

"When it comes to health care, people do not put the equivalent amount of worry to what the experts throughout health care tell them are the biggest risks. Smoking, obesity -- there's a disconnect between what the figures and the facts will tell us and how people in general treat those risks in their mindset," Paling says.

In their book Risk! A Practical Guide for Deciding What's Really Safe and What's Dangerous in the World Around You, Ropeik and co-author George Gray, PhD, list factors that shape our perceptions of risk.

  • We have a greater fear of human-made risks than natural risks (such as radiation from nuclear waste exposure, which is rare, rather than from sun exposure, which is common).

  • Voluntary risks such as smoking, poor diet, dangerous forms of recreation are seen as less threatening than risks over which we may not have direct control, such as air pollution or someone else's drunk driving.

  • We have a greater fear of risks from unknown or untrusted sources. "Imagine being offered two glasses of clear liquid," Ropeik and Gray write. "One comes from Oprah Winfrey. The other comes from a chemical company. Most people would choose Oprah's, even though they have no facts at all about what's in either glass."


We Can't Help Ourselves

Blame it on human nature. Our bodies are primed by millions of years of evolution to react first and think later by pumping out stress hormones such as adrenaline (also called epinephrine) when we're suddenly confronted with the choice of fight or flight. Those hormones get the heart racing, send the blood pressure soaring, put muscles on alert, and help prepare our bodies for outrunning a snarling dog, mugger, or saber-tooth tiger.

"The whole topic of understanding risks these days tends to be based on facts," Jon Paling, PhD, founder and research director of the Risk Communication Institute in Gainseville, Fla., tells WebMD.

"However, humans as a species have had to deal with risks from our earliest tribal and pre-tribal days, and clearly those that were best at surviving risks were the ones that propagated the next generation, so we have very, very deeply seated, hard-wired responses to risks that have nothing to do with graphics or numbers, because in essence the human species has had to be geared up to intuitively deal with risk over eons."

But that instinct for self-preservation can also cause us to put ourselves in, rather than out of, harm's way. For example, when you're being charged by a grizzly bear, wildlife experts recommend that you stand your ground. But do you listen to your brain telling you to stay still, or to your guts screaming, "Get me outta here!"

Is It Safe?

The keys to making clear-headed decisions about specific risks, experts agree, are knowledge and trust, and both health-care consumers and their doctors have an important role to play in informing patients about medical risks.

"I work at a university training center and we try to emphasize that to our residents: Every time you're with a patient is a teachable moment and you can use that moment to re-orient patients about the biggest risks that they should be concerned about and have an intelligent discussion with them about the risks that maybe are important to know about but that they don't need to be obsessed over, compared to more life-threatening risks." says Greenberg.


Paling puts it this way: "If a doctor or a surgeon is not responsive to questions or shrugs them off as being unimportant, then the risk gets bigger. When the patient really trusts the doctor, the risk automatically has gotten far smaller in perception. Trust may or not be justified, but it's a factor."

Sensible risk avoidance is also a matter of self-awareness, Ropeik tells WebMD.

"We have to understand that there are these emotional prisms that filter the facts into the decisions that we make. We have to recognize that that can be dangerous, if we underestimate a risk or overestimate it, we might not take proper precautions. We might be worried, too stressed; and stress is bad for our health."

His take-home message? "Seek out trusted, trustable sources of information, and work a little harder at being informed."

WebMD Feature Reviewed by Michael W. Smith, MD on February 18, 2004


SOURCES: Jon Paling, PhD, Risk Communication Institute, Gainesville, Fla. David Ropeik, Harvard Center for Risk Analysis, Boston. Michael I. Greenberg, MD, MPH, Drexel University School of Public Health, Philadelphia. Nanette K. Wenger, MD, Emory University School of Medicine and Grady Memorial Hospital, Atlanta. Ropeik, D, Gray, G: Risk! A Practical Guide for Deciding What's Really Safe and What's Dangerous in the World Around You. Houghton Mifflin, 2002; American Heart Association; U.S. Centers for Disease Control and Prevention. National Safety Council, "What are the Odds of Dying?" Banff Environmental Action and Research Society.

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