Halloween isn't the only time monsters jump out of closets. Various health bogeymen jump out of the newspaper pages every day! Threats are raised but seldom discounted if new information emerges. Or fear is free form, vaguely touching everything we eat, or every breath and pill we take.
- A 28-year-old says a third of the people in the U.S. have AIDS; he is married and faithful, but afraid of catching it. The real number is about 1.5 million.
- Another 20-something stopped eating chicken because of bird flu, which as far as scientists know is not in the meat, or even in the U.S., for that matter.
- More women fear breast cancer than heart disease, although heart disease kills more of them. Even among the cancers, lung cancer kills more women than breast cancer does.
Are people afraid of the wrong things? Is fear even a good motivator to make lifestyle changes?
Health fears are not the "flee or fight" type, but more like dread and anxiety. People are thinking: "Will I become demented like Mom? My father died at my same age. I know so many women with breast cancer. I am so fat, I am dying any minute." That sort of thing.
Media: A Cause of Free-Form Fear?
Jessie Gruman, PhD, executive director and president of the Center for Advancement of Health in Washington, D.C., tells WebMD that the media plays a large role in skewing health fears.
"Public health in this country is so undervalued and underfunded," she says, "that it has had to link up with mass media. The problem is that mass media fly on news -- meaning information has to be tarted up to be used. This plants the seeds of fear instead of education."
Gruman says even the much-ballyhooed bird flu needs to be put in perspective. It's not here, and cases of person-to-person transmission are rare where it is present in poultry; if in the worst possible case, 1.5 million people died here, that means hundreds of millions did not die. "It would be a lot, but it would not wipe out the country," she says. "This does not mean we should not think about it, prepare, and be cautious. But it is an example of the problematical interaction of public health and news."
Gruman points out that when the link between smoking and lung cancer came out people stopped smoking in noticeable numbers. But now that has leveled out. Since the link between various diseases and obesity came out in the mid-1990s, there has been no downward change in weight in the nation. Quite the opposite.
Women went "nuts," as Gruman puts it, over the statistic that one in nine women will suffer from breast cancer. But they didn't know how to personalize that risk, including their own family background and lifestyle choices. "There was just a screen of hysteria. We make choices of what to fear."
Control: An Element in Dissipating Fear
One doctor pointed out that heart disease may be less feared because it is considered to be chronic and controllable by medication, stents, and the like. Breast cancer can also necessitate major surgery, radiation therapy and chemotherapy, making it scarier.
In an example of a positive form of fear, AIDS has also become less scary since it became more controllable. Some people with the disease are now indulging in risky behaviors again.
Gruman maintains that taking steps to exert control of a condition also controls fear. But if people can control smoking, weight, and exercise -- if these are controllable variables -- then why don't people feel less fear?
Gruman says these factors may be controllable, but control is very difficult to achieve. Washing hands frequently during the day is the one thing public health officials say could mitigate the risk of infection with flu and other diseases. This is easy and doable and can ease fear. "But they don't say that," she says, "instead they say, 'There isn't enough vaccine.'"
Fear: A Poor Motivator
Many studies have been done suggesting that fear messages are not effective in changing behavior. One theory is that people not only do not want to feel fear, but they also want to feel secure and hopeful.
The commercial of the man who ignored medical advice and smiles in embarrassment as he rises and taps his cane to get across the room is a fear message.
And some people want the messages to be even scarier. "Younger people, especially," Gruman says, "say show the bloody lung, the person breathing through her throat. Some people are moved by fear, some are not."
Paul Jellinger, MD, is the former president of the American College of Endocrinology. He tells WebMD that even if people with diabetes are careful of their diet and sugar levels, they can still suffer some complications. "Eating right is only a piece of the puzzle," he says. On the flip side, he adds, people who are poorly controlled sometimes escape all complications.
"I think it is a bad tactic to bombard people with gruesome conclusions," Jellinger says. "There are ways to address the issue better. I say, 'There is recent evidence that reducing blood sugar leads to fewer complications.'"
Jellinger doesn't say, "Do you want to live to see your grandchildren?" He says, "I am sure you want to enjoy your children growing up."
For a younger person, he adds, he tells a "positive" tale of the great tools of control we have today, which was not always the case. "I talk about their fertility and pregnancy and how we have come so far. I tell them their life span will be very little reduced by having this disease, if they handle it."
Educating is better than striking fear, he says.
"I believe," Jellinger says, "in being positive, but positive with fact behind it."
"We all believe and hope," Gruman adds, "that there are things we can do to protect ourselves and our family. The way to control fear is with good information. Otherwise, fear takes over."