Saturday Soapbox: Thankless Science

>> Sunday, October 25, 2009

*Steps on soapbox*

Since my blogging was so spotty last week, I'm combining my Sunday Soapbox with a Thieving Thursday, because I want to expand on a comment I made for Project Savior regarding the Swine Flu. Project Savior and I often see eye to eye and we're doing it on this topic as well, but I thought the topic (or at least my comment) was bigger than swine flu or even vaccinations, it was all about rewarding people for the wrong damn things.

I pointed out that scientists often have a thankless task. Take for instance, seismologists. Let's say, for instance, that we've been watching a volcano situated close to several small villages/towns and there's a very good chance, well over 70%, that it will blow to high heaven in the next few months. There are thousands of people at considerable risk. To my way of thinking, there are two options and four possible outcomes, three of which treat the scientist like crap.

First, let's say the scientists issue warnings and recommend evacuations. If anything less than their direst possibilities come to pass, everything from a mild eruption to a very limited loss-of-life thanks to the warnings to nothing happening at all, people will go up in arms for being dragged "needlessly" from their homes, suffering because of manufactured scientist panic and, next time, the warnings stand much less chance of being heeded.

But, even if their direst predictions came true, if the loss-of-life is minimal--even as a direct result of the warning--what people will remember was that there weren't nearly as many deaths as predicted and they will start thinking, often within months of the disaster, that the scientists were alarmists, far too quick to assume the worst. If people failed to heed the warnings, and the loss of life is extreme, scientists will be blamed for not warning more forcefully.

Believe me, it can be tempting to just shut up which is the other option. If the eruption isn't assured, it can be very tempting to just keep it close to the chest until there's more info. Unfortunately, there's always a chance that, while you were waiting, the worst case scenario unfolded and people, who might have left if they'd been warned, will die. That's a pretty hard thing to live with under the best of circumstances, and the news will be all over it because, of course, scientific data is almost always publicly available. Someone will realize scientists "knew" and will villify them in the media.

Which leads us to the only non-painful scenario--when one fails to warn and nothing happens.

You hear this sort of blather now, people who are all up in arms because there isn't a horrible Swine Flu epidemic dropping people like flies. Ironically, it's the same people calling the CDC alarmists who are screeching with fear at the thought of *gasp* getting a vaccination that might save your life if you would otherwise catch it (and there have been hundreds of thousands of swine flu cases world-wide and thousands of death; thankfully, though, not millions). Perhaps swine flu never had the potential of doing what the so-called "Spanish Flu" did in 1918, or perhaps the steps taken to date have made the difference between a nastier flu season than normal and an epidemic that cut a swathe of millions through the populace.

My point is that we have a skewed view of what effective safety, what effective medicine is. Doctors know that that little shot in the thigh or arms for millions of kids is some of the most effective medicine they'll ever do. No one will kiss their cheeks and send them gift baskets for saving their children, though the vaccines do exactly that, but parents might very well do that if the doctor pulls a kid through who managed to get chicken pox in his lungs. The second, easily tracked, readily paid for, quite flamboyant save gets the kudos, but it's the shots that are really doing the good for children who will never get measles or chicken pox or whooping cough. But we don't track the disease children don't get any more, at least not for the general public, so they become easily swayed by nebulous claims that vaccines are dangerous and we put our children at risk for deadly diseases (and we risk the children around them) because we don't realize that the most effective medicine is represented by the diseases we never get.

Food poisoning is rare today, largely because of improvements in food prep, refrigeration, and food standards. It happens, but it's far less frequently deadly and it's often prevented because everyone from the rancher to the slaughterhouse to the meat packing plant to the grocery story to the consumer has a better awareness of the potential risks. Ditto for cleanliness in general, particularly in doctor's offices and hospitals. Vaccines and hygiene are cheap ways of saving lives, some of the most effective medicine in the world - and people readily dismiss how important they are, how much good they've done us and at such a modest cost.

A thoracic surgeon peforming a triple bypass may be considered a hero when no one would think of saying the same for a GP who talked someone into some lifestyle changes so that he never needed any surgery at all. But, who's the real hero there?

I'm not a doctor, but I really understand this conundrum. As a safety person, I know that the best safety program in the whole world, by far the one that's most effective is the one that is all but transparent to the outside and, to some extent, the inside. A truly effective safety program involves communication and education at every level, where every technician, every engineer, every manager, makes it a priority in every decision they make. If everyone is doing this, there are no safety metrics to measure because the problems that might have occurred never happened, the failures to be corrected never manifested. It's easy, in such an environment to think your safety program is superfluous, even cut it, but that awareness is easy to set aside in high pressure situations when schedule and budgets are beating one down and, without the safety folks keeping you honest, it's easy to rationalize oneself into some pretty scary decisions.

Until we start giving the most effective programs and steps, like preventive medicine, safety processes, and even such things as education the recognition and respect they deserve, they will continue to be ineffective. After all, it can be mighty challenging fighting for the right thing, when you get pounded coming and going for doing so, without ever getting the thank you you deserve.

So, for those of you out there fighting for doing the right thing against all the odds, hey, thanks!

Someone somewhere appreciates it.

*Steps off soapbox*


  • Project Savior

    Thanks for the shout-out,
    Science in this country has been getting a bad rap for the last thirty years, and those who work on the safety end of it get the worst rap of all.

  • Roy

    Adding my applause for the developers of the vaccines and the doctors and nurses who give them, and also for the public agencies who go before the news media to urge people to get the vaccines. Whatever happened to that old folk saying: "An ounce of prevention is worth a pound of cure." Don't we as a society believe in that any more?

    Good points all, Steph. Well done!

  • Stephanie B

    The thing is, Roy, I don't think we do. We've moved away from the "do the right thing now and reap the profits later" thinking to "live well now and you can always fix it later." It's a factor in credit catastrophes. It's a factor in the health care attitudes in this country.

    Too often, today, things that need fixing but aren't urgent are kicked down the road. "We can't afford to to that now" or "We're fighting fires." The problem with that logic is that, if you wait long enough, something easily preventable becomes yet another fire, with no assurance that the other fires will be gone.

    Why don't we stop that? Medical care after the fact is astronomically more expensive. Ditto for fixing something on the ground, like faulty space hardware that could be readily discovered on the ground, which has historically happened time and time again.

    Even so, the system is stacked against doing the right thing. Doctors don't get paid for preventive medicine like they are for reactive cures (though I believe most try to get people to do the right thing anyway), and, if they make lifestyle recommendations, those are the most readily discounted as opposed to a prescription. People can be very stupid that way.

    Likewise, when designs run into headaches and schedules and budgets are squeezed, testing to screen out problems, to find issues, to prove capabilities are often what's discarded because no one can quantify the benefit, even if the whole testing/verification program is the fraction of the cost of a single on-orbit failure.

    No wonder crap costs far more than it should WITHOUT better results.
    Better stop now or I'll be writing another post.

  • The Mother

    The single most important public health advance in human history isn't the angioplasty or radiotherapy for cancer or the C-section.

    It's the development of sanitation systems. You know, SEWERS.

    Just not sloshing our poop into the streets is the most important medical advance EVER.

    No one kisses the guys at the sanitation plants, either.

    We moderns forget. Oh, gods, do we forget.

  • Stephanie B

    they dumped their effluence in, but it was more than that, it was tossed on the street, willy-nilly. Can you imagine walking the streets and sidestepping human feces? 200, even 150, years ago, imagination was not required, though actual sewers were part of the Roman architecture. The Western notion of cleanliness was an embarassment for centuries.

    As many people died of dysentary as bullet wounds in the Civil War. Cholera, as a scourge in advanced nations, is all but unknown because people no longer are exposed to untreated human feces as was frequently the case in the nineteenth century.

    I've often thought that there was no advance in surgery as remarkable as the notion of cleanliness, though I have nothing to back that.

    Too bad such universal, even society-altering, steps are all but lost to the general public. Water treatment and plumbing have long been reason enough for me not to think of those romantic days of yore as any I'd like to be associated with.

  • Jeff King

    Great post and responses... thx

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