You Are at Risk, Just Not from What Worries You

David L. Katz, MD, MPH, FACPM, FACP, FACLM
LinkedIn
I’ve noticed the inevitable during my travels of the past week: a whole lot of anxious conversations about the coronavirus.  This is not entirely unfounded- the pandemic is alarming. 
Shark coming out of water

For those wanting good, up-to-date, expert intelligence about the virus, its spread, the risks, and suitable responses- they are available.  My contribution is a reality check about risk.  To date, the global death toll from the coronavirus- as I write this- is 638.  The risk is not evenly distributed, of course, but if it were, it would at present mean a personal risk of death from this virus of roughly 1 in 12.5 million.  If you bank at all on odds like that, do be sure to get your Powerball ticket today.

In contrast, measles, before there was a vaccine introduced in 1963, routinely killed over 2.5 million people a year, most of them children.  The most recent statistics, fueled by global gaps in vaccine coverage and anti-vaccine conspiracy theories, are 140,000 deaths, again mostly young children, in 2018.  Before the coronavirus is as bad as just a garden-variety-year for measles, it will need to kill 219 people for every one it has killed thus far.

The point here is that when it comes to the assessment of risk, we are, in a word, nincompoops.

We routinely dismiss large risks genuinely likely to impact our lives, and exaggerate risks that are new, newsy, or exotic; we get wildly worked up for a little while about risks that come and go, while cultivating the contempt famously born of familiarity when risks stay and never stop stealing years from lives and life from years.  Threats to you and those you love literally orders of magnitude greater than coronavirus don’t just hide in plain sight; you welcome them daily into your family kitchen.

With that in mind, let’s have a look at the new processed meat study, published in JAMA Internal Medicine.  The study is of considerable size and careful methods. The associations between meat (especially processed meat) intake and adverse health effects are consistent with virtually all prior research on the topic, including the systematic reviews on which the contrarian, so-called “guidelines” last September were allegedly based.  Those studies, too, found statistically significant harm- more death, more heart disease, more cancer, more diabetes- with higher intake of red and processed meat, they just graded certainty in their own findings as low, and chose to recommend…the opposite.

People worry routinely about risks vanishingly smaller- from plane crashes to sharks to lightning strikes.   At the level of just two servings per week, the authors found a roughly 7% increase in the risk of cardiovascular disease with processed meat, and a 3% increase with red meat.  The risk of death was increased roughly 3% by both.  Are these really “modest” risks?  Consider that the current risk of death by coronavirus averaged over the global population and expressed as a percent is 0.000008%.

A 3-7% increase in the risk of heart disease or death that is entirely controllable by individual choice- is a very big deal. At the population level of the United States, 3% is 9 million people. For only the population over age 50, it’s still well over a million. Roughly 3 million people die annually in the United States; a relative 3% bump in that figure is an additional 90,000 deaths. Does that sound like a small number- when you start thinking about 90,000 families anguished at the CCU, or grieving at the cemetery? Does that magnitude of unnecessary loss and grief sound…small?

That’s the problem with universal exposures like diet and statisticians who forget that behind their “numbers” are actual people.  Small shifts in risk at the individual level can add up to enormous differences in public health.  There is nothing small about tens of thousands of entirely avoidable deaths or heart attacks every year.

As you chew on that, be sure to put the risks that compete for your attention into reasonable perspective.  Coronavirus is scary, but thus far, very, very unlikely to affect you or anyone you love.  Stay tuned, but keep calm and carry on.

Conversely, just try to picture 90,000 variants on the theme of anguish written across the face of wife, husband, daughter, son, sister, brother.  You won’t make it through the tiniest fraction of that sum before conceding- there is nothing small about it.

 

-fin       Dr. David L. Katz; co-author with Mark Bittman of the forthcoming How to Eat

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