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Unit6RisksRisksandYouAtsometimeorother,allofushaveplayedthepartofahypochondriac,imaginingthatwehavesometerriblediseaseonthestrengthofveryminorsymptoms.Somepeoplejusthavetohearaboutanewdiseaseandtheybegincheckingthemselvestoseeiftheymaybesufferingfromit.Butfearofdiseaseisnotouronlyfear,andneitherisriskofdiseasetheonlyriskwerun.Modernlifeisfullofallmannerofthreats-toourlives,ourpeaceofmind,ourfamilies,andourfuture.Andfromthesethreatscomequestionsthatwemustposetoourselves:IsthefoodIbuysafe?Aretoysformychildrenlikelytohurtthem?Shouldmyfamilyavoidsmokedmeats?AmIlikelytoberobbedonvacations?Ouruncertaintiesmultiplyindefinitely.Anxietyabouttherisksoflifeisabitlikehypochondria;inboth,thefearoranxietyfeedsonpartialinformation.Butonesharpdifferenceexistsbetweenthetwo.Thehypochondriaccanusuallyturntoaphysiciantogetadefinitiveclarificationofthesituation-eitheryouhavethesuspecteddiseaseoryoudon't.Itismuchmoredifficultwhenanxietyaboutotherformsofriskisconcerned,becausewithmanyrisks,thesituationisnotassimple.Risksarealmostalwaysamatterofprobabilityratherthancertainty.Youmayask,"ShouldIwearaseatbelt?"Ifyou'regoingtohaveahead-oncollision,ofcourse.Butwhatifyougethitfromthesideandenduptrappedinsidethevehicle,unabletoescapebecauseofadamagedseatbeltmechanism?Sodoesthismeanthatyoushouldspendtheextramoneyforanairbag?Again,inhead-oncollisions,itmaywellsaveyourlife.Butwhatifthebagaccidentallyinflateswhileyouaredrivingdownthehighway,thuscausinganaccidentthatwouldneverhaveoccurredotherwise?Allofthisisanotherwayofsayingthatnothingwedoiscompletelysafe.Therearerisks,oftenpotentiallyseriousones,associatedwitheveryhobbywehave,everyjobwetake,everyfoodweeat-inotherwords,witheveryaction.Butthefactthattherearerisksassociatedwitheverythingwearegoingtododoesnot,orshouldnot,reduceustotremblingneurotics.Someactionsareriskierthanothers.Thepointistoinformourselvesabouttherelevantrisksandthenactaccordingly.Forexample,largercarsaregenerallysaferthansmallonesincollisions.Buthowmuchsafer?Theansweristhatyouareroughlytwiceaslikelytodieinaseriouscrashinasmallcarthaninalargeone.Yetlargercarsgenerallycostmorethansmallones(andalsousemoregas,thusincreasingtheenvironmentalrisks!),sohowdowedecidewhenthereducedrisksareworththeaddedcosts?Theultimateriskavoidermight,forinstance,buyatankoranarmoredcar,thusminimizingtheriskofdeathorinjuryinacollision.Butistheaddedcostandinconvenienceworththedifferenceinprice,evensupposingyoucouldaffordit?Wecannotbegintoanswersuchquestionsuntilwehaveafeelforthelevelofrisksinquestion.Sohowdowemeasurethelevelofarisk?Somepeopleseemtothinkthattheanswerisasimplenumber.Weknow,forinstance,thatabout25,000peopleperyeardieinautomobileaccidents.Bycontrast,onlyabout300dieperyearinmineaccidentsanddisasters.Doesthatmeanthatridinginacarismuchriskierthanmining?Notnecessarily.Thefactisthatsome200millionAmericansregularlyrideinautomobilesintheUnitedStateseveryyear;perhaps700,000areinvolvedinmining.Therelevantfigurethatweneedtoassessariskisaratioorfraction.Thenumeratorofthefractiontellsushowmanypeoplewerekilledorharmedastheresultofaparticularactivityoveracertainperiodoftime;thedenominatortellsushowmanypeoplewereinvolvedinthatactivityduringthattime.Allrisklevelsarethusratiosorfractions,withvaluesbetween0(norisk)and1(totallyrisky).Byreducingallriskstoratiosorfractionsofthissort,wecanbegintocomparedifferentsortsofrisks-likeminingversusridinginacar.Thelargerthisratio,thatis,thecloseritisto1,theriskiertheactivityinquestion.Inthecasejustdiscussed,wewouldfindtherelativesafetyofcartravelandcoalminingbydividingthenumbersofliveslostineachbythenumberofpeopleparticipatingineach.Here,itisclearthattheriskinessoftravelingbycarisabout1deathper10,000passengers;withmining,therisklevelisabout4deathsper10,000miners.Soalthoughfarmorepeoplearekilledincaraccidentsthaninmining,thelatterturnsouttobefourtimesriskierthantheformer.Thoseratiosenableustocomparetherisksofactivitiesorsituationsasdifferentasapplesandoranges.Ifyouareopposedtorisks,youwillwanttochooseyouractivitiesbyfocusingonthesmall-ratioexposures.Ifyouarereckless,thenyouarenotlikelytobeafraidofhigherratiosunlesstheygetuncomfortablylarge.Onceweunderstandthatriskcanneverbetotallyeliminatedfromanysituationandthat,therefore,nothingiscompletelysafe,wewillthenseethattheissueisnotoneofavoidingrisksaltogetherbutratheroneofmanagingrisksinasensibleway.Riskmanagementrequirestwothings:commonsenseandinformationaboutthecharacteranddegreeoftheriskswemayberunning.Thosewithamindto"livefortoday"areapttobeindifferenttohealthrisksthathaveaverylongincubationperiod.Althoughthisisshort-sighted,itdoesmakesensetodiscountlong-termrisksmorethanshort-termones.Afterall,whenvirtuallyanyofusisconfrontedwiththechoiceofdoingsomethinglikelytokillustodayversusdoingsomethinglikelytokillusintwodecades,thechoiceisgoingtobethelesserofthetwoevils.Onecommonlyusedmeasuretodealwithsuchproblemsisaconceptcalledyearsofpotentiallifelost(YPLL).Theideaisthatfora25-year-old,doingsomethingthatwillkillhimin5yearsismuchmore"costly"thandoingsomethingthatwillkillhimin40years.Bothmayinvolvethesameelementofrisk—thesameprobabilityofeventuallydyingfromthatactivity—butariskthatmaycauseimmediatedamageismuchmorecostlythanoneforwhichthepiperneedn'tbepaidforalongtime.Inthefirstcase,hewillhavehisnormallifespancutshortbyabout45years;inthelattercase,thedeficitisabout5years.Thinkingaboutmattersinthislightinevitablycausesareassessmentofmanyofthethreatstohealth.Forinstance,heartdiseaseisthesinglelargestkillerofAmericans,wayinfrontofcancerorstrokes.However,heartdiseasetendstostriketheelderlyinmuchgreaterproportionsthanyoungerpeople.Cancer,bycontrast,killsfewerpeoplebuttendstostrikesomewhatearlierthanheartdisease.Hence,moreYPLLsarelosttocancerthantoheartdisease—despitethegreaterincidenceoffatalheartcases.Specifically,cancersclaimabout25percentmoreYPLLsthanheartdisease(ifwedefinetheYPLLasayearoflifelostbeforeage65).TheconceptofYPLLshasanimportant,ifcontroversial,influenceonissuesinhealthcareeconomics.Itisfrequentlyarguedthatmoneydevotedtomedicalresearchoncuringdiseasesshouldbedivideduponthebasisofthenumberofliveslosttoeachdisease.Thus,somecriticsofthemassivelevelsoffundingdevotedtoAIDSresearchclaimthat—comparedtokillerssuchasheartdiseaseandcancer—AIDSreceivesadisproportionatelyhighsupport.ThatcriticismfailstoconsiderthefactthatAIDS,byvirtueofstrikingpeopleprincipallyintheir20sand30s,generatesfarmoreYPLLsthanthebarefigureof20,000deathsperyear,badasthatis,mightsuggest.10Putdifferently,findingacureforAIDSwouldbelikelytoaddabout25to30yearstothelifeofeachpotentialvictim.Findingacureforheartdisease,althoughitmightsavefarmorelives,wouldprobablyaddonlyanother5to10yearstothelifeofitsaveragevictim.Theassessmentoftheseriousnessofariskchanges,dependinguponwhetherweaskhowmanylivesitclaimsorhowmanyYPLLsitinvolves.Someofthedifferencesarequitestriking.Forinstance,accidentaldeathsappearrelativelyinsignificantcomparedtocancerandheartdiseasewhenwejustcountthedeathscaused.Butoncewelookatthenumberoflostyears,accidentsloomintofirstplaceamongthekillersofAmericans.Thesedatashowthatweneedtoasknotonlyhowlargeariskisbutalsowhenitbecomespayable.Otherthingsbeingequal,thesoonerariskcausesdamageordeath,themorethatriskistobeavoided.健康威脅1民意調(diào)查一再告訴我們,美國(guó)人最為擔(dān)心的就是他們的健康,其次才是環(huán)境問(wèn)題。這是完全可以理解的,因?yàn)樯眢w健康顯然比生病要好。美國(guó)人現(xiàn)在對(duì)健康如此關(guān)注,是有點(diǎn)令人吃驚,因?yàn)樗麄兡壳氨纫酝魏螘r(shí)候都要健康得多。許多曾令人恐懼的疾病現(xiàn)在或者已經(jīng)徹底根除,或者已得到控制。盡管艾滋病是個(gè)顯著的例外,但是現(xiàn)在幾乎沒(méi)有什么新的能置許多人于死地的疾病出現(xiàn),以取代那些已被根除的疾病。2然而,健康以及對(duì)健康的各種威脅,仍然是人們永久關(guān)注的問(wèn)題。畢竟,如果目前的趨勢(shì)無(wú)法制止的話,我們中將有不止一半(57%)的人將死于心臟病或是癌癥。3將威脅健康的危險(xiǎn),特別是致命的危險(xiǎn),進(jìn)行比較時(shí),有一個(gè)主要的問(wèn)題,就是這些危險(xiǎn)的緊迫性有很大差異。例如艾滋病,如果你染上的話,很可能幾年后就死亡。然而,由吸煙或輻射誘發(fā)的癌癥,也許要經(jīng)過(guò)20至30年的時(shí)間其災(zāi)難性的后果才會(huì)出現(xiàn)。因此,在對(duì)健康的各種危險(xiǎn)做出選擇時(shí),務(wù)必要考慮進(jìn)行冒險(xiǎn)與承受其后果之間的時(shí)間間隔。4那些一心要“今朝有酒今朝醉”的人們,往往對(duì)潛伏期較長(zhǎng)的危害不放在心上。盡管這是一種目光短淺的行為,但不理會(huì)滯后期長(zhǎng)的危險(xiǎn),重視近期危險(xiǎn)還是有道理的。畢竟,如果我們真的面臨選擇,是去做今天就可能使我們喪命的事,還是去做20年后才可能使我們喪命的事,我們往往會(huì)兩害相比取其輕。5對(duì)待這類問(wèn)題有種常用的計(jì)算方法,就是考慮可能少活的年數(shù)(YPLL)。其意思是,對(duì)一個(gè)25歲的人來(lái)說(shuō),去做一件使自己五年后喪生的事要比做一佴:40年后喪生的事“代價(jià)高昂”得多。二者同樣都具有危險(xiǎn)因素——即最終因從事某事而導(dǎo)致死亡的可能性相同——但是,會(huì)馬上引起傷害的危險(xiǎn),要比一個(gè)很長(zhǎng)時(shí)間不需付出代價(jià)的危險(xiǎn)要昂貴得多。在第一種情形下,他的正常壽命減少了約45年,而在第二種情形下,減少了約5年。從這種角度看問(wèn)題必然會(huì)對(duì)威脅健康的許多因素進(jìn)行重新評(píng)估。例如,心臟病是奪去美國(guó)人性命的頭號(hào)殺手,遠(yuǎn)遠(yuǎn)超過(guò)癌癥或中風(fēng)。然而,老年人患心臟病的比例大大超出了年輕人。相比之下,癌癥的死亡人數(shù)雖然要少于心臟病的死亡人數(shù),但患癌癥的人群比較年輕。所以,盡管心臟病死亡率要大,但癌癥損失的YPIfI要比心臟病多。具體來(lái)講,與心臟病相比,癌癥讓人大約多損失了25%的YPLL(如果我們將YPI_L定義為65歲以前壽命縮短的年頭)。6YPLL這一概念,盡管人們對(duì)它還有爭(zhēng)議,卻對(duì)保健經(jīng)濟(jì)學(xué)有著重要影響。人們經(jīng)常爭(zhēng)辯說(shuō),用于醫(yī)學(xué)研究攻克疾病的資金應(yīng)該按每種疾病死亡人數(shù)的多少來(lái)分配。因此,一些人士抨擊將大量資金用于艾滋病研究。他們認(rèn)為與其他致命的疾病如心臟病和癌癥相比,艾滋病得到了不成比例的高額資助。該批評(píng)沒(méi)有考慮到這樣一個(gè)事實(shí):由于艾滋病的主要受害者為二三十歲的年輕人,盡管每年只造成20,000人死亡——該數(shù)字本身也不小了——但是艾滋病引起的YPLL要大得多,遠(yuǎn)比簡(jiǎn)單的死亡人數(shù)更值得我們重視。換句話說(shuō),找到治療艾滋病的方法,將可能增加每位潛在的艾滋病患者25至30年的壽命。找到治療心臟病的方法,雖然可能拯救更多人的生命,但對(duì)每位受害者來(lái)說(shuō)只能增加平均5到10年的壽命。7對(duì)一種危險(xiǎn)的嚴(yán)重程度的估算會(huì)有差異,這要看我們是關(guān)注它所引起的死亡人數(shù)還是它所導(dǎo)致的YPLL的多少。有些差異很令人吃驚。比如,如果我們只算引起的死亡人數(shù)的話,與癌癥和心臟病相比,意外死亡就顯得無(wú)足輕重。然而,一旦我們關(guān)注所損失的YPLL,意外事故卻赫然位居美國(guó)殺手榜的榜首。這些數(shù)據(jù)顯示,我們不僅要探究危險(xiǎn)程度的大小,而且要探究危險(xiǎn)什么時(shí)候要我們付出代價(jià)。在其他因素都相等的情況下,危險(xiǎn)所導(dǎo)致的損害或死亡來(lái)得越快,人們就越應(yīng)該回避這種危險(xiǎn)。RisksfromNatureandTechnologyWeliveinanagewhennaturalhascometomean"benign"andanythingmadebyhumansseemsbothartificialandsuspect.Butactuallythenaturalandthebenignarenotnecessarilythesamething.Naturedoesalotofnastythingstous.Floods,storms,earthquakes,hurricanes,volcanoes,andtornadoesarejustthetipoftheiceberg.Mostdiseasesarenatural.Manynaturallyoccurringsubstancesarepoisonous.Thesinglelargestsourceofcancer-producingradiationisradongas,abyproductofthedecayofradioactiveelementsintheearth'scrust.Othersourcesofcancer-causingradiationarecosmicraysandordinarysunlight.Indeed,deathitselfisnatural.Ifwehavebeenabletoprolonglifebeyonditstraditionalspanofseventyyears,thatisbecausewehavebeencleverenoughtocontrivewaysofdelayingthedecay,disease,anddestructionthatisinflictedonusbynature.Thinkaboutitanotherway.Allplants,includingthoseweeat,containmanynaturallyoccurringpesticides.Theyhaveevolvedthesetoxic—inmanycases,carcinogenic—defensesagainstinsectsandotherpredatorsovermillionsofyears.Ithasbeenestimatedthatweconsume10,000timesasmanynaturalpesticidesasartificialones.Inotherwords,natureisnotbenign.Othernumbersprovethisevenmoreconvincingly.Itisawidelyusedruleofthumbamongriskspecialiststhat,inanygivenyear,about30timesasmanypeoplewilldieinnaturaldisastersasinmanmadeones.Inadditiontonaturalcatastrophes,therearestillplentyofwaysinwhichourtechnologicalsocietyposesmajorthreatstoourlivesandhealth,especiallythroughdamagetotheenvironmentinwhichwelive.Theunhappyfactisthatwehavesomegroundsforthinkingthatmanyairandwaterpollutantsmayberisky,butwehaveasyetnodependabledataonthesizeoftherisktheypose.Inotherwords,althoughwehaveaprettygoodideaoftheamountoftheprincipalpollutantsreleasedintotheairandwaterintheUnitedStates,thereareveryfewstudiesonthehealtheffectsofspecificconcentrationsofparticularpollutants.Suchstudiesaredifficulttoperformbecausetherearetoomanyvariablesoutsideourcontrol.Isacertainoxideofnitrogendangerousinaparticularamount?Usuallytheansweristhatwedonotknow.Becauseeverythingisrisky,itismeaninglesstobetoldthatthisorthatpollutantposesa"potential"risk—untilweknowwhattherisklevelis.Unlessweknowwhetheracertainpollutantincertainconcentrationskills5,000peopleayearor1personeverydecade,wecannotdecidewhetheritposesanunacceptablerisk.Scientistshavegenerallynotyetbeenabletoidentifythesizeofmanyoftherisksposedbymostofthepollutantsintheenvironment.Infact,suchstudiesasthereareraisedoubtsaboutthecommonlyassumedrisksofsomepollutants.InNewYorkCity,forinstance,levelsofsulfurdioxidefellmorethan90percentbetween1969and1976inresponsetotheCleanAirActof1970.Despitethismajorshiftinoneofthemostcommonairpollutants,dailymortalityratesinNewYorkdidnotchangeatall.NodoubtNewYorkCitysmellsbetter,butitisunclearwhetheranylivesweresavedbythereductioninsulfuremissions.Theproblemofassessingenvironmentalrisksismadeworsebytheofficialdoublespeakonthesubject.Considerbutoneexample.Fromtimetotime,afederalagencywillannouncethatithasidentifiedacertainsubstance(naturalorartificial)asa"possiblehumancarcinogen".Suchannouncementsaregenerallygreetedwithmuchwringingofhandsfromthegeneralpublic,whosupposethatonemoreitemmustbetakenofftheirmenus.Thefacts,however,arequiteotherwise.Toqualifyasapossiblehumancarcinogen,theremustbeevidencethatthesubstanceinquestionproducescancerinratswhentheyreceivedosesofthesubstancethatareoftenamilliontimesstrongerthanahumanbeingreceives,evenallowingfordifferencesinbodyweight.Evenifwesupposethatthelikelihoodofcancervariesdirectlywiththelevelofexposureandthatwhateveriscarcinogenictoratsisdangeroustohumans(andbothassumptionsaredubious),thesefiguresmeanthatthelikelihoodofahumanbeinggettingcancerfromnormalexposurestothesubstanceisaboutamilliontimessmallerthantherat'schances.Ifyoureflectontheotherriskstatistics,itwillbecomeclearthatsuchariskisextraordinarilylow—infact,itisaboutascloseto"safe"aswenormallygetinthislife.Accordingly,thediscoverythatsomethingisapossiblehumancarcinogenisthediscoverythatitmaybelessharmfulthanmanyofthethingsweroutinelydo.尋求刺激者1“簡(jiǎn)單的冒險(xiǎn)”已成為一種新興的假日娛樂(lè)項(xiàng)目。如今在西方每逢節(jié)假日,游客都有很多旅游勝地和娛樂(lè)項(xiàng)目可以選擇。但同時(shí)大多數(shù)旅行代理商都認(rèn)為傳統(tǒng)的海灘度假已不再時(shí)髦,越來(lái)越多的人在尋找新的娛樂(lè)項(xiàng)目。2英國(guó)林頓·庫(kù)柏旅行社的彼得·伊文思解釋說(shuō):“我們絕大多數(shù)顧客都喜歡冒險(xiǎn)性的活動(dòng)

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