Of Risk and Reason
On October 4, 1992 an El-Al jet crashed into a high-rise building in a residential area near Amsterdam, The Netherlands, killing 43 people and injuring many more. The incident has become known in this country as the “Bijlmerramp”, and is an example of poor disaster management, muddled political responsibility and amateurish media handling. But there is more. The contents of the cargo bay have never been disclosed but are popularly held responsible for a range of health complaints, and it has become an urban legend that “men in white suits” were sent to clean up the mess. Six years after the event people were upset by another fact: the refusal of the Ministry of Health to investigate the cause of disease symptoms reported by persons present at or near the site of the crash. Why this reluctance?

I am aware of the risk of being misinterpreted in what I want to discuss here, i.e. the relationship between, and interdependence of, perception and reality. As a boy in a German Jesuit school I was struck by the stigmata of Jesus Christ that St. Francis of Assisi showed on paintings - I first regarded them as artistic liberty. Then I read about Catherine of Siena, and finally was shown the bleeding crucifixion wounds on the hands and feet of Theresa, a modest, pious farmer's daughter then living in Konnersreuth, Bavaria. What further evidence did I need to believe in a miracle? Some fifty years later miracles are no longer so plausible. What has been reported time and again is, for me, convincing evidence of psychosomatic interdependence - the pathophysiological effects of a strong belief. While I cannot dismiss Theresa's stigmata, and while I do not question the reality of the complaints of the “Bijlmerramp” patients, it is the cause-effect relationship that begs questions. In other words, Theresa's stigmata do not prove God's existence, and neither do the “Bijlmerramp” complaints prove that a hazardous cargo was on board the Israeli Boeing. The Vietnam veterans, the Gulf War syndrome and Agent Orange also come to mind.

After investigating the widely quoted, ill-health effects of the Agent Orange defoliant on soldiers a US journalist wrote: '¼you can imagine my horror when this story, the biggest of my life, began to slip through my fingers like so much journalistic quicksilver. I couldn't substantiate anything... anything at all. As other newspapers printed front-page stories about Agent Orange victims with brain tumours, quoted congressmen and senators ranting and raving, I checked the quotes and found them hollow¼ The story got stranger and stranger. The squadron was supposed to wear protective clothing. Rubber suits - in the tropics! Well, they wore boxer shorts and tennis shoes, and were commonly covered with Agent Orange. When they sprayed, the crewmen would stand in the open bay doors, getting swept by cool air - and Agent Orange¼ these guys were obviously prime targets for epidemiologists, and their health, 25 years later, is normal. No excess cancer, heart disease, alcoholism. Most newspapers didn't run this story; those that did minimised it.' [2].

Something is obviously wrong here. Although Western societies have become increasingly secular, belief still reigns - notably in domains where reason could give the answers. The same medal shows irrational fear on one face, irrational hope on the other. Risks are exaggerated and expectations drawn out of proportion - by the public, the journalists and, let us admit it, also by the scientists. People are concerned about radiation from cellular phones but buy untested homeopathic potions to cure cancer. The Balkan syndrome (arising from exposure to depleted uranium warheads) has been mentioned. The tabloids publish unsubstantiated horror stories and report equally unsubstantiated miraculous cures. In their struggle for funding, scientists may accept grants for research to legitimise commercially successful products. Post-modern man is about to forget about the Enlightenment (the 18th century philosophical movement that emphasised the use of reason to scrutinise previously accepted doctrines and traditions) and its principal institution, science. This is not the result of poor science (poor in the sense of 'bad' or 'little') - there have never been more researchers on this planet - but because many scientists are poor communicators, not so much amongst themselves, but rather to politicians and the general public.

The Enlightenment also became known as the Age of Reason. As one of its protagonists, Francis Bacon proposed induction (the reasoning from the particular to the general) as the logic of scientific discovery. Now elements of human behaviour, such as aggression and sexuality, are analysed scientifically with the aim of discovering patterns, perhaps even laws. Risk perception and management is a recent addition to the range of topics, and Peter M. Sandman, whose enterprise 'Consulting, Training, and Research in Risk Communication', has formulated 'Risk = Hazard + Outrage' to encapsulate its composite nature [3]. A high outrage component can jeopardise any attempt to explain a hazard (e.g. of Agent Orange), and a negligible hazard can be offset by high outrage. The obvious message is to communicate. In risk communication four stages of communication have been recognised:

1.	Stonewall: no communication; ignore the public
2.	Missionary: one-way communication; show the public why you are right and they are wrong
3.	Dialogue: two-way communication; learn from the public the ways in which they are right and you are wrong
4.	Organisational: internal communication; become the sort of organisation that finds dialogue possible, even natural

Ostensibly these stages may be applied to other types of communication occurring between an organisation and its outsiders. Which stage have veterinary scientists reached?

I have touched only on the aspect of risk in irrational behaviour, but a similar editorial could have been written with the title 'Of Gullibles and Gurus'. The two faces of the medal are equivalent: people have really fallen ill from perceived pathogens, as they have really been cured by perceived therapeutics. Placebo research has yielded fascinating results [1], and memory can be treacherous, as the inquiry into the “Bijlmerramp” witnesses has shown. Not only is forgetting very easy, but also the mind can mistake imagined scenes for reality.

For the individual, as for society, irrational behaviour - that not controlled by reason - is normal. In the normal (Gaussian) distribution curve, there has always been a segment of society that preferred belief above reason, before and after the Enlightenment. Though normal statistically, it may not be desirable in highly complex, technological, democratic societies, where political decisions must be carried by informed majorities. On this basis, the academic community should realise its responsibility, take up the challenge and communicate.

The perceived and actual risk of infectious disease, whether zoonotic or not, has occupied centre stage during the last few years, from BSE to Classical Swine Fever to the current outbreak of Foot and Mouth Disease. The inherent risks of the EU non-vaccination policy were assessed carefully, I am sure, and the economic consequences of an epidemic weighed against the cost of vaccination. What has not been taken into account, however, is the changing attitude of Western society towards animals and animal production, the emotional strain caused by large-scale culling, the unreliable partnership of farmers in disease control and the arrogance of the legal system - in short, the public outrage. But it is not only farmers and citizens who are frustrated. The politicians are clueless how to reconcile their EU responsibilities with an increasingly reluctant, if not hostile, electorate. After all, vaccination has been a winning formula in the past.


References

1. Brown, W.A. (1998) The Placebo effect. Sci. Am. 278, 68-73.

2. Franklin J. (1996) Poisons of the Mind. Opening address at the Annual Meeting of the American Society of Animal Science, Rapid City, South Dakota, USA.

3. Sandman, P.M. (1997) Risk = Hazard + Outrage. Opening address at the Annual Meeting of the American Society of Animal Science, Nashville, Tennessee, USA.


The author gratefully acknowledges inspiring exchanges with Dr William Enright, Intervet International B.V., who also provided the two references from the ASAS meetings.

Professor Marian C. Horzinek
Editor-in-chief Veterinary Sciences Tomorrow
Department of Infectious Diseases and Immunology,
Faculty of Veterinary Medicine, Utrecht University,
P.O. Box 80163, 3508 TD Utrecht, The Netherlands.