War and the Art of the Napkin Risk-Benefit Analysis
The Art of the Napkin Risk-Benefit Analysis for COVID and the War on Misinformation:
Once again, they are trying to get people vaccinated by calling them dumbf*cks. I’ll be here all winter.”
Imagine if we were writing letters home from our various perspectives of the war on misinformation? What would yours say? And to be more specific, I’m referring to health misinformation since we are still in the throes of a pandemic nearly two years later. Of course I’m aware that not everyone agrees on what is misinformation, dissent, and what isn’t which is why we need the chact feckers to set us straight.
Every time I scroll through social media, I see insults being hurled towards folks who aren’t following conventional public health advice. Lots of verbal missiles being launched from all sorts of people…parents, journalists, physicians, public health officials, stand-up comics, influencers and more. There is return fire too. The folks who don’t want to get vaccinated, wear a mask or think it’s all a “plandemic” often mock the public health advice, roll their eyes at a virus with a “less than 1% death rate” and call anyone following the advice a “sheeple”, an insult to sheep everywhere by the way as they are almost as gifted as pigs. While the conflict could be classified as a cold war, I think it’s more the consequence of our toxic communication skills, made all the worse by digital platforms that foster disinhibition and tribalism. But why do most wars start? Because people fail to communicate, so they turn to bullets to do the talking for them.
I get especially amused when I see doctors or public health professionals hurling the insults, because I wonder what their ultimate goal is. If it’s to get the people they are insulting to change their behavior, my what a peculiar strategy. In my experience on earth thus far, I don’t know anyone who responds positively to insults. I’ve never heard anyone say, “Well, I wasn’t going to get vaccinated, but then this really smart guy with a blue check mark next to his name (that’s how I know he’s smart) just called me a selfish dipshit, so I changed my mind and scheduled an appointment.” I’ve never heard anyone say, “I wasn’t going to get vaccinated, but then these people on Twitter called me a moron, accused me of taking horse pills, and told me I shouldn’t reproduce. So I went and got vaccinated.”
And lately the label “AntiVaxxer” holds about as much weight as a “Yo Mama” jab. Once a term reserved for cretins blessed with the privilege to deny the undeniable historical benefits of vaccines, its overuse has killed its punch. Now when I hear it, I think of Claude Robichaux from John Kennedy Toole’s masterpiece A Confederacy of Dunces who runs around accusing everyone of being a “Communiss.”
Whenever I create a health-comms piece for a particular audience, I always ask myself: Will this resonate with them or will this isolate them? No matter the audience, insults always fall in the latter category, so even though I like to exercise my snark muscles here and there, I avoid insults when I want to motivate someone to do something for his/her health.
I realize that there are strong, strong, STRONG feelings about the COVID-19 vaccines and COVID policies in general. And I realize that whenever there are strong feelings, there will be vitriol. There will be tribalism, insults, and toxic communication. There may even be violence. Given human nature, there is no way around that. To quote J.P. Donleavy in A Fairy Tale of New York, “I got disappointed in human nature as well and gave it up because I found it too much like my own.” However, and even though I’m a the-glass-is-75%-empty-and-please-fill-it-up-with-wine kinda gal, there is always still time and room to try to be a communicator who resonates and doesn’t isolate. Sometimes it feels like there are multiple sets of facts floating around out there, but even still…we can make an effort to resonate and not isolate.
Ok, perhaps the ship has sailed on cultivating empathic communication and everyone is either down a rabbit hole or crouched in a foxhole, so maybe save this art-of-the-risk-benefit-analysis piece for the next pandemic. There will be a next pandemic, mostly because we stupid humans are driving the factors that lead to emerging infectious diseases in how we carelessly interact with our environment and fellow species, but I’ll save that cheerfulness for a future post.
It doesn’t matter what your stance is on the vaccine or any other public health intervention for that matter, the risk-benefit analysis is always a helpful tool. It is there for your peace of mind. Yet in my experience with focus groups or casually chatting with people about the vaccine, it’s rare that anyone tells me they did a risk-benefit analysis. People seem to only focus on the risks or only focus on the benefits, lump everyone into one category, end up “taking a side” and what should be an intellectual and thoughtful process becomes anti-intellectual and reductive. Once a health decision becomes reduced to “taking a side” or “following an order” we’ve lost the essence of what we’re trying to do, which is weigh the risks against the benefits and come to a decision based on that analysis. The process is designed to make the decisionmaker more comfortable, not more anxious, not more fearful and certainly not like he or she is being punished.
So I had a crazy idea from the battlefield: What if all the health professionals hurling insults on social media or in person instead sat down with someone and helped him/her do a risk-benefit analysis? Do it with someone who is a grandmother, a teenager, a young mother, a thirty-something pregnant woman, a child, an athlete in his twenties, a person in his 70s with underlying conditions…all of those risk-benefit analyses will be different. They could do this over Zoom or take out a pen and paper, markers and a white board, lipstick and a napkin, catsup and a forearm (whatever) and do it in person. It doesn’t have to be fancy, but I find that writing stuff down is more helpful than just talking about it.
When it comes to health communications, keeping it simple (without losing accuracy) is always best. Luckily, a risk-benefit analysis doesn’t have to be complicated. It just needs to have a few basic parts. My recommendation is to start with a question. Ask the person why he/she is doing this risk-benefit analysis. There is a conflict or a dilemma of some sort, what is it? What is the core issue that brought them to this point? Whatever it is, write it down. Then I make a chart with 4 columns on a piece of paper: Risk; Benefit; Who; and Frequency. Next, I ask the person to help me identify things that are both risks and benefits. If it’s a risk, write it down under “Risk.” If it’s a benefit, write it down under “Benefit.” Sometimes people will ONLY write down risks (the “Awful Ex” analysis) OR benefits (the “Prince Charming” analysis). That’s a problem, and you need to coach them to think about and list both. If they are struggling to come up with risks and/or benefits, help them fill in the chart by asking questions. What about this… (insert risk)? Or what about this…(insert benefit)? Did you ever think of this? If they say something that you know isn’t true or completely batsh*t, gently point it out and tell them why it’s not true.
Then I ask the person WHO is at risk or WHO benefits. If it’s everyone, write down everyone. If the risk or benefit is specific to a particular population, make a note of it. Then I move to the “Frequency” column, which I think is the most important column, because it can help a person put risks and benefits into perspective. Find out and write down the statistical likelihood of a risk or benefit happening. If someone struggles with statistics (and many people do) try using props or stories with colorful imagery to make the statistics easier to understand. My go-tos are marbles, blueberries and a bucket of crayons. In my experience, most people’s perception of a risk does not match its statistical likelihood.
Throughout this exercise, it’s important to be honest about what is known and what is not known. A risk-benefit analysis is a scientific exercise not a sales pitch, meaning if you are assisting a person in completing one, don’t treat it like a marketing opportunity. The risk-benefit analysis is meant to empower a person with both knowledge and the confidence to make an important decision about his/her health. At the end of the analysis, ask the person to assess the risks vs the benefits and what his/her decision will be. Maybe they still need time to decide, it’s okay. Be respectful and meet them where they are. Whatever you do, don’t talk down to them while telling them what to do. Let it happen organically and show them that you are on their side, not there to be a dictator in their lives and certainly not someone who wishes them harm.
Detox the Vax Recipes? Another Toxic Extention of Toxic Health Communication
On the Battlefield of Misinformers, Dissenters and Staunch Stakeholders of the Almighty Narrative
Check out my personal essay: My Long First Date with Death
Read Dr. Eeks’ book Manic Kingdom, based on a true story, here
Listen to her parody (audiobook) Yours in Wellness here.
Listen to her health podcast Causes or Cures here.
This right here is why I follow and admire what you have to say. Zubin Demania always talks about the being “alt middle” in the scientific realm. For the most part he is, but I’ve witnessed his dismissive side toward certain ideas that run counter to the legacy narrative. He can be very insulting when he feels a notion is simply too preposterous. You on the other hand tend to get your jabs in, but you do it with class, and seem to have a genuine want and desire to educate people, not insult them. I think the risk / benefit analysis is a great idea. If you think about it, it’s how the rest of medical treatment is performed for any illness. We don’t just simply decide that there’s a problem with heart disease, and put the whole society on anti hypertensives, or low fat cardiac diets. We target the population who have hyperlipidemia, and hypertension. I mean there’s something to be said for promoting societal wellness, to decrease the overall prevalence of heart disease, but we don’t just treat everyone for heart disease. Same could be said for vaccinating. With clear evidence now stacking up that the vaccines aren’t really doing much to decrease transmission, the focus should be on attempting to vaccinate the most vulnerable, with the highest risks. Same could be said for any other mitigation efforts (mask use, distancing etc etc).
Great article. And keep that alt middle keepin’ on.