Risky business: When dealing with complexity, it all comes down to trust.

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Trust is the cornerstone of sustainability in an uncertain world

By David Salt

Humans are lousy at risk assessment. In some situations it’s close to non-existent. I have a very clear memory of how poor I was at calculating risk when the chips were down.

When my wife was in hospital delivering our first child, things didn’t go to plan; the plan being a short, easy, natural birth unassisted by pain relief. What actually happened was a long and painful labour which ended in an emergency caesarean. During this trial, after a seemingly endless and traumatic labour, the doctor offered my wife an epidural (a local anaesthetic in to the space around the spinal nerves in the lower back) to ease her suffering. It was in the early hours of the morning, we were at our wit’s end, and were open to any medical intervention that would ease my wife’s pain. However, before the epidural could be delivered, the doctor first needed us to sign a form acknowledging that we had had explained to us all the risks associated with the injection. These ranged from a 1-in-a-hundred chance of feeling nauseous to a 1-in-a-ten thousand chance of paraplegia or even death. We simply didn’t care, my wife needed an intervention. The doctor thought an epidural was sensible; we signed the form, the injection was given and relief was found.

Those risk numbers I just ‘quoted’ I made up. That’s because I really can’t remember what we were told. My wife can’t remember the whole episode. I was pretty stressed out, too. However, I do remember there was a risk, a low risk, of catastrophic outcomes of paraplegia and death.

I also remember being appalled that we were being asked to consider these possible catastrophic outcomes when we were so stressed already; it only added to our trauma. I assumed it was simply to give the hospital cover from litigation if things turned pear shaped. But, I thought, there had to be a better way.

That was many years ago. The pain and anxiety is long forgotten but the memory of my incapacity to rationally consider risk remains very strong.

Clots in the system

Fast forward to now, the end phase (hopefully) of a global pandemic. The risk assessment most of us (in Australia) are making is ‘should I get vaccinated’? For older people, like me, that means a jab of AstraZeneca, but a couple of people have died from a rare side effect involving blood clotting.

According to the Australian Government, the chances of getting this serious but rare side effect (called thrombosis with thrombocytopenia syndrome or TTS) is four to six in a million people for the AstraZeneca vaccine. About one in four people with this condition may die.

Attempting to work out whether it’s worth the risk, I phrase it like this: there’s approximately a 1-in-a-million chance of dying of TTS from getting the AstraZeneca jab! But if corona breaks out we know it can, in some situations, kill over 1 in every hundred people*. Take the jab I say (and I did).

But my back-of-an-envelope risk assessment isn’t worth the shred of metaphorical paper it’s written on because, according to health experts, everything depends on context. It depends on your age, your genetic makeup, your country (and the laws of that country) and your behaviour. Each factor dramatically affects the risk calculation.

So, hoping for a more nuanced and understandable explanation of the risk I turned to the official government explanations** where they tell us:
“It is important that consumers weigh up the potential benefits and risk of harm from COVID 19 Vaccine AstraZeneca to ensure that they make a fully informed decision about receiving the vaccine.”

And then they provided numbers (cases of TTS per 100,000 vs hospitalisations and deaths prevented per 100,000 people in different age groups) for low, medium and high exposure risks to COVID.

I could not make any sense of this information (which contained no understandable summary or recommendation) and I would be surprise if your average “consumer” could do much better.

Indeed, so upset was I at the government’s effort to give the impression that it was doing a good job at helping “consumers weigh up the potential benefits and risk of harm” that my blood pressure went dangerously high (thereby significantly increasing my risk of harm).

Who do you trust?

I present these two cases of risk assessment – one personal, one affecting everyone – because I believe they reflect something well known to cognitive psychologists and decision scientists: humans are lousy at assessing risk. We are riddled with biases, delusions and faith-based truisms which skew and distort the information at hand; even if we had the mathematical acuity to combine the many factors that need to be considered as we make our risk calculation.

And yet, in spite of this, we make decisions around risk every day; and most of the time we get it right (or maybe that should read we don’t get it so badly wrong that we reap the worst consequences possible). How is that?

That’s because, even if we don’t like to acknowledge it, we follow the cues of the people and institutions we trust.

I was so angry at the hospital for forcing a risk assessment on me when I was least prepared to do it, but at the end of the day, the doctor thought an epidural was good and I trusted doctors and hospitals in general. I was able to move past the risk.

I can’t understand the government’s risk explanation around AstraZeneca but, at the end of the day, I do trust most of the people advocating AstraZeneca for the over 50s (including Australian Nobel laureate Peter Doherty, who had one himself), so I got the jab.

In a complex world with growing uncertainty, trust enables us to move forward. Or, conversely, when we stop trusting the institutions upon which our society is based (think governments, the rule of law, science, emergency services), our capacity to deal with risk is also lost.

Risky business

Which is why recent trends suggesting trust in governments in many OECD countries is deteriorating (and particularly in the supposed leader of the free world, the USA) we should all be very worried.

The future is increasingly uncertain. Report after report (such as on climate change or biodiversity decline or land degradation or pollution) is telling us we are moving in the wrong direction, often at an accelerating pace. We are living unsustainably with dark and risky consequences for the generations to come.

At the very time we should be placing a premium on trust and cooperation to help us navigate the choppy waters ahead, our political leaders seem instead hell bent on ramping up prejudice and tribal fear. Populism and nationalism seem to be winning formula, trust seems to be the victim.

Australia’s traumatic Black Summer and the ongoing unravelling story of the COVID pandemic tells us the world is an unpredictable and risky place. The best response would be a concerted effort to build up the trust bank in regards to government and our many important institutions. We need transparency and accountability around all forms of decision making, and a rock solid foundation of integrity upon which we can reliably place our trust.

If we believed in the manner in which decisions were being made by our elected leaders then we would all be in a much better position when it came to making our own decisions in the face of enormous (and often growing) uncertainty and risk. Trust me on this.

Image by Gerd Altmann from Pixabay

*According to some calculations I’ve read, while COVID poses a real and present threat, you’re around 12 times more likely to die by drowning; around 30 times more likely to die while driving a car; and 170 times more likely to die during a Caesarean.

**It’s important to point out that I read this vaccine advice on 11 June. I looked at this site a month earlier and the advice was different in terms of details, though the overall approach was the same. On both occasions their explanations and scenarios were essentially meaningless to me.