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.

Trust lies bleeding

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A world of science is there to save us – and nobody trusts it

By David Salt

Every day the world goes a little crazier, and with every slip everyone grows more fearful of what the future holds. Central to our fears is trust, or a lack of it. If we can’t trust our leaders, or the institutions upon which civilisation is founded, then how can we trust in the future?

2020 has been an awful and tumultuous year full of ‘natural’ disasters, plague and populist politics. We want it to be over; we want some return to normal; but most of us are too scared to honestly engage with what science is telling us – that there is no return to ‘normal’ in respect of the Earth System.

Yesterday, as I write this, Trump announced he was CoVID positive (one of his few ‘positive’ tweets quipped one larrikin tweeter), one month out from the US election. Today it’s turning out the White House is actually a hotbed of infection. If things were uncertain, now they seem to be slipping towards deep chaos.

And chaos creates a feedback loop that can lead to despair.

The antidote to chaos is trust. When the chips are down, when the fire is lapping at our front door, when a pandemic stalks the streets; it’s trust in our leaders, our friends, our neighbours, our mainstream media, our emergency workers, and health workers (and other miscellaneous experts) that will see us through.

Trust is one of the bulwarks of community resilience, and in this year of tumult, I fear it’s often forgotten and been allowed to whither.

Science and truth

Trust lies bleeding and this has enabled our partisan politics to eviscerate truth; and that comes with some awful consequences. Consider the strange paradox of the power of science (and technology). It has enabled us to transform our planet while seemingly being impotent to save it.

On the one hand we have an enormous bank of evidence and a scientific consensus telling us that human activity has pushed Earth into a new state of being, referred to by many as the Anthropocene. Global modification involving too many carbon emissions, biodiversity decline and nutrient pollution (to name three planetary boundaries) is causing changes to our climate and life support systems. Our coral reefs are bleaching while our great forests are going up in flames. Sea ice is disappearing, the permafrost is melting and seas are rising – it’s everything science has been predicting but 2020 has seen those predictions become horrifyingly real.

Science has also told us what we need to do to reduce the impact of these changes.

On the other hand we see our political leaders pandering to the lowest common denominator; prioritising the short term over the long; and ignoring, discounting or rubbishing the science.

Consider this exchange a couple of weeks ago between President Trump and the California Secretary for Natural Resources in the wake of California’s horror fires:

“It’ll start getting cooler, you just watch.” – President Trump.

“I wish science agreed with you” – CA Natural Resources Secretary.

“I don’t think science knows actually.”- President Trump.

Trump has been denigrating and discounting the institution of science since he took office, as have many other populist leaders. It serves his political agenda and the coterie of vested interests that stand behind him.

He can stare into the flames of a massive and unprecedented conflagration and simply deny its reality and the science that explains it. That he is allowed to get away with this strikes me as surreal and absurd. However, that a sizeable chunk of America will simply accept what he says (they don’t think ‘science actually knows’ either) I find horrifying. They don’t trust science.

Trust this knowledge

It’s strange to think that we live at a time in history when science and technology (and specifically Information Technology) has made the world’s storehouses of knowledge (think libraries, universities and scientific journals) available to anyone with a smart phone or tablet. We have more scientists working today than at any time in history, and the power of science enables us to see further, or closer or finer than ever before.

And yet, in this same age, some 40% of Americans lap up every falsehood blurted out by a sociopathic anti-science president who has ignored all the warnings on climate change and CoVID to the detriment of his own country (and now looks to have fallen to the same infection he has shown no leadership on). A time when anti-vaxxers are on the rise, conspiracy theories abound and voodoo cures have as much currency as mainstream science.

I try to understand what explains this growing abyss between our burgeoning knowledge and the floundering confidence in that knowledge being shown by so many in the community; with one symptom of this gulf being the rise and rise of anti-truth tellers like Trump (and Bolsonaro in Brazil). And I think the answer has everything to do with the loss of trust.

Inequity and dispossession

It’s widely said that a major reason that Trump won in 2016 was because Hilary Clinton inadvisably described Trump’s supporters as “basket of deplorables”, people of little worth, who are ignorant and wrong-headed. It was enough, some believed, to rile them up and get them to spit in the eye of traditional politics and vote for Trump the outsider.

I think of that basket of deplorables as more of a barrel of the dispossessed. They largely come from poor socio-economic backgrounds and they no longer believe the future holds much for them. The status quo in recent decades seems to have enabled the rich to get even richer (truly filthy rich) while most of humanity looks at a bleaker and bleaker future.

Science reinforces this bleakness, shouting from the side lines that we’ll all be ruined if society doesn’t change to a more sustainable pathway.

And all the time inequity grows, while the winners of the status quo increase their stranglehold on the levers of power.

Trust lies bleeding.

In such an atmosphere, hyper charged by the reach and speed of social media, the simple solutions put forward by the Trumps, Johnsons and Bolsonaros of the world find fertile ground. And rather than solving the complex challenges rising around us, they sow further distrust and chaos.

Here’s just one topical example. According to Anne Applebaum at The Atlantic, 38% of media stories containing misinformation about the virus refer to the President: Trump is literally, not metaphorically, the single most important reason so many Americans distrust information they receive about the disease.

Cause or symptom

But the rise of the sociopathic liars I believe is a more a symptom than the cause of the problem. Their capacity to spread untruth is only made possible when a significant portion of the community don’t trust the mainstream media or the science it reports on.

Anti-vaxxers and Q-Anonists don’t get to spread their vicious conspiracies if the broader public is resistant to their poison; informed and responsive to real emerging threats.

And climate deniers (and the many vested interests that use them to sustain their wealth) won’t be able to distort and pervert important policy reform to move humanity to a more sustainable footing.

Today leaders are so obsessed with the impact of CoVID on our economic life (which clearly preferences society’s winners). Maybe we should all be rethinking our slavish neoliberal obsession with protecting traditional stocks of capital and investing more in social and environmental capital, and specifically making a few deposits into the rapidly draining trust bank.

Our capacity to absorb disturbance and sustain a quality life as we move into an increasingly uncertain future absolutely depends upon it.

Images by Gerd Altmann from Pixabay

A good decision in a time of plague

Could it be there is no ‘right’ decision, just a good process?

By David Salt

What’s the best decision to make in a time of plague? Close your borders? Isolate your citizenry? Ration supplies? Close schools? Scorch the landscape? (Actually, for our east coast, the forests have already all been scorched and it doesn’t seem to be slowing the rate of infection.)

Of course, versions of all these actions are being applied in different measures here and overseas in the face of COVID-19. We have all been impacted by these decisions and most of us have strong views on which decisions are good and which are bad. Indeed the ‘strength’ of those views is on clear view in the twitterverse and in the mass media, and at times that strength is verging on the hysterical.

I can say from my own family’s experience, we are scared.

There is no perfect

I think most fair minded people would acknowledge that no-one has the perfect solution (or even a near perfect solution). Every option is problematic. Each comes with difficult trade-offs including constraints on personal freedoms, social isolation and reduced access to important goods and services. For some (eg, the wealthy), these trade-offs are inconvenient but they’ll cope. For many they are life changing; and for some they are life threatening.

What’s more, given the complexity of the systems being managed here, there is enormous uncertainty about how different options will actually pan out.

Given all this, surely we should all be more passionate about the process by the which a decision is made rather than it’s ‘rightness’ – because there simply isn’t a ‘correct’ answer. Or, in other words, rightness is actually more about the process of making a decision rather than the decision itself.

Good decision making

What are the ingredients of a good decision-making process in a time of crisis?

Here are a few key elements: the process needs to make use of the best information (and experts) available; it must be transparent, fair and adaptive. Above all, the process needs to be trustworthy.

Trust is not a given, it’s earned. It’s difficult to build and is easily lost. However, if the process is genuinely well informed by the science – and is transparent, fair and adaptive – the trust bank is built on solid foundations and will continue standing regardless of tough operating conditions, setbacks, slip ups and sub-optimal decisions – all of which are a given in a time of plague and mass disruption.

So far our governments haven’t done too badly. They have acknowledged the gravity of the situation, been open about the medical expert advice they have been receiving and how it informs their decisions, and have made some massive resource commitments to bolster the economy and ecology of our society.

Yes our governments (state and federal) have made many slip ups and sub-optimal decisions including slow responses, ambiguous and contradictory messaging, and letting cruise ships unload in Sydney with zero vetting. Yes it’s been messy, and social media has been even more venomous and judgmental than usual. But society is still functioning, riots don’t appear likely and the general public is acknowledging the need for harsh restrictions in the face of an unprecedented threat. (I hate using the word ‘unprecedented’ but it really does apply here. However, every pandemic is unprecedented because each is different. The Spanish Flu pandemic may have been bigger – so far – but it was a different world 100 years ago.)

In any event, while our response hasn’t been perfect, I trust our system and I’d rather be in Australia at the moment than in the US or the UK. The US, in particular, looks to be headed for grief on a massive scale. And they have a leader who says this disturbance will be over in a fortnight.

Transparent, fair and adaptive

For trust to be sustained in our decision making we need to see what it is based on. It needs to be a transparent process. We live in an open society with a free press and a strong set of institutions to validate information and the manner in which the government hand out resources.

Authoritarian governments might find it easier to impose draconian measures to counter a plague but the lack of transparency in such places is also a recipe for a plague to take off. Such was the case with the birth of the COVID-19.

We have a strong belief that government resources should be used for the common good and that the most vulnerable in society are looked after. In a time of plague this is doubly important, something our elected leaders are all too aware of.

The ‘rule of law’ is a particularly important component of being ‘fair’. That is the rules and constraints applied to the community are applied to everyone without fear or favour, something that is ensured by transparency and strong institutions. ‘Exceptionalism’, the practice of making rules for others but believing you are the exception – will simply not be tolerated in a time of plague and politicians caught out doing it are essentially robbing from the trust bank. That’s one reason I’m glad I’m not in the US at the moment. Their leadership has raised exceptionalism to an art form.

Being adaptive – changing your strategy to adapt to changing circumstances – is less often spoken about when it comes to coping with a massive disturbance. I think that’s because our leaders want to convince the population that they have the answers and there is nothing to worry about. I think this was on show during our recent bushfire emergency.

Such hubris is simply unacceptable in a time of plague. Our leaders need to acknowledge the enormous uncertainties facing us and have the humility to say they don’t have the answers and that we all make mistakes. Making mistakes is not a sin, not learning from them is.

This is where a brains trust of experts feeding into a transparent process of decision making is critical.

What decision will we make next week?

Have we done enough to counter this pandemic? Have we gone too far? It’s impossible to say. We’ll probably know in a month.

The only certainty is that more big decisions will need to be made in the coming days, and the situation will change significantly in the coming weeks. None of the decisions our leaders make will be perfect. I accept that. But, for the sake of my family and my society, may those decisions be transparent, fair and adaptive. If they’re not, my trust will wither.

And in a time of plague, trust is everything.

Image: Image by Stefan Keller from Pixabay