460,000 French Can't Be Wrong

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All right, despite their protectionist laws, ludicrous theories about literature, and surrender-prone combat style, even the French occasionally get something right, and what better time to honor them than now, with Bastille Day upon us (even if the Revolution was a tragically misguided eruption of mass murder that threatened the foundations of civilization)?

French TV viewers, reports the Associated Press, recently saw an ad that warned of a highly-toxic, carcinogenic product commonly consumed by millions of French people. "Cyanuric acid, mercury, acetone, and ammonia have been found in a product regularly consumed," said the ad. Viewers were invited to call a toll-free hotline to find out the identity of the product, which was, of course: cigarettes.

According to a spokeswoman for the ad's sponsors, the National Health Institute for Prevention and Education, some 460,000 French people called the hotline almost simultaneously. The resulting increased awareness of smoking's dangers may help decrease France's annual 60,000 smoking-related deaths.

The sweetly ironic part of the ad, though, is that is an implicit reminder how skewed the public's health priorities are. Rhetoric associated with the ongoing crusade against minor environmental risks was used to lure people in and remind them of an immense threat about which many people are complacent.

France is a country full of environmentalists, anti-biotech activists, and alternative medicine adherents a country not so different, really, from our own and there is widespread fear there of minute chemical residues and genetically-modified crops. Meanwhile, the far more substantial and far more scientifically-verified risks of smoking are passively accepted by most of the population, since smoking seems more familiar and easily understood. It's not clear anyone has ever been harmed by minute chemical residues in the environment or by genetically-modified food, but they sound spooky to the French and American masses alike, while smoking is fun, at least in the short term, but leads to the premature deaths of about a third of its users.

No one would want a food additive, household cleanser, or malfunctioning car with a kill rate like that.

Some will argue that smokers simply make a rational calculation that their pleasure from smoking outweighs the substantial odds of death (and the certainty of at least slightly impaired health even without death). While they certainly have the right to make that trade-off, it seems a bit of an exaggeration to say they make a rational calculation, given the great concern that many of the same citizens show over other, relatively trivial risk increases. It would seem more accurate to say that most people are very bad risk calculators, and they are particularly reluctant to make accurate risk calculations about events seen as distant in time, such as death from lung cancer years from now.

The claim that people are not afraid of chemically-induced health risks is contradicted by their intense, fearful reaction to things such as the French public service announcement. Imminent, spooky threats (unknown new chemicals) seem more real to people than long-term, familiar threats (smoking-induced lung cancer), but this is hardly a vindication of the rationality of smokers. While smokers have every right to continue making their own decisions, people who understand statistics and relative risks are under no obligation to affirm the wisdom of those decisions.

Indeed, it might be argued that those who understand risk assessment are under a special moral obligation to sound the alarm about smoking, not calmly accept the decision to smoke as final, a mere matter of subjective taste. An engineer would not sit calmly by while thousands of his fellow citizens, due to their poor grasp of math and physics, walked onto a bridge doomed to collapse and kill them all. He would loudly tell them they're making a mistake, even if many, in the end, refused to be deterred.

Or to put it another way: the French incident shows that people do want to protect themselves against unnecessary risks. The task now is to show them which are the real risks and which the imaginary ones.

Sasha Volokh took issue with the importance this article attached to risk calculation in his 8:01am, July 27 entry on Volokh.blogspot.com

Responses:

July 27, 2002

[Sasha , 8:01 AM]

THE FRENCH: My friend Todd Seavey writes, in Health Facts and Fears, about French attitudes toward smoking and chemical risk. The National Health Institute for Prevention and Education ran a TV ad "that warned of a highly-toxic, carcinogenic product commonly consumed by millions of French people. 'Cyanuric acid, mercury, acetone, and ammonia have been found in a product regularly consumed,' said the ad. Viewers were invited to call a toll-free hotline to find out the identity of the product, which was, of course: cigarettes."

"The sweetly ironic part of the ad," says Todd, is that this is "rhetoric associated with the ongoing crusade against minor environmental risks," which are often trivial. People shouldn't be concerned about smoking because of trace amounts of chemicals; they should be concerned about smoking because it's known to kill you regardless of these extra chemicals. Or, the way I would spin this: knowing what chemicals are in an item is a very blunt and often inaccurate way of judging how dangerous something is the healthiest natural foods contain (natural) chemicals that are also carcinogens. Why even bother with or care about the chemical contents of a product when you have ample evidence of the actual consequences of using it?

Todd argues that people are very bad risk calculators, given their complacency about smoking and their disproportionate fear of "minute chemical residues and genetically-modified crops." He continues:

Indeed, it might be argued that those who understand risk assessment are under a special moral obligation to sound the alarm about smoking, not calmly accept the decision to smoke as final, a mere matter of subjective taste. An engineer would not sit calmly by while thousands of his fellow citizens, due to their poor grasp of math and physics, walked onto a bridge doomed to collapse and kill them all. He would loudly tell them they're making a mistake, even if many, in the end, refused to be deterred.

Here's where I don't understand. I'm willing to believe that people don't perceive risk rationally though even there, I'm not sure it's irrational to be more accepting of (1) risks that come with pleasurable products or (2) known risks that come with familiar products. The first is just cost-benefit analysis; the second is just risk aversion (who knows what unknown risks lie behind genetically modified foods?), together with some antipathy to social change (who needs these new-fangled genetically modified foods anyway?).

But, even if they do have irrational risk attitudes . . . why does that mean we should sound the alarm about smoking? Why not instead consider it one's moral duty to sound the alarm about the tiny risks which are misperceived to be large? Maybe people are saying, by their revealed preference in smoking, that they don't mind large risks; maybe they'd be happier not if they quit smoking but if they used more chemicals in other products. What do you want to do, live forever?

I'm not sure either discouraging smoking or encouraging other chemicals is a "moral imperative" for the person who understands risk assessment, but at least I don't see why mere risk misperception should make us focus on reducing smoking. The article doesn't claim that smokers underestimate the risks of smoking; there's some evidence that they overestimate these risks, which is admittedly controversial, but I'd like to see a discussion of that; in any case, it's pretty clear that people do overestimate the risks of industrial chemicals.

Also, there are other reasons why you might want to convince people not to smoke. Maybe people smoke too much because they misperceive their self-control abilities, and you think it's O.K. to reduce their smoking by skewing their risk perceptions in the opposite direction. Or maybe you share the public-health community's obsession with lengthening life, even though we're utility maximizers, not life maximizers. Anyway, the risk perception argument doesn't seem terribly strong to me.

P.S. Also see the interesting article in Health Facts and Fears, "Girls Worried About Weight More Likely to Smoke." First, it casts light on the possible rationality of smoking (though of course it doesn't say that). Second, it has an interesting discussion of how early cigarette advertising used to stress the weight-control advantages of cigarettes the 1910 Lucky Strikes campaign said, "First a shadow, then a sorrow; Reach for a Lucky Instead of a Sweet."

UPDATE: This isn't good enough to blog separately, but on similar issues, see this recent (March 2000) issue of Risk in Perspective from the Harvard Center for Risk Analysis, on whether contingent valuation is useful as a way of valuing lives saved in regulatory cost-benefit analysis.

Meanwhile, reader Stanton Brown says he read somewhere "that beer has 13 times more radiation than nuclear power plant waste water. But the best example of people failing to use benefit/cost rationality to assess risk has to be car mpg requirements. Or the idea that we have to reduce speed limits to 55 to save lives. Why not 45, or 35, or 20 and save even more lives? Oh there's a trade off involved! Imagine that."