Some of our decisions on the societal level are so irrational that you might wonder if natural selection fell asleep at the switch. Take a case of resource allocation. The CDC, our premier epidemiological gatekeeper, has to beg for funding each year for better tracking of our food supply. Yet, it is still tracking rodents and fleas to guard against an outbreak of plague…When did you last hear about a plague epidemic in the U.S.? Even Europe, which was decimated by the bubonic plague in the 14th century, is not worried too much about a recurrence.

I recently came across a delightful article in Nature by Daniel Gilbert of the Department of Psychology at Harvard University. In it, he recounts the story of a law that is on the books in the U.K.

He says that the London Association for the Prevention of Premature Burial was founded in 1896 to prevent “premature burial generally, and especially amongst the members”.1 Because nineteenth-century physicians couldn’t always distinguish the nearly dead from the really most sincerely dead, premature burial was a problem. But not a big problem.

The odds of being buried alive in 1896 were, like the odds of being buried alive today, very close to zero. Nonetheless, the good citizens of England formed action committees, wrote editorials,and promoted legislation that ultimately led to expensive safeguards against “the horrible doom of being buried alive.”1 Most of those safeguards—such as the costly requirement that bodies spend time in ‘attractive waiting mortuaries’ before being buried—are still with us today. The frequency with which modern cadavers use this waiting period to demonstrate that they’ve been misdiagnosed is approximately never.


Why do we make such ridiculous decisions?

The short answer is that we are hardwired to avoid risk. Our ancestors survived by being constantly on guard against predators, against the rustling in the grass, against groups wielding sticks. Is there any wonder that we put a great premium on risk avoidance?

But since those leopard-eat-man days, a lot has changed. We don’t regularly face predators (the four-legged kind), snakes in the grass (ditto), or marauding tribes. But our brain hasn’t changed a pace. This is why we worry about inordinately small risks, at the expense of avoiding much bigger risks; yes, I did mean “at the expense”.

Regardless how rich we are, our resources are limited. So allocation of resources to avoiding one risk by necessity comes at the expense of other. The war in Iraq came at the expense of Afghanistan; the war on fleas comes at the expense of maintaining a clean food supply chain, and so forth. The medical profession, as much as it prides itself with hewing to science and hard evidence, is not exempt from irrationality. And I don’t just mean the crazy quilt that is our health care “system”—if you can call this chaos a system.


Just take the bone marrow (or stem cell) transplantation that was offered women with stage IV breast cancer. Why was it done? The evidence for it was limited to a few small, poorly controlled studies. The results of even those studies were mixed. But as Warren Buffet famously quipped, “To the man with a hammer, the whole world looks like a nail.” Transplant surgeons know how to transplant and oncologists know how to combat graft vs. host rejection. And from that, a treatment was born. Forget the fact that 20 years later, that the procedure actually killed one in five women prematurely (later improvements reduced the death rate to “only” 1 in 20).

Just consider the societal cost of a bone marrow transplant. The cost per procedure is $100,000-$200,00, and the average hospital day is 45 days. This princely sum doesn’t include the frequent hospital admission due to infections, psychiatric complications, and chronic rejections.

So why didn’t society allocate those resources to nutrition programs for undernourished children? Or universal vaccination? Or revamping our crumbling schools? The answer is at least partly hardwired in our brains: Cancer is a terrible, visible danger. Undernourished children do not threaten to strike us tomorrow or the day after.

But there is another reason for our poor decision making: Our morality. Surprised? After all, moral behavior is the glue that keeps us together as a society, giving us an enormous selective advantage. So how could it also be the cause of bad decisions? The obsession with the view that abortion is immoral causes a significant portion of our society to be oblivious to the terrible price of thousands of children born of unwanted pregnancy.

In our outrage at street crime, we passed a law called “three strikes and you are out.” The result is thousands of people are jailed for life because they were convicted for such offenses as shoplifting, check fraud or possessing drugs, at a cost exceeding a million dollars per convict. That’s more than putting each one of them through Harvard.


What’s to be done?

The answer is education. We need to start teaching quantitative and critical thinking. Three-year-old toddlers possess a “numbers sense.” Kids in first grade can already grasp mathematical and statistical concepts such as average and normal distribution. Young people can be trained to think through social issues critically, ferret out inconsistencies and expose intellectual fraud.

Biological determinism is a wrong reading of biology. Just the fact that we have the genes for type 2 diabetes doesn’t mean that we are doomed to have it. Likewise, just because we are hardwired to avoid risk doesn’t mean that we cannot analyze the risk/reward of the decision at hand. Just because a “gut reaction” sounds moral doesn’t mean that it is.

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.


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