Response to a Friend about Fear of Death

My friend Ross Levatter sent me a thoughtful email challenging some aspects of my posts (here and here) on the risks we should fear. He gave me permission to post the whole thing. I also shared it with co-author Charley Hooper, who emailed me his thoughts. I’ll answer, and give Charley’s answer, after his letter. Here’s Ross’s letter:

I briefly skimmed your posts on what people are frightened of, where you note that many are frightened about rare events rather than more common causes of death or injury. You write “What should we fear? What threats are most likely to kill us?” Your underlying assumption is that the answer to the latter should strongly inform us in answering the former. But I don’t think that’s right.

The fact is, most adults have made peace with the fact they’re going to die at some point. Most people are not scared of dying per se. They go through the 5 stages, ending with acceptance. You don’t find massive amounts of fear in hospices.

It seems your paper’s underlying assumption is that FEAR of death by X should track LIKELIHOOD of death by X. But I don’t think that’s correct.

What ARE people frightened about?

1. UNEXPECTED deaths. Cardiovascular disease kills lots of people. Cancer kills lots of people. Shark attacks DO NOT kill lots of people. One might be frightened to anticipate dying of something that hardly kills anyone.

2. PAINFUL deaths. Here’s an Anthony Jeselnik joke: “My grandmother died last year. Initially, we all thought she died in the best way possible. What’s the best way possible? Right, in her sleep. But then we had an autopsy and we found grandma died in the worst, most gruesome way possible. During an autopsy.” In fact, numerically, dying in one’s sleep is orders of magnitude more likely than dying during an autopsy (which I doubt has actually ever happened unless you count vivisection.) But it’s hopefully understandable why the thought of the latter is more frightening than the thought of the former.

3. SUDDEN deaths. The *novel* coronavirus infection is very unlikely to kill you, especially if you’re under 70. But unlike dying of cardiovascular disease, this is not a death you’ve given any thought to up until a year ago. So it’s more frightening. A *NEW* way to die.

4. UNFAIR deaths. The odds of dying of a terrorist attack are extremely low. But to most people it seems very UNFAIR to be a perfectly healthy, active individual with decades of life ahead of him in the morning and dead in the afternoon.

I’m sure if I gave it more than casual thought I could come up with other distinctions, but I hope my point is clear. The belief that fear of death from X should track likelihood of death from X is an assumption that is not obviously true—it needs at least to be argued for—and is most likely, IMHO, false.

I basically agree with most of what he said because Ross keyed in on our words “fear” and “afraid.” I think we should have focused not on fear but on what things it makes most sense for a person to invest in preventing. Terrorism? No. Shark attacks? No. Being killed by a policeman while unarmed? No. Living a life to avoid heart attacks or delay them by 5 years? Yes. Being cautious around social groups to avoid COVID-19? Yes.

Charley put it better. He wrote:

His [Ross’s] points are correct and we did use the word “fear,” but what we were getting at isn’t fear as much as being smart about risks. If you want to live a long life, what should you think about and do?

To summarize his points, if we make peace with a manner of death, we no longer fear it. We fear those deaths that are sudden, painful, and unexpected.

We could have used “being smart about fatal risks” instead of “what fatal risks to fear.” But at some point, we start sounding like Star Trek’s Spock.

Now back to me: Consider the hospice point. If you’re in a hospice, then, if it was a good decision for you to be there, you have exhausted the alternative ways of preventing, without great discomfort, the thing or things that you’ll die of. It makes sense both not to fear the thing that will kill you and also not to invest further in preventing it. The time to act would have been much earlier when possibly a change in life style could have given you a couple more years of good life.

Ross then added a short additional point:

BTW, here’s another (I think incorrect) implication of this line of reasoning. Assume “Dying in your sleep” and “Dying from shark attack” are statistically exactly equally likely. Does it then follow that one should be equally frightened at the two prospects? I suspect most people, told they are equally likely, would still more greatly fear dying of shark attack.

I answered Ross as follows:

Yes, I would much rather die in my sleep, as my grandfather did, rather than dying in sheer terror, as his passengers did.

But seriously, folks, it is true that if you  choose between two ways of dying that have equal probabilities, the one that is more painful is the one to avoid.

You could alter our analysis by scaling the numbers, though, and in many cases that won’t matter. For instance, imagine that you would hate being killed by a shark 1,000 times as much as dying in your sleep. The odds of being killed by a shark are still so low that it doesn’t make sense to take account of that in deciding whether to swim in the ocean.

 

 

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Answer to a Reader on What We Should Fear

I received the following letter last week and the author gave me permission to quote without using his name.

Hi Dr. Henderson,

My name is X, I’m a fan of your writing, so I wanted to thank you for your work and insight that I’ve been able to enjoy…

I recently read your article “What should we fear most and what should we do about it” in the recent Regulation magazine, and while I generally agree with the policy prescriptions for the FDA I was somewhat confused about the discussion around people’s irrational reaction to different threats in life.  I’ve also heard other economists discuss irrational threat response behavior and honestly it strikes me as a bit misguided.  But I’m also not an economist or an academic so I may be missing something, and I’d be grateful to hear your thoughts on it..

One thing is that isn’t there a categorical mistake being made when comparing something like shark attacks to things like heart disease or cancer?  The latter two seem to be more or less results of aging (or long-term behaviors like excessive eating or smoking, for example).  In other words, aren’t illnesses or diseases that come with the territory of aging and dying categorically different than something like a shark attack?  I feel the same reasoning could be used to tell people not to worry about walking in a bad part of the city because your chances of dying from cancer are higher than getting shot.  It seems like a non-sequitur to me.  One way is a gruesome and sudden end to (hypothetically) a younger person’s life while the other is something that is more or less accepted by people as a very possible ending to their lives when they are older–illness and death at the end of life are accepted as part of the tragedy of the human condition.  This is not to say that I think people should be very worried about shark attacks, just that the statistical probability analysis comparing these events is missing something.

The second thing is the uncertainty of some risks as opposed to others.  I’d agree with the proposition that we shouldn’t go too far in restricting freedoms in order to prevent terrorism, but comparing it to illness or automobile accidents again seems misguided to me.  I think most people would have found it irrational to say, for example after the attack on Pearl Harbor, that people should be more worried about automobile safety and cancer than Japanese acts of war because their likelihood (at that point) of dying in an attack was much lower.  People worried about it because there was uncertainty about further attacks, a time sensitivity to stop aggression as early as possible, and the possible defeat of the US in a war.
Am I missing something here?  I appreciate your time and any thoughts you may have on this.  I look forward to reading more of your writings!

X was referring to this article by Charley Hooper and me.

Here’s my answer.

First, thanks for the compliment.

Second, let’s consider the shark versus heart disease/cancer point. They are different categories, but I don’t think there’s a category mistake. You’re right that the heart disease and cancer risk come with age whereas the shark attack is pretty much unrelated to age. They do come with the territory, but there’s a lot you can do about the territory. Just as you can avoid the almost infinitesimal risk of being killed by a shark by staying out of the ocean, you can substantially reduce a risk that’s a few orders of magnitude greater by, say, not smoking cigarettes, getting exercise, and eating in moderation. As someone who just turned 70, I don’t passively say, “Oh, that risk comes with the territory. I want to make it to 100 and I’m doing a number things will help me.” And I haven’t even mentioned medications that will help me as I age.

Regarding the point about walking in certain parts of town, if the risk is high enough, then it easily could be the case that you’re more at risk from dying in an hour from walking in that part of town than you are at risk from dying from a heart attack or cancer in an hour. The sensible way to think about risk is per unit time, whether it be an hour, a day, or a year. As I’m sure you noticed in our article, we normalized by having it be risk in a year.

You said that comparing terrorism to illness or automobile accidents seems misguided, but you didn’t say why. Why do think that?

Re Pearl Harbor you wrote:

I think most people would have found it irrational to say, for example after the attack on Pearl Harbor, that people should be more worried about automobile safety and cancer than Japanese acts of war because their likelihood (at that point) of dying in an attack was much lower.  People worried about it because there was uncertainty about further attacks, a time sensitivity to stop aggression as early as possible, and the possible defeat of the US in a war.

You make a good point. The way to compare risks there is not to see Pearl Harbor as a one-off event but to put it in context. What was the probability of further attacks? What was the chance the United States would have been defeated in war and what would have been the consequences of that?

What that basically says is that it makes sense to look at the whole thing, not just a piece. I would give you my views on the war with Japan because they are different from the views of almost everyone else I know, but that would take us too far away from the statistical issues you’ve raised.

I shared the letter with my co-author Charley Hooper, who answered as follows:

If we don’t want to die, or at least die at a young age, there are certain actions we can take. These actions have a cost and an expected benefit. That expected benefit is the probability times the benefit.

There’s a cost I incur if I avoid swimming in the ocean to reduce my risk of a shark attack. The expected benefit is minuscule because the probability is already so low that it’s difficult to lower it further. In other words, the expected benefit is negligible.

There’s a cost I incur if I exercise more, take a medication, practice meditation, or avoid eating certain foods. The expected benefit may be large because I only need to reduce the probability of dying from a heart attack or cancer a little bit to make a noticeable improvement. In other words, the expected benefit is large.

X is saying that we accept heart disease and cancer because they are a part of aging. If that’s the case, then why are so many drugs sold, so many procedures completed, and so much medical attention devoted to treating cancer and heart disease? Plus, if you could prevent a death from any source, you’ve still prevented a death. A heart attack can kill you just as certainly as can a shark.

We don’t act as if we accept heart attacks and cancer. And even if we did, we shouldn’t.

Regarding Pearl Harbor and WWII, again it comes to probabilities, actions, and outcomes. An individual might have a greater chance of dying in a car crash than dying in the war, but the risk of war is more than death: it’s having your house destroyed, your family killed, your government overthrown, your wealth destroyed, and your daughter raped. War is hell.

We shouldn’t worry about either car crashes or wars; we can worry about both and take the appropriate steps to reduce the risk of each.

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What Should We Fear Most and What Should We Do About It?

Some acquaintances recently paddled surfboards and kayaks into the Pacific to disperse a relative’s ashes where he loved to surf. During the memorial service, one brother of the deceased expressed concern about the risk from sharks.

The image of an aggressive shark in the deep ocean is graphic and terrifying, but the risk of mundane threats far outweighs the risk from shark attack. The dead man’s brother should worry much more about heart disease, which felled his brother, and devote his attention to lowering that and similar risks. There is only so much time and energy; each unit of energy spent on lowering the risk from sharks is one less unit that can be spent on hearts.

What should we fear? What threats are most likely to kill us? Setting aside cataclysmic events such as nuclear wars and planet-altering meteorites, there are some risks that generate a lot of fear but few deaths, such as shark attacks, terrorism, and killings by police. On the other end of the spectrum are everyday risks that kill a large number, such as heart disease and cancer. In between are risks from motor vehicle collisions and the seasonal flu. And this year is a new risk: COVID-19.

This is from David R. Henderson and Charles L. Hooper, “What Should We Fear Most and What Should We Do About It?, Regulation, Winter 2020-21.

Another excerpt:

Larger risks / The typical American faces much greater risk of death from comparatively mundane causes. Heart disease kills about 1 in 502 Americans each year, while cancer kills 1 in 542.

The number of deaths from seasonal flu varies significantly from year to year, but it has averaged about 40,000 in the United States in recent years, which works out to 1 death in 8,125 Americans. The good news is that rate has fallen significantly over the decades; if the death rate from flu in the 1950s and 1960s were applied to today’s population, we would see over 160,000 deaths per year.

If the death rates from these diseases seem high, it is because they are. Heart disease alone kills as many Americans each year as the combined U.S. combat casualties from all American wars.

Read the whole thing and check out our table.

 

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Is Cowen Right about the Great Barrington Declaration? Part 2

 

Yesterday, I reviewed the first half of Tyler Cowen’s critique of the Great Barrington Declaration. This is the last half. As before, quotes from him are highlighted and my responses are not.

Here are the key words of the Great Barrington Declaration on herd immunity:

The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.

And then:

What exactly does the word “allow” mean in this context? Again the passivity is evident, as if humans should just line up in the proper order of virus exposure and submit to nature’s will. How about instead we channel our inner Ayn Rand and stress the role of human agency? Something like: “Herd immunity will come from a combination of exposure to the virus through natural infection and the widespread use of vaccines. Here are some ways to maximize the role of vaccines in that process.”

It means, as the document says, “allow those who are at minimal risk of death to live their lives normally.” I’m not sure why Cowen has trouble understanding. Allowing people to live their lives has nothing to do with passivity. It certainly is consistent with the idea of human agency, even if you don’t go all Ayn Rand on it. When people are allowed to do something, that doesn’t mean they have to do it. There’s necessarily human agency.

He’s right about how herd immunity will come about. But then he says, “Here are some ways to maximize the role of vaccines in that process.” The problem here is, as former Obama economist Austan Goolsbee pointed out in a related context, that this is like the old economics joke where the punch line is “assume a can opener.” We don’t yet have a vaccine, so right now maximizing the role of vaccines gets you to a maximum of zero.

In practical terms, the most problematic paragraph in the declaration is this one:

Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.

In most parts of the Western world, normal openings for restaurants, sporting events and workplaces are likely to lead to spiraling caseloads and overloaded hospitals, as is already a risk in some of the harder-hit parts of Europe. Reopenings, to the extent they work, rely on a government that so scares people that attendance remains low even with reopening.

The middle paragraph is from the Great Barrington Declaration. The paragraphs that bookend it are from Cowen.

I’m not familiar with Europe but Georgia (in the United States) opened without overloaded hospitals. As for spiraling caseloads, that’s part of how you reach herd immunity. And if you follow his link to a Bloomberg article, you’ll see that it says not a word about overloaded hospitals.

Cowen is right that governments have reacted by scaring people. That’s one reason the Great Barrington Declaration is important. It seeks to tell people not to be so afraid unless they’re particularly vulnerable. Notice the statement in the Declaration that “Young low-risk adults should work normally, rather than from home.” The authors are not saying that they should be forced to; they’re saying they should. As I understand the Declaration, they’re trying to talk to young people as well as others and say, in effect, “Come in, the water’s fine.” Does Cowen object? If so, he doesn’t make clear and he doesn’t say why.

Don’t get me wrong: The Great Barrington strategy is a tempting one. Coming out of a libertarian think tank, it tries to procure maximum liberty for commerce and daily life. It is a seductive idea. Yet consistency of message is not an unalloyed good, even when the subject is liberty. And when there is a pandemic, one of the government’s most vital roles is to secure public goods, such as vaccines.

Notice how he jumps from the idea that the message is tempting and seductive (I agree) to government’s role in vaccines. Little problem: WE DON’T HAVE A VACCINE. The Great Barrington Declaration makes clear that it’s addressed to what to do while we’re waiting for a vaccine. Insert can opener joke.

The declaration is disappointing because it is looking for an easy way out — first by taking the best alternatives for fighting Covid off the table, then by pretending a normal state of affairs is also an optimum state of affairs.

Does he care to tell us what “the best alternatives for fighting Covid” are? It strikes me that he has two in mind: (1) vaccines, which haven’t yet been approved, in part thanks to the FDA, which Cowen has earlier said should not approve one from Russia, and (2) lockdowns, which Cowen says aren’t that important and, by the way, we should tighten them.

My worldview is both more hopeful and more tragic. There is no normal here, but we can do better — with vigorous actions to combat Covid-19, including government actions. The conception of human nature evident in the Great Barrington Declaration is so passive, it raises the question of whether it even qualifies as a defense of natural liberty.

I missed the hopeful part. OK, so what are the vigorous actions that include government actions? Blank out, as the aforementioned Ayn Rand loved to say. And how does he know that the authors of the Great Barrington Declaration would not favor those actions? Cowen is fixated on the idea that three non-libertarians produced a libertarian statement. As I mentioned in Part 1, that sends him down a rabbit hole from which he doesn’t emerge.

 

 

 

 

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Combating COVID-19: How Should Banking Supervisors Respond?

By Tobias Adrian  and Ceyla Pazarbasioglu The massive macro-financial shock caused by the pandemic continues to ravage the global economy and has put both banks and borrowers under severe strain. Supervisors find themselves confronted with unprecedented challenges which call for decisive action to ensure that banking systems support the real economy while preserving financial stability. […]

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