The spread of Ebola has dominated the headlines for the last couple of days, with a nurse in Spain being the first to contract the virus outside of West Africa. There is talk of the US screening airline passengers as they arrive and experimental vaccines being trialled as the urgency to find a cure intensifies. I remember similar alarm being raised a few years ago in connection with Avian Flu and before that it was SARS. Naturally the practicality of worldwide travel is on my mind a great deal at the moment so I suppose it is inevitable that I wonder whether the risks are any greater now. I’ve mentioned before the process we’ve been through when contemplating our forthcoming trip – all the pros and cons, as it were, so the question is, should the potentially increasing threat of Ebola make any difference to our decision to go?
Here is where I find an interesting overlap in what I do for a living (supporting new families and in particular helping them make choices that are specifically right for them) and what we are doing in our personal life; the decision to opt out of mainstream education, travel the world and live a less conventional life for a while. So far the impact on factors like affordability, the kids’ education, our future employability and so on (let’s call them the private factors) have been relatively easy to evaluate – we have most of the relevant information available to us. But what about a potential global health problem that we know very little about? How can we assess the risk of increased travel both to our family on an individual scale (a private factor) but also in terms of any increased threat we might pose to the general public, just by virtue, for example, of having taken so many flights with hundreds of others who have also been travelling?
In NCT we teach parents the BRAIN decision making tool – when presented with options we ask what are the Benefits, Risks and Alternatives of those options, what does our Instinct say and what if we do Nothing? Years and years ago when I practised law part of my job was to assess and try to minimise risks for clients. Even if I did my job well though, those risks still exist and sometimes, even if the odds were in your favour, the outcome may not be what was hoped for.
I’ve always liked Martin Lewis’s example of risk taking. He says, suppose I offered you a bet – we’ll toss a coin and if it lands on heads you must pay me 10p but if it lands on tails, then I must pay you £100. Do you take the bet?
Of course you do, (unless you are represented by a city lawyer, in which case she is probably trying to hedge your 10p, but I digress). If the coin then lands on heads, the outcome is not what you had hoped for but does that mean you made the wrong decision? I see this all the time when working with pregnant couples and part of being comfortable with decision making is understanding that you can’t control all the outcomes but if the worst happens, it doesn’t prove that you made the wrong choice. Applying this to private factors, I am bullish when it comes to risk taking – we may not get our old jobs back but we’ll probably find others etc. Matters of public health feel a bit different though. It feels like we need more facts.
I had the pleasure of hearing Ben Goldacre speak at the weekend. He came along to the NCT conference to give a keynote speech, the theme of our conference being the potential conflict between facts and feelings and how that impacts on decision making. Goldacre is currently a Research Fellow in epidemiology at London School of Hygiene and Tropical Medicine and he is known for exposing the misuse of research and statistics by those with a vested interest. I would love to have heard his views on both how the public does respond and indeed how it should respond to each of these new pandemics as they sweep the globe. I imagine he would have had nothing to say about individual cases but from a policy point of view, when, if at all, does it become better for the greater good, for the general public to stop travelling large distances? One flippant answer to that is, when your government says so. Now I would have thought such action from any government extremely unlikely; the economic consequences would be difficult to comprehend but sometimes travel is advised against if it is not “essential”. The truth is, what we have planned is not “essential”. So, hypothetically, what do we do if non essential travel is advised against? I’d like to think that we could look at the evidence; make up our own minds if all travel is risky, or only to certain regions, for example.
Sadly for me, Goldacre wasn’t there to speak about this issue but he had plenty to say about how much we can rely on “evidence,” and about the need to consider the motives of those who are carrying out or reporting research. It is conceivable that if the Government ever did reach the point of prohibiting travel, or advising against it in general, it might not be because that is what the evidence points to; it could just as easily be to address the need to be seen to be doing something, to be in control so that we all feel better. Even on a macro scale feelings as well as facts are relevant.
Ultimately whether this latest global outbreak impacts upon our plans will depend upon what happens over the coming months and, of course, how we feel about it. I’m hoping that, like bird flu and SARS, this will be long forgotten in 12 months time because if not, I’m not sure that BRAIN is going to help me. How could I assess the risks if I don’t have all the facts and where could I reliably get them from? Maybe an email to Goldacre?