Spotty Deference

The public often defers to medical experts, but not always:

Imagine you are seated at a table with two bowls in front of you. One contains peanuts, the other tablets of the illegal recreational drug MDMA (ecstasy). A stranger joins you, and you have to decide whether to give them a peanut or a pill. Which is safest? You should give them ecstasy, of course. A much larger percentage of people suffer a fatal acute reaction to peanuts than to MDMA. … 

As New Scientist went to press, the UK government's Advisory Council on the Misuse of Drugs was widely expected to recommend downgrading it, based on evidence of its limited harmfulness (see "Ecstasy's legacy: so far, so good"). Yet the government has already rejected the advice.

No doubt this is partly a reaction to the furore over the government's de facto decriminalisation of cannabis in 2004, based on another advisory council recommendation. Despite the fact that the move actually reduced the quantity of cannabis being smoked … the government recently reversed it in the face of implacably bad press.

For evidence of how irrational and lacking in perspective the public debate has become, consider how the advisory council's chairman, David Nutt, found himself in hot water last weekend for comparing the harm caused by ecstasy to the harm caused by horse riding.

How does the public decide when to believe medical experts and when not to?  

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  • http://profile.typekey.com/SoullessAutomaton/ a soulless automaton

    A related question: when they’re clearly not listening to experts (medical or otherwise), are they listening to someone else instead? Or making choices on some other basis entirely?

  • Doug S.

    New Scientist lost all credibility a few years ago when it published a cover article about a reactionless drive (an impossibility on the order of a perpetual motion machine).

  • http://everythingaustinapartments.com/ Chris L

    They listen when science provides justification for the moral choices.

    Like statistics about how improbable it is that the universe could support life proves there must be a supreme being that created it.

    But when statistics suggest alien life forms they are dismissed, or the fossil record supports evolution they are ignored.

    Science that proves drugs are bad = good. Science that proves drugs aren’t that bad = bad.

  • spriteless

    Someone allergic to peanuts is more likely to recognize them on sight than someone allergic to MDMA recognize the contents of a tablet.

    The dangers associated with recreational drugs are *scarier* than just comparing the statistics. An addict scarcely has a choice whether to take more drugs, and while using many of them you aren’t as in control of your faculties as otherwise. They seem to take away free will.

    Meanwhile, people *choose* to play sports. Before you go hunting, skiing, or horseback riding, you know their is chance of injury, and choose to play anyways. It all appears to be calculated risks.

    Alternately, drugs are associated with bad people, and sports with good people. Don’t want to have less bad people go to jail than good people.

    Or it could be we have different goals/viewpoints than the scientists.
    http://www.pbs.org/cringely/pulpit/2004/pulpit_20040812_000822.html

  • Manon de Gaillande

    MDMA is safe. Ecstasy pills may not be; they’re rarely pure MDMA. The contents can be any mix of MDMA, speed, aspirin, sugar and other ingredients in any dosage. I would go with peanuts.

    As to the question, the absurdity heuristic is enough explanation.

  • Nick Tarleton

    What Chris said. People decide DRUGS = BAD and react with hostility to any claims to the contrary; but even if they didn’t, they still wouldn’t support policy changes as a result, because DRUGS = BAD is a moral primitive.

  • Nick Tarleton

    What Chris said. People decide that DRUGS = BAD and condemn anyone who disagrees; but even if they didn’t, they wouldn’t update their opinions on policy along with their beliefs, because DRUGS = BAD is a moral primitive.

  • frelkins

    when not to?

    1. when experts contradict deeply-held religious/beliefs or cultural habits
    2. when experts are believed to be in thrall to paid interests (ski vacations for prescribing x amount of brand name drug, consulting income and paid speaking appearances related to treatments)
    3. when experts contradict accepted previous habits (public is confused by whip-sawing repetitive studies, throws up hands, keeps taking vitamins)
  • http://shagbark.livejournal.com Phil Goetz

    Usually, you can find another expert willing to give you an opposing opinion. Even in the case of evolution, you can find a handful of biologists to oppose it. (Although the most famous authors at present advancing creationism are a lawyer and an astronomer.) The only controversy I can think of in which there is, literally, not a single expert who disagrees, is over whether human activity causes global warming.

    I don’t think this issue of experts is different than any other issue in which people believe what they want to believe.

    In issues that touch on morality, remember that everyone believes they are an expert on morality. I’d like to write a post on the bias people have against believing that morality is a mental task. People will generally agree that making tough moral decisions requires concentration, careful consideration of alternatives, objectivity, creativity, insight, the ability to predict outcomes, and a host of other skills that we associate with high intelligence. But they don’t like it if you then conclude that more intelligent people can make better moral decisions than less intelligent people. (I imagine they don’t. I haven’t actually asked anybody. Maybe, in Jewish religious culture, people already believe that?)

  • Douglas Knight

    Phil Goetz,
    Why focus on intelligence? From the particular claims, can’t you already get a contradiction that everyone’s an expert, yet some variable traits, like concentration, are relevant? If people are more bothered by the idea of the relevance of intelligence than creativity, that might be important, but that goes beyond the evidence, if I understand your claims correctly. (If you want to say that it’s purely based on your intuition, that’s fine, but I would have phrased it all very differently; in short, I’m confused about what you’re saying.)

  • Sideways

    Robin Hanson’s near/far dichotomy bears on this subject: people will generally listen to expert advice (any variety, not just medical) on “far” matters, but on “near” matters they will disregard expert advice in favor of their own prejudices. For example, some prominent activists asserting a link between vaccines and autism are parents of vaccinated autistic children; their own life stories make it impossible for them to hear the evidence of clinical studies showing no connection.

    A “near” issue need not have arisen in one’s own life. Just knowing a story about a situation can make it a “near” issue.

    Before 9/11, Americans didn’t worry about terrorist attacks; after 9/11, we began spending millions on emergency supplies, disaster training, and so on. Why the difference? The actual risk of terrorism didn’t change appreciably in September of 2001, except for members of the intelligence community with access to classified information; and large amounts of Homeland Security money went to fortifying non-urban areas that would be unlikely targets for terrorist attacks. 9/11 made terrorism a “near” issue for all Americans, even those who had never been to New York–because after 9/11, they had a story about terrorism to hand.

  • Stuart Armstrong

    How does the public decide when to believe medical experts and when not to?

    I think the clue is in:

    implacably bad press

    Drugs like opium used to not be much of an issue, until a bunch of politicians and journalists decided to make them so.

  • http://www.transhumangoodness.blogspot.com Roko

    “Robin Hanson’s near/far dichotomy bears on this subject:”

    indeed. Robin really has found something important there.

    I wonder how people’s attitudes towards the singularity will change when some event makes it a “near” issue?

    Nick Tarleton: “because DRUGS = BAD is a moral primitive.”

    Yes. I have personal experience with this, even when the drug in question is a medicine, and is perfectly appropriate for the problem it is meant to be solving.

  • Julian Morrison

    It’s not so much that people personally believe DRUGS = BAD. It’s that they believe you have to signal that way or you’re being irresponsible. The press always prints what it thinks it ought to signal. The politicians make laws the same way. They strenuously resist mere facts.

    Perhaps the problem is that convincing people, as individuals, is not effective because they don’t update their external presentation from their internal beliefs. They only update from (their internal understanding of) their culture’s “external beliefs”.

  • http://timtyler.org/ Tim Tyler

    Uh, how many people ever died after eating one peanut?

    …and what about the concept of “risk aversion”?

    Peanuts are a low-risk food, whereas if you choose to feed a stranger MDMA, there is a high probability that they will be very cross with you – not least of all because of the well-documented “brain-damage” issue.

  • http://profile.typekey.com/bayesian/ Peter McCluskey

    I presume there’s some status quo bias involved. Back when horse riding and peanut eating became common, the need for transportation and calories made the risks bearable. If horse riding started recently for recreation, I bet the risks would create moderate controversy.

  • http://diogenes42.blogspot.com diogenes420

    Robin — have you been to a doctor in the past 20 years? I know economists hate empirical work — but I would highly recommend you attempt visiting a hospital at one point and talking with a doctor. The medical profession *rarely* discusses ecstasy. Many physicians tell there patients they would rather have them continue smoking marijuana and stop cigarettes.

    The drug that receives the most medical attention is probably heroin — mostly due to its many complications — infection (AIDS, endocardititis), chance for treatable overdose, and high addictive potential. Then probably cocaine — addiction potential and chance for complications (heart attack).

    People who make national drug policy DO NOT represent the consensus of medicine in any way whatsoever. These positions are made on the basis of politics — and rarely medical considerations. Alcohol and cigarettes cause significantly more harm than marijuana and ecstasy — and I would bet the overwhelming majority of physicians would agree.

  • http://profile.typekey.com/SoullessAutomaton/ a soulless automaton

    Uh, how many people ever died after eating one peanut?

    Probably far more people than have died from a single dose of pure MDMA. Somewhere on the order of 50-100 people a year, if memory serves me. Statistically, if you take a random American about whom you know nothing, feeding them the peanut is indeed more dangerous, on average.

    And yes, the anaphylactic shock from eating even a single peanut is decisively lethal to people with serious peanut allergies. The main reason people don’t die particularly often is that the reaction is apparent within seconds, takes the better part of an hour to reach the point of being lethal, and medication to suppress the histamine response is widely available.

    As to why peanuts are as common as they are, allergies as a whole have become, and are becoming, dramatically more common in industrialized nations for as yet unknown reasons. A popular explanation is that this is caused by excessively sterile environments for children but I don’t know how well proven that theory is.

  • http://timtyler.org/ Tim Tyler

    “Somewhere on the order of 50-100 people a year, if memory serves me.”

    That is the figure sometimes given for the total annual US peanut deaths – not the deaths after eating one peanut.

    UK death figures from “MDMA (‘ecstasy’) – from “A review of its harms and classification under the Misuse of Drugs Act”:

    “Data from the np-SAD for the period 1997 to 2006 recorded that MDMA was implicated in a mean of 50 deaths per year and around 10 where it was considered the sole drug (Rogers et al., 2009).”

    A smaller country, and how many people eat peanuts compared to how many eat MDMA? What case supports peanuts being more dangerous – even if fatality is the only harm being considered?

  • http://profile.typekey.com/SoullessAutomaton/ a soulless automaton

    That is the figure sometimes given for the total annual US peanut deaths – not the deaths after eating one peanut.

    In general, someone allergic enough to risk death will get a sufficiently strong reaction from even far less than a single nut. This is why food packaging will mention if there was shared equipment with peanut products; even dust can be lethal.

    And again, the only reason the numbers are that low is that it is comparatively easy to treat the allergic reaction before the point of fatality.

    “UK death figures from “MDMA (‘ecstasy’) – from “A review of its harms and classification under the Misuse of Drugs Act”:

    “Data from the np-SAD for the period 1997 to 2006 recorded that MDMA was implicated in a mean of 50 deaths per year and around 10 where it was considered the sole drug (Rogers et al., 2009).”

    It’s my understanding that the leading causes of death where MDMA is involved are not strictly caused by the drug, but by dangerous behaviors engaged in during the altered mental state; that’s a death caused by the drug only in the loosest sense.

    From all the information I can find, the direct toxicity of the drug is relatively mild and it requires substantially more than a single typical dose to risk direct danger from the toxicity, and to my knowledge there’s no evidence of long-term effects except possibly from heavy, chronic usage.

    In other words, giving a person a single dose of pure MDMA probably isn’t going to do squat to them in the long run, whereas there is a nontrivial percentage of the population who will unquestionably die from a single peanut without immediate medical intervention.

  • e3fne

    @ phil goetz: you need to expand your media intake variety, there is quite a virulent cohort of global warming propaganda resisters claiming experts’ support

  • http://timtyler.org/ Tim Tyler

    Re: In general, someone allergic enough to risk death will get a sufficiently strong reaction from even far less than a single nut.

    There are some strong peanut allergies out there – but I am inclined to want to see some actual figures. Hand-waving is not very convincing. Usually the dose makes the poision.

    Re: It’s my understanding that the leading causes of death where MDMA is involved are not strictly caused by the drug, but by dangerous behaviors engaged in during the altered mental state; that’s a death caused by the drug only in the loosest sense.

    Hmm. If you get run over by a car, after mis-judging time and space, or while believing that the whole universe loves you – then you are just as dead as if you die some other way.

    The article’s claim that “a much larger percentage of people suffer a fatal acute reaction to peanuts than to MDMA.” in the context of one peanut is unreferenced – and strikes me as pretty dubious, looking at the stats I have seen.

    My action would probably be dominated by concerns of legality and personal safety. Acute reactions are too rare to be worth considering – but there does seem to be some risk of making an enemy by feeding the MDMA. Also, could you be sued? If you feed the peanut, what happens to the MDMA? Are you left in posession of a Schedule 1 substance? Eeek!

  • http://profile.typekey.com/SoullessAutomaton/ a soulless automaton

    I don’t have and could not find any stats on degree of peanut allergy sensitivity, sorry. I’m going mostly off of conversations with a couple friends who have peanut allergies, as well as the degree to which that particular allergen is mentioned on warning labels.

    Mentioning the legality is irrelevant; you seem to be missing the essential point of the article, which is that MDMA is legally restricted absurdly out of proportion to its actual dangers and with total disregard for the opinions of medical experts on the matter. Consistency would seem to demand either legalizing MDMA (as well as marijuana and possibly other substances), or banning things like common food allergens as well as alcohol and tobacco, which have similar or higher danger levels.

    i.e., many people have an irrational “illegal drugs = bad” bias with no grounding in fact.

  • http://timtyler.org/ Tim Tyler

    Consistency would seem to demand either legalizing MDMA (as well as marijuana and possibly other substances), or banning things like common food allergens as well as alcohol and tobacco, which have similar or higher danger levels.

    You mean in the hypothetical case where medical safety were the issue? This isn’t medicine, it’s politics and “the war on drugs”.