In February 2005, the New York City Department of Health and Mental Hygiene issued a warning about a possibly disastrous new strain of the AIDS virus. It was widely criticized for alarming people before it had solid evidence that the strain was spreading.
Also in February 2005, the United Kingdom’s Food Safety Authority held off announcing that many prepared foods were contaminated with tiny amounts of the banned red dye Sudan 1, because it wanted to prepare a list of affected products first. It was widely criticized for the delay, and Sudan 1 briefly became Britain’s most notorious possible carcinogen.
In the weeks just after these two stories hit the news, an oil company inquired about whether it made sense to notify neighbors when something went wrong that could potentially require evacuating the neighborhood. Since most glitches are resolved before they turn into crises, the client said, wouldn’t it be more sensible to wait till an evacuation was actually needed? The national health agencies of two countries pondered the pros and cons of launching a high-visibility campaign to warn people that avian influenza in Southeast Asia might precipitate an influenza pandemic. How useful is it to scare or worry the general public about a risk that may or may not materialize, the clients asked, especially when so much of what can be done to prepare for a pandemic is in the hands of governments and doctors? And a university research program devoted to food bioterrorism pondered a protocol for announcing incomplete evidence of a possible attack. Until you know which food to tell people to stop eating, the client mused, does the government even have the right to undermine the fortunes of a major industry, not to mention the public’s faith in the food supply?
All this came only a few short months after one of the world’s most stunning examples of failure to warn: the December 2004 tsunami. Not to mention the seemingly endless controversy over another recent failure-to-warn example: the cardiac effects of such anti-inflammatory medications as Vioxx, Bextra, and Celebrex.
Clearly, when to release risk information is a serious dilemma.
There is no simple answer. Well, actually, there is a simple answer: In almost all situations, you should release risk information as early as possible – even if it is (as it usually is) uncertain. But there is no easy answer. As New York City’s health department found out, you are likely to face criticism whatever you do.
Nonetheless, on balance, early is better. And there are ways to diminish the downsides of early release. Among them: Validate the reasons why some people think you should have waited, and acknowledge the real harm early release can do; emphasize the uncertainty of your current information; express your regret that you don’t know more, and that what you do know may frighten people, perhaps needlessly; talk frankly about what you’re doing to resolve the uncertainty, and what others can do in the meantime to protect themselves; and remind yourself and your publics that they are resilient and able to bear bad news.
The Case for “Inform Early”
Risk communication experts have often addressed the tough question of when to tell the public. Invariably, they come out on the side of informing the public early.
The following arguments for informing early are from Improving Dialogue with Communities: A Risk Communication Manual for Government (Hance, Chess, and Sandman), published by the New Jersey Department of Environmental Protection in 1988. This early risk communication manual was based on interviews with government environmental officials, talking about their experiences releasing (or not releasing) information. The overwhelming majority strongly favored very early release, even of preliminary, uncertain information. The manual lists some of their reasons for early release in these words:
- Early release of information sets the pace for resolution of the problem.
- If you wait, the story may leak anyway. When it does, you are apt to lose trust and credibility.
- You can better control the accuracy of information if you are the first to present it.
- There is more likely to be time for meaningful public involvement in decision-making if the information is released promptly.
- People are entitled to information that affects their lives.
- Prompt release of information about one situation may prevent similar situations elsewhere.
- Less work is required to release information early than to respond to inquiries, attacks, etc. that might result from delayed release. Also, your project is more likely to stay on schedule if you don’t have to backtrack over steps you took without the public’s knowledge.
- You are more apt to earn public trust if you release information promptly.
- If you wait, people may feel angry and resentful….
- People are more likely to overestimate the risk if you hold onto [withhold] information.
This list of arguments for early release was developed in the context of pollution controversies – where typically the problem was chronic rather than potentially catastrophic, the solution was in the hands of regulators and corporate managements, and there was relatively little members of the public should or could do to protect themselves. The case for early release is much stronger, of course, if you’re talking about a potential acute public health emergency – such as a new strain of HIV – where there are precautionary steps individuals should take, and where maintaining trust between health officials and the public may become essential to getting through the crisis.
In its 2005 Outbreak Communication Guidelines, the World Health Organization addressed the when-to-release-information dilemma in a public health context. One of the five sections of the Guidelines is entitled “Announcing Early.” It reads:
The parameters of trust are established in the outbreak’s first official announcement. This message’s timing, candour and comprehensiveness may make it the most important of all outbreak communications.
a. In today’s globalized, wired world, information about outbreaks is almost impossible to keep hidden from the public. Eventually, the outbreak will be revealed. Therefore, to prevent rumours and misinformation and to frame the event, it is best to announce as early as possible.
b. People are more likely to overestimate the risk if information is withheld. And evidence shows that the longer officials withhold worrisome information, the more frightening the information will seem when it is revealed, especially if it is revealed by an outside source.
c. An announcement must be made when public behaviour might reduce risk or contribute to the containment of the outbreak.
d. The small size of an outbreak alone or a lack of information are insufficient arguments to delay an announcement. There are times when even one case, such as an Ebola report, can justify early announcements.
WHO acknowledges that early announcements are not an unmitigated blessing:
Early announcements are often based on incomplete and sometimes erroneous information. It is critical to publicly acknowledge that early information may change as further information is developed or verified.
But the agency concludes: “The benefits of early warning outweigh the risks, and even those risks (such as providing inaccurate information) can be minimized with appropriate outbreak communication messages.”
The drawback that WHO emphasizes – uncertainty and the possibility of error – is the drawback most often cited by government and corporate officials who are reluctant to release risk information. It takes many forms: We haven’t finished quality-controlling the data yet; we haven’t developed our management plan yet; this could all blow over and then we would have frightened people for no good reason; we don’t want to look like chicken-little alarmists; etc. These aren’t foolish arguments. But waiting for certainty before warning people about risk very often means waiting too long. Whether it’s a possible side-effect of a medication, a newly discovered pollution problem, or a new strain of HIV, the harm done by unnecessary warnings has to be balanced against the harm done by failing to warn.
It isn’t hard to come up with a hypothetical situation where withholding preliminary information seems sensible: Everything looks fine except for one anomalous data point that you’re pretty sure has got to be some kind of measurement error; it will only take a few hours to find out; even if the rogue data point is accurate the health risk is pretty minimal anyway.
But remember the Sudan 1 example. The health risk there was pretty minimal; the delay was only a few days to put together a list of affected foods; without such a list there wasn’t much people could do to protect themselves. And still the delay provoked a furor, a blow to the government’s credibility, and a grossly exaggerated sense of risk.
Or consider the U.S. Department of Agriculture’s mad cow dilemma. The USDA’s screening test for BSE (mad cow disease) is prone to false positives; you don’t know you’ve found a mad cow until a confirmatory test is also positive. That takes a week or so. What should the USDA do in the meantime? Announce that a preliminary test just found a possible new case but we won’t know for a week if it’s real? Or say nothing until the confirmatory test comes back positive too? The first approach risks doing unnecessary damage to the beef industry – at least until the media and the public get used to false positives and stop paying attention. The second approach increases the frequency and impact of rumors; it also risks loss of trust, especially when a confirmatory positive turns up and critics point out that USDA has “known” about the problem for a week already. Since in this case the health risk of waiting a week is negligible, it’s debatable which is the right strategy.
To its credit, the USDA’s current policy is to announce its positive screening tests (it calls them “inconclusives”). We think this is wise, though much of the beef industry disagrees. But even if the USDA decided to withhold screening test results, at least the policy itself would be public. People would know that there might be some inconclusives pending at any time, but only confirmed cases would be announced.
Waiting too long to release risk information is a much, much more common problem than jumping the gun. The temptation to withhold potentially alarming news is nearly universal. Uncertainty aside, it’s likely to prove embarrassing; it may generate public pressure to take remedial actions you don’t want to take; if the news does economic damage you may get blamed. And so officials and managers naturally look for reasons to keep mum – and find them – and more often than not eventually come to wish they had gone public sooner. You will be tempted to wait too long; you will not be tempted to speak too soon. We have a long list of companies and government agencies that got into trouble for withholding information; our list of those that were criticized for “prematurely” informing the public is much shorter.
Most dilemmas over whether to warn now or wait can be resolved by applying two tests:
Will an early warning be useful?
The case for “inform now” is strongest when the early warning is useful. Usually that means it’s actionable – there are precautions people can take once they’re informed. But time to get used to a new danger is also useful. (See “Adjustment Reactions: The Teachable Moment in Crisis Communication.”) And bear in mind two points. First, precautions you consider unnecessary still count. You warn people so they can take the precautions they choose to take, not necessarily the ones you recommend. And second, a warning that enables people to take precautions against an uncertain risk is useful even if the risk never materializes or turns out to be minor. Hindsight doesn’t invalidate the warning; it was useful because people would have been better prepared if the situation had become serious.
Will delay do damage?
Health damage aside, imagine that you decide to withhold the information for awhile, and before you get around to releasing it, someone else blows the whistle. Is your reputation damaged? Is your ability to lead the public through the crisis (if it turns into a crisis) damaged? Is the public’s ability to notice it’s not serious (if it turns out not serious) damaged? Government and corporate officials are always alert to the damage that communicating might do; they often pay too little attention to the damage that not communicating might do.
If the answers to these two questions are no and no – an early warning won’t be useful and delay won’t do damage – you should feel free to handle the situation however you prefer. But if the answer to either question is yes, then there is a prima facie case for going public now. You still need to balance this case against the arguments for waiting. As you do so, remember that your natural bias is probably in the direction of waiting too long. If it looks really obvious to you that you should wait, there’s a chance you might be right. If it looks more like a toss-up to you, odds are you should go public now.
New York City’s HIV Decision
On February 11, 2005, the New York City Department of Health and Mental Hygiene issued a news release, headlined: “NEW YORK CITY RESIDENT DIAGNOSED WITH RARE STRAIN OF MULTI-DRUG RESISTANT HIV THAT RAPIDLY PROGRESSES TO AIDS.”
The headline announced two potentially important pieces of news: A new strain had been encountered that was resistant to most (but not all) of the medications used to treat HIV, and the new strain appeared to turn into full-blown AIDS much more quickly than HIV usually does. What wasn’t clear yet (and still isn’t) was whether the new strain was spreading. The health department recommended three precautionary actions, each aimed at a different target audience:
- First, in “a wake up call to men who have sex with men,” Commissioner Thomas Frieden pointed out that the gay community had successfully reduced its risk of AIDS in the 1980s, and called for the gay community to do so again now in the face of this new risk. Frieden also stressed the increasing rates of other sexually transmitted diseases, plus the dangerous new practice of unprotected sex during crystal meth parties.
- Second, the commissioner called on city doctors to increase HIV counseling, HIV testing, drug susceptibility testing, and partner notification.
- Third, he exhorted the public health community to improve both HIV treatment and drug resistance monitoring, and to improve prevention strategies.
Some of Frieden’s recommendations were unchanged from previous communications about HIV; he was simply tacking a new news peg onto old advice. But there were genuinely new reasons for added caution. Furthermore, Frieden’s calls for doctors to do more drug susceptibility testing and for public health clinics to do more drug resistance monitoring were specifically geared to the new threat. In terms of our two criteria – Will an early warning be useful? Will delay do damage? – the answers were yes and yes. If the new strain turned out to be spreading, the warning could save lives, and delay could cost lives. Whether the new strain was spreading or not, the warning could build trust, and delay could cost trust. By these standards, at least, going public was a no-brainer.
Yet Frieden probably expected some criticism. In an unusual feature, very much in line with gold-standard risk communication guidelines, the news release included quotations from nine “local influentials” – medical and community leaders from such groups as the Gay Men’s Health Crisis, Gay Men of African Descent, Cornell and Columbia Universities, and a local community health center. In this way, the health department “borrowed credibility” from outside leaders – a particularly important strategy for target audiences that may trust these outside leaders more than they trust the government.
The announcement produced both approval and outrage. The outrage took two main forms, worth analyzing in order to help public officials grapple with the ever-recurring question of when to inform the public. Some (mostly AIDS activists) accused the health department of promoting stereotypes of sex-crazed gays, and of trying to scare gay men into having safe sex. And some (mostly scientists) argued that the New York City announcement was either premature or old news or both, that it was irresponsible to go public before more was known. (Members of both outraged groups also raised questions about whether the health department had a conflict of interest with the lab that had identified the new HIV strain.)
The Community HIV/AIDS Mobilization Project, for example, worried aloud about the risk of stigmatizing gay men as “crazed drug addicts, carelessly or wantonly spreading a killer bug.” But the only such references that we could find in the mainstream press came from gay activist groups themselves. Phrases like “super-strain” or “killer bug” or “crazy drug-addled gays” appeared nowhere in the New York City announcement.
Those who disapproved of homosexuality did use the New York City announcement as new ammunition for their old pet projects. William F. Buckley brought up mandatory contact tracing as an epidemiological concept whose time had come again (“Killers at Large: AIDS carriers and their victims,” The National Review, February 19, 2005). Buckley also exhumed his once-famous 1986 proposal for “a discreet tattoo” for HIV carriers. On extremist homophobic blogs and bulletin boards, the new AIDS case was used by writers who wanted to express, for the thousandth time, their disgust (and continued preoccupation) with homosexual practices. But did the New York City announcement significantly increase the quantity or nastiness of anti-gay propaganda? Not that we can tell.
Some gay groups criticized Frieden’s announcement as an unduly alarmist scare tactic that would not work. “It felt like they were trying to scare people into safe activities, but fear is not always a lasting or effective public health strategy,” Terje Anderson, executive director of the National Association of People with AIDS, told HoustonVoice.com. Anderson is right about “lasting,” but wrong about “effective.” The literature on fear as a strategy of persuasion says that scaring people is usually among the most effective ways to talk them into taking precautions. But then we become resistant to the fear appeal, just as viruses like HIV become resistant to an antiviral medication. A new fear appeal, like a new medication, works anew for a while, until the resistance builds against that one too. There is no magic bullet that keeps working forever.
While some activists attacked New York City’s decision to “inform early” as giving aid and comfort to anti-gay stereotypes or as trying to scare gays into changing their sexual behavior, criticisms from the scientific community tended to focus more on whether the news was certain enough, important enough, or new enough to justify such an early announcement.
Shortly after the initial news release, Newsday reported that “Dr. Robert Gallo, a leading AIDS virologist at the University of Maryland, said city officials jumped the gun when they announced that an unidentified man had contracted the 3-DCR HIV strain…. Just one case, Gallo said, was not enough to warrant a public health alert.” Similarly, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a leading AIDS expert, told the Los Angeles Times: “I’m not ready to call this a super-bug…. Show me 10 people that have this, and then I will say, ‘Whoa, we’ve got a problem here.’” But as the World Health Organization’s Outbreak Communication Guidelines point out, sometimes “even one case, such as an Ebola report, can justify early announcements.”
Other experts said the announcement was inappropriate because the situation was not new; there had been similar cases before. “This is a nonstory…. There have been many cases of rapid [HIV] progression,” Paul Volberding, director of the Center for AIDS Research at the University of California, told The New York Times. As for multiple disease resistance, that too is nothing new, and becoming predictably more common as the HIV virus gets used to the drugs used to fight it. Several experts cited the published 2001 cases of two Canadian men with both problems – highly drug-resistant HIV that was also progressing rapidly – in support of the “nothing is new” rationale for not announcing the New York case so quickly. But the author of those case studies, Julio Montaner, told the Washington Post that the cases were not directly comparable. The New York case, he said, was “more florid, with more resistance, and the patient more sick” than his cases.
Among the many things that New York City health authorities didn’t know yet, the most important was whether their one case was the tip of an iceberg or an isolated incident. The patient had apparently had sexual contact with hundreds of others, including many who were anonymous and unreachable. Did the patient get the new virus from one of these contacts? Did he spread it to others? Contact tracing and follow-up medical tests of those who could be found would take months. (As we write, these efforts are still ongoing.) Many experts jumped on all the uncertainties as reasons the announcement should have been delayed. Many also accused New York City health officials of jumping to premature conclusions – entirely failing to notice how often and how emphatically those officials acknowledged the uncertainty of their very preliminary findings.
Why did uncertainty seem such a compelling reason to withhold information about a potentially serious risk? Precisely because it was information that people could see as potentially serious – that is, information that could frighten people.
On the Web, Salon reported (with no data whatsoever) that the health department announcement set off “a pandemic of fear.” Like many other news stories, the Salon report put the phrases “super bug” and “super strain” in quotes, without saying who was being quoted. It certainly wasn’t the New York City Department of Health and Mental Hygiene, which never used these phrases. Like the fearful language, the fear itself was unsourced.
The New York Times quoted Project Inform, a group that educates the public about AIDS, as saying the early announcement was “unnecessarily alarming to the public.” “Unnecessarily alarming” is an interesting phrase. Certainly the news was alarming, especially to those practicing unprotected sex. Will the alarm turn out to have been unnecessary? That is a question for later; the answer depends on whether the patient’s drug-resistant HIV strain is isolated or starting to spread, a question that is still unanswered. Project Inform implies that until that question is answered, the news should be suppressed.
The founding director of Project Inform, Martin Delaney, told Agence France Presse: “Those who practice good science would have waited. They would have shared and discussed the data with scientific peers and then – most importantly – they would have gone back to the labs and followed up on the patient for another six months before drawing any hard conclusions…. Let’s not freak people out with stories of a superbug. We’re all freaked out enough, thank you, by HIV itself.” Delaney told The New York Times: “By pushing this out early, the public health department set off panic nationwide.”
Delaney’s “another six months” is time for an awful lot of exposures to HIV. We asked him if he genuinely thought people were “freaked out” and panicking because of the early announcement.
He replied:
The “panic” I have observed includes the following:
I have been contacted by excited reporters and worried community groups from more than a dozen cities.
In several cities, public meetings are being held, some as early as this week, to address the concern and controversy this has set off in gay urban centers.
Right wing talk radio [has] devoted many hours to this over a period of days, stirring up the public with renewed discussions of quarantine, refusal of insurance … and generalized attacks on what they describe as a promiscuous, sex crazed and drug addled community….
I have received calls from … freaked out [international] reporters asking how people can protect themselves from the fierce new virus.
I could go on, but I think these examples make my point.
Nothing Delaney cites looks like panic to us. It is certainly true that some gay-bashers seized on this latest excuse for gay-bashing. And we hope it’s true that some gays – and straights, and needle-users – were alarmed enough to rethink their views on AIDS prevention, perhaps even to change their behavior while awaiting further news about the new HIV strain. That’s just what the health commissioner envisioned: a wake-up call. (Other gays, of course, were already taking appropriate precautions and had little practical use for an additional reason to do so.)
New York Mayor Michael Bloomberg responded to the critics with this unanswerable rebuttal: “The truth of the matter is we have, first and foremost, a responsibility to educate the public as to what they can do to save their lives…. And we’d be derelict in our duty if we did not.” (New York Daily News, February 15, 2005)
Associate Commissioner Sandra Mullin, the health department’s top communicator, told us later that day: “First time in my career that I’ve experienced criticism … for being too early and, as you know, it feels much more comfortable than the other way around!”
Ameliorating Outrage at Early Announcements
Outrage is pretty reliably lower when risk information is announced early than when it’s withheld for too long. But as the New York City case study shows, early announcement has its own problems. How can those problems be ameliorated? What else could New York City’s health department have done? From a 20-20 hindsight vantage point, here are some recommendations.
The health department might have “shared the dilemma” about announcing scary news based on just one case. It might even have acknowledged (if it was so) that the decision to go public wasn’t unanimous. All this was possible even in that first press release – something like this:
We anguished over whether to announce this so quickly after evaluating just one patient’s shocking history and lab results. There were some scientists and policy officials who wanted to wait until we had more information, and who worried about scaring people prematurely.
But on balance, most of us felt a responsibility to let the at-risk population know as quickly as possible, and to inform the medical and public health professions about possible implications for their practice. If we had tried to tell professionals without telling the public, inevitably that would have come out – and we would have been rightly criticized for failing to trust people with the truth. This is the truth, as we see it: There are people who might become HIV-positive between the time we first learned that this new strain exists and the time we learn whether it is just a single case or more widespread than that. Those people deserve to know as much as we know, and they deserve to know it now.
- The health department might have gone even further in the direction of dilemma-sharing by offering its Day One podium to some critics of its decision to make the announcement so soon. The public was going to hear these criticisms anyway. Putting them under the umbrella of the health department would have demonstrated, and shared, the robust debate that responsible governments go through in advance of hard decisions. Much of what people like Robert Gallo and Martin Delaney were soon telling the media could productively have been included in the health department’s own communications, including that first news release.
The health department might have talked more about the history of AIDS activism. When the scourge of AIDS first appeared, public health officials hesitated too long to sound the alarm. Gays figured out more quickly than many officials that “Silence = Death” – as the famous 1987 purple poster proclaimed. Some early versions of the Silence is Death message included these words: “Turn anger, fear, grief into action.” It is hard to come up with better risk communication advice than that.
Early on in AIDS, while officials dawdled (largely out of a fear of frightening people), activists did not try to suppress anger and fear – they harnessed it. With humility, the New York City health department could honestly have said that it had learned this lesson. We don’t know the politics of HIV well enough to know whether “Silence is Death” could have been invoked in New York’s February 11 news release. But early in the controversy, that tragic and instructive history deserved an echo.
The health department might have acknowledged much more aggressively both the ways in which the news was old and the ways in which the news was uncertain and might turn out to be a false alarm.
The news was old insofar as drug-resistant HIV has long been a problem everyone worries about. Resistance to multiple drugs combined with fast progression to AIDS compounds the problem. The New York case was a genuinely new development (as far as New York authorities were aware), but not a totally unexpected or unprecedented one.
As for the possibility of a false alarm, New York City’s announcement was very clear that health authorities had only one case so far. But the health department could have used a paragraph like this:
It will take months of work, and some luck, before we can trace enough of our one patient’s sexual contacts to determine whether this new drug-resistant, fast-acting strain of HIV has begun to spread. If it turns out to be an isolated case, then today’s announcement will be, in hindsight, a false alarm. Of course the threat of drug-resistant AIDS and the risks of unprotected sex are as serious as they have always been. What we don’t know yet is whether they are more serious than they have always been.
The health department might have tried to talk more about stigma. This is a very difficult issue, as New York City officials have learned after 9/11, during SARS, and many other times. One appalling but predictable result of nearly every high-profile HIV-prevention campaign is a brief boomlet in anti-gay rhetoric. Not that such campaigns create new anti-gay feelings or beliefs; they don’t. But they do give homophobes and those who cater to homophobes something new to talk about.
The health department did not say anything remotely anti-gay, nor was it accused of doing so. But it was accused, accurately, of providing new ammunition for gay-bashers. It might have helped for the department to say something like this:
Throughout the AIDS epidemic, some people have always seized on new medical information as an excuse for gay-bashing. Hateful speech is always hurtful. And hateful speech against gays is off-target when it comes to AIDS. Many gays practice safe sex, and most avoid dangerous drugs. Many heterosexuals also act in ways that endanger themselves and others through unsafe sex and drug abuse. Our goal is to prevent disease, not to pass judgment on anyone’s sexual orientation. We will not allow professional haters – or those who fear them – to stop our efforts to keep all New Yorkers as well-informed and as safe as possible.
The health department might have been more candid about the issue of trying to scare gay people into having safe sex.
This too is a tough issue. Many institutions are unconflicted about using fear to motivate behavior change. Parents try to scare their kids into not playing with matches or running into the street. Preachers try to scare their flock into avoiding hellfire by obeying moral strictures. Environmental groups try to scare us all into polluting less. And, of course, public health officials try to scare the public into protecting their health: exercising, eating right, getting vaccinations, not smoking … and practicing safe sex. It would be unconscionable not to do so! Though fear appeals don’t always work, they are among the most powerful tools of persuasive risk communication.
But for reasons we don’t entirely understand, public health officials are likelier than parents, preachers, and environmental groups to disavow their use of fear appeals. What we call “fear of fear” sometimes actually deters officials from issuing warnings that could save lives – or, more frequently, fear of fear leads to timid warnings lacking in drama. For two discussions of this important phenomenon, see Fear of Fear: The Role of Fear in Preparedness … and Why It Terrifies Officials and Worst Case Scenarios. For a very hot current example, see Pandemic Influenza Risk Communication: The Teachable Moment.
We wish the New York City Department of Health and Mental Hygiene had issued even more dramatic fear-provoking messages than it did. But that would have been asking a lot. Aside from the nearly universal official “fear of fear,” many gay leaders are at least ambivalent, if not actively hostile, when official sources target gays with fear appeals. (Some are okay with it; the issue is sometimes polarizing within the diverse gay community.) Health departments rightly want to work with gay leaders, not against them. On balance, the health department’s communications were as scary as could be expected.
What could the department have said when it was accused of trying to scare gays into safer sexual practices?
Uncertain though it is, this news is genuinely scary. We do want people to see some sexual practices as very dangerous right now.
We feel bad that the news is so frightening for a lot of you. It is frightening for many people we know and love, too. We can’t think how to tell you scary news without scaring you. Our purpose isn’t just fear for the sake of fear. Our purpose is to grab your attention about this possible new strain of HIV, and remind you over and over about prevention and treatment.
People are resilient. New York’s gay community has coped with many frightening moments in the past few decades. We believe New York’s gays will cope with this one too. Gay people will make their own decisions about whether and how to alter their behavior while waiting to learn more about the new strain. Our job is to give them the unvarnished frightening truth as we discover it, trusting that they can bear it and use it to guide their personal decisions.
Conclusion
Hippocrates’ first aphorism begins: “Life is short, the art long.” When it comes to life-and-death issues regarding AIDS, there is no time to be absolutely certain before making recommendations. The time for safer sex is now; further research is not needed. New York City officials trusted their hardy public to bear the frightening uncertainties about the possible new HIV strain. And despite the outcry from some scientists and AIDS activists, we have been unable to document a single episode of panic or irrational behavior resulting from the early announcement.
Hippocrates had never heard of risk communication, but his first aphorism continues: “The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.” In other words, the physician must communicate with key target audiences about the risk. And Hippocrates’ risk communication goal is not just to inform; it is to persuade those target audience to take reasonable protective action, even in the face of clearly identified uncertainty.
When it comes to Sudan 1, the U.K. government’s delayed announcement about a possibly carcinogenic food additive had little if any health impact on the British public. In terms of our first criterion for informing early – will an early warning be useful? – arguably the answer is no. There wasn’t much people could have done (except trying to avoid manufactured foods altogether) before the list of affected foods was available. But the second criterion – will delay do damage? – makes the Sudan 1 decision clearly unwise. Starting in 1986, the U.K. government embargoed early information about mad cow disease. In 1990, it confidently and repeatedly asserted that the disease could not spread to humans. Ever since that reassurance turned out false, the British public has wondered what other health risks its government might be hiding or minimizing. This suspicion – reinforced yet again by the Sudan 1 delay – undermines public confidence in government officials, which in turn undermines the officials’ ability to lead when a genuine crisis comes along.
In New York City, people have far less reason to wonder if their government is hiding or minimizing scary information. And in New York City, people were given enough information to make their own decisions about whether and how to protect themselves from the new strain of HIV.
Copyright © 2005 by Peter M. Sandman and Jody Lanard
