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1、Unit 6 RisksRisks and YouAt some time or other, all of us have played the part of a hypochondriac, imagining that we have some terrible disease on the strength of very minor symptoms. Some people just have to hear about a new disease and they begin checking themselves to see if they may be suffering
2、 from it. But fear of disease is not our only fear, and neither is risk of disease the only risk we run. Modern life is full of all manner of threats-to our lives, our peace of mind, our families, and our future. And from these threats come questions that we must pose to ourselves: Is the food I buy
3、 safe? Are toys for my children likely to hurt them? Should my family avoid smoked meats? Am I likely to be robbed on vacations? Our uncertainties multiply indefinitely. Anxiety about the risks of life is a bit like hypochondria; in both, the fear or anxiety feeds on partial information. But one sha
4、rp difference exists between the two. The hypochondriac can usually turn to a physician to get a definitive clarification of the situation-either you have the suspected disease or you dont. It is much more difficult when anxiety about other forms of risk is concerned, because with many risks, the si
5、tuation is not as simple. Risks are almost always a matter of probability rather than certainty. You may ask, Should I wear a seat belt? If you re going to have a head-on collision, of course. But what if you get hit from the side and end up trapped inside the vehicle, unable to escape because of a
6、damaged seat belt mechanism? So does this mean that you should spend the extra money for an air bag? Again, in head-on collisions, it may well save your life. But what if the bag accidentally inflates while you are driving down the highway, thus causing an accident that would never have occurred oth
7、erwise? All of this is another way of saying that nothing we do is completely safe. There are risks, often potentially serious ones, associated with every hobby we have, every job we take, every food we eat-in other words, with every action. But the fact that there are risks associated with everythi
8、ng we are going to do does not, or should not, reduce us to trembling neurotics. Some actions are riskier than others. The point is to inform ourselves about the relevant risks and then act accordingly. For example, larger cars are generally safer than small ones in collisions. But how much safer? T
9、he answer is that you are roughly twice as likely to die in a serious crash in a small car than in a large one. Yet larger cars generally cost more than small ones (and also use more gas, thus increasing the environmental risks!), so how do we decide when the reduced risks are worth the added costs?
10、 The ultimate risk avoider might, for instance, buy a tank or an armored car, thus minimizing the risk of death or injury in a collision. But is the added cost and inconvenience worth the difference in price, even supposing you could afford it? We cannot begin to answer such questions until we have
11、a feel for the level of risks in question. So how do we measure the level of a risk? Some people seem to think that the answer is a simple number. We know, for instance, that about 25,000 people per year die in automobile accidents. By contrast, only about 300 die per year in mine accidents and disa
12、sters. Does that mean that riding in a car is much riskier than mining? Not necessarily. The fact is that some 200 million Americans regularly ride in automobiles in the United States every year; perhaps 700,000 are involved in mining. The relevant figure that we need to assess a risk is a ratio or
13、fraction. The numerator of the fraction tells us how many people were killed or harmed as the result of a particular activity over a certain period of time; the denominator tells us how many people were involved in that activity during that time. All risk levels are thus ratios or fractions, with va
14、lues between 0 (no risk) and 1 (totally risky). By reducing all risks to ratios or fractions of this sort, we can begin to compare different sorts of risks-like mining versus riding in a car. The larger this ratio, that is, the closer it is to 1, the riskier the activity in question. In the case jus
15、t discussed, we would find the relative safety of car travel and coal mining by dividing the numbers of lives lost in each by the number of people participating in each. Here, it is clear that the riskiness of traveling by car is about 1 death per 10,000 passengers; with mining, the risk level is ab
16、out 4 deaths per 10,000 miners. So although far more people are killed in car accidents than in mining, the latter turns out to be four times riskier than the former. Those ratios enable us to compare the risks of activities or situations as different as apples and oranges. If you are opposed to ris
17、ks, you will want to choose your activities by focusing on the small-ratio exposures. If you are reckless, then you are not likely to be afraid of higher ratios unless they get uncomfortably large. Once we understand that risk can never be totally eliminated from any situation and that, therefore, n
18、othing is completely safe, we will then see that the issue is not one of avoiding risks altogether but rather one of managing risks in a sensible way. Risk management requires two things: common sense and information about the character and degree of the risks we may be running. 风险与你1 在说不定的某个时候，我们大家
19、都曾充当过疑病症患者的角色,只凭一些轻微的症状便怀疑自己得了某种可怕的病。有的人只要一听说一种新的疾病，就会去检查，看自己是否可能患了这种病。然而，对疾病的恐惧并非我们唯一的恐惧。同样，患病的危险也并非我们唯一会遇上的危险。现代生活中充满了各种各样的威胁，诸如对我们生命的威胁，对我们平和心境的威胁，对我们家人的威胁，对我们未来的威胁。从而产生了好些问题，我们不得不问自己：我买的食品安全吗？给孩子们的玩具会伤害他们吗？我们家的人是不是不该吃熏肉？我度假时会不会遭抢劫？我们的疑虑就无休止地增加。2 对生活中风险的担忧与疑病症有相似之处；二者的恐惧或忧虑皆起因于信息不全面。但二者之间也存在一个明显的
20、差别。疑病症患者通常可以求助于医生，以便澄清疑虑要么你得了你所怀疑的疾病，要么你没得。但当涉及到其它形式的风险时，事情就要困难得多，因为对许多风险来说，情况并不那么简单。3 风险几乎总是一个可能性的问题而无确定性可言。你也许会问：“我该不该系安全带？”如果你坐的车要与其它车正面相撞，那当然该系安全带。倘若你的车侧面被撞，结果你被困在车里，又因安全带装置遭破坏而无法挣脱，那怎么办呢？这是否意味着你该再花些钱在车内安一个保险气袋呢？同样，在正面相撞的情况下，保险气袋完全可以救你一命。但是，万一正当你在高速公路上开车时，保险气袋突然意外充气膨胀，从而导致了本来绝不会发生的事故，那又该如何是好？4 上
21、面说的这一切，只是从另一角度说明我们所做的事没有一件是百分之百安全的。有些风险常常是潜在的重大风险与我们的每个业余爱好、所做的每项工作、所吃的每种食物有关，换句话说，与所进行的任何活动有关。但我们又不能，也不该因危险存在于我们将要做的每件事，而变成战战兢兢的神经症患者。有些活动是比其它活动更危险。关键在于要让自己了解相应的风险，然后相机行事。5 例如，两车相撞时，大车总的说来要比小车安全些。可究竟能安全多少呢？答案是这样：在一起严重的车祸中坐小车丧生的可能性是坐大车的两倍左右。然而，大车通常比小车贵（并且消耗更多的汽油，由此给环境带来了更大的风险！）。那么我们该怎样确定什么时候值得为降低风险增
22、加花费呢？例如，避免风险最保险的做法也许是去买一辆坦克或装甲车，从而把撞车时死亡或受伤的风险降到最小。然而，即便你买得起，这笔额外的费用以及忍受坦克或装甲车所带来的不便是否值得呢？6 在我们尚不知所涉及的风险程度之前，我们还无法回答这些问题。那么，我们该如何去衡量风险程度呢？有些人似乎认为答案只不过是一个简单的数字。例如，我们知道每年大约有25,000 人死于车祸。相比之下，每年只有大约300人死于矿山事故和灾难。这难道就意味着乘坐汽车要比采矿危险得多吗？未必。事实是，在美国每年大约有两亿人经常性地以车代步；而大概只有70万人从事采矿作业。我们评估一种风险时，所需要的有关数字是一个比率或分数。
23、该分数的分子告诉我们在某个特定时期由于从事某种特定活动而丧生或受伤的人数；其分母告诉我们在这一时期从事这种活动的总人数。这样，所有的风险程度都是由比率或分数表示，其大小介于0（无风险）到1（完全风险）之间。7 通过把所有风险都简化为这种比率或分数，我们便可以开始比较不同种类的风险，如比较采矿与乘坐汽车。这个比率越大，也就是说它越接近1，那么有关活动的风险就越大。在刚才讨论的例子中，我们可以用每一活动中死亡的人数除以参与该活动的总人数，从而找出汽车旅行与采煤的相对安全性。此处，我们可以很清楚地看到，乘坐汽车旅行的风险是每一万人中大约有一人丧生；而就采矿而言，其危险程度是每一万矿工中大约有四人死亡
24、。所以，尽管在车祸中丧生的人远比采矿要多，其实后者的风险是前者的四倍。这些比率使我们能够对毫不相干的活动或情形的危险性加以比较，即便差别如苹果与橘子那样大也能比较。如果你反对冒险，你就会选择风险比率较小的活动。如果你无所畏惧，那么你往往会对高比率不太在乎，除非它们大得令人难以承受。8 我们一旦明白了风险是永远无法从任何情况中完全去除的，因而就没有绝对安全的事，我们也就会明白问题的关键不是要彻底避免风险，而是要理智地管理风险。风险管理需要两大要素：常识以及与我们可能要承担的风险的性质和程度相关的信息。Health RisksOpinion polls repeatedly tell us tha
25、t the only thing Americans worry about more than the environment is their health. This is entirely understandable, for health is obviously preferable to illness. What makes todays preoccupation with health slightly surprising is that Americans are far healthier now than they have ever been. Many dis
26、eases that once struck terror into hearts have either been completely eliminated or brought under control. Although AIDS is a notable exception, few new mass killers have come along to replace the ones that have been eliminated. Nonetheless, healthand the various threats to itremains everyones perma
27、nent concern. After all, more than half of us (57 percent) will die from either heart disease or cancer, if current trends continue. One major problem with any comparison of health risksespecially life-threatening onesis that they differ enormously in their immediacy. For instance, AIDSif you get it
28、will probably be fatal after a number of years. Cancer induced by smoking or exposure to radiation, on the other hand, may take 20 to 30 years before its catastrophic effects show up. In making choices about health risks, therefore, it is important to bear in mind the likely time lag between taking
29、a risk and suffering its consequences. Those with a mind to live for today are apt to be indifferent to health risks that have a very long incubation period. Although this is short-sighted, it does make sense to discount long-term risks more than short-term ones. After all, when virtually any of us
30、is confronted with the choice of doing something likely to kill us today versus doing something likely to kill us in two decades, the choice is going to be the lesser of the two evils. One commonly used measure to deal with such problems is a concept called years of potential life lost (YPLL). The i
31、dea is that for a 25-year-old, doing something that will kill him in 5 years is much more costly than doing something that will kill him in 40 years. Both may involve the same element of riskthe same probability of eventually dying from that activitybut a risk that may cause immediate damage is much
32、 more costly than one for which the piper neednt be paid for a long time. In the first case, he will have his normal life span cut short by about 45 years; in the latter case, the deficit is about 5 years. Thinking about matters in this light inevitably causes a reassessment of many of the threats t
33、o health. For instance, heart disease is the single largest killer of Americans, way in front of cancer or strokes. However, heart disease tends to strike the elderly in much greater proportions than younger people. Cancer, by contrast, kills fewer people but tends to strike somewhat earlier than he
34、art disease. Hence, more YPLLs are lost to cancer than to heart diseasedespite the greater incidence of fatal heart cases. Specifically, cancers claim about 25 percent more YPLLs than heart disease (if we define the YPLL as a year of life lost before age 65). The concept of YPLLs has an important, i
35、f controversial, influence on issues in health care economics. It is frequently argued that money devoted to medical research on curing diseases should be divided up on the basis of the number of lives lost to each disease. Thus, some critics of the massive levels of funding devoted to AIDS research
36、 claim thatcompared to killers such as heart disease and cancerAIDS receives a disproportionately high support. That criticism fails to consider the fact that AIDS, by virtue of striking people principally in their 20s and 30s, generates far more YPLLs than the bare figure of 20,000 deaths per year,
37、 bad as that is, might suggest. 10 Put differently, finding a cure for AIDS would be likely to add about 25 to 30 years to the life of each potential victim. Finding a cure for heart disease, although it might save far more lives, would probably add only another 5 to 10 years to the life of its aver
38、age victim. The assessment of the seriousness of a risk changes, depending upon whether we ask how many lives it claims or how many YPLLs it involves. Some of the differences are quite striking. For instance, accidental deaths appear relatively insignificant compared to cancer and heart disease when
39、 we just count the deaths caused. But once we look at the number of lost years, accidents loom into first place among the killers of Americans. These data show that we need to ask not only how large a risk is but also when it becomes payable. Other things being equal, the sooner a risk causes damage
40、 or death, the more that risk is to be avoided. 健康威胁1民意调查一再告诉我们，美国人最为担心的就是他们的健康，其次才是环境问题。这是完全可以理解的，因为身体健康显然比生病要好。美国人现在对健康如此关注，是有点令人吃惊，因为他们目前比以往任何时候都要健康得多。许多曾令人恐惧的疾病现在或者已经彻底根除，或者已得到控制。尽管艾滋病是个显著的例外，但是现在几乎没有什么新的能置许多人于死地的疾病出现，以取代那些已被根除的疾病。2然而，健康以及对健康的各种威胁，仍然是人们永久关注的问题。毕竟，如果目前的趋势无法制止的话，我们中将有不止一半(57)的人将死于
41、心脏病或是癌症。3将威胁健康的危险，特别是致命的危险，进行比较时，有一个主要的问题，就是这些危险的紧迫性有很大差异。例如艾滋病，如果你染上的话，很可能几年后就死亡。然而，由吸烟或辐射诱发的癌症，也许要经过20至30年的时间其灾难性的后果才会出现。因此，在对健康的各种危险做出选择时，务必要考虑进行冒险与承受其后果之间的时间间隔。4那些一心要“今朝有酒今朝醉”的人们，往往对潜伏期较长的危害不放在心上。尽管这是一种目光短浅的行为，但不理会滞后期长的危险，重视近期危险还是有道理的。毕竟，如果我们真的面临选择，是去做今天就可能使我们丧命的事，还是去做20年后才可能使我们丧命的事，我们往往会两害相比取其轻
42、。5对待这类问题有种常用的计算方法，就是考虑可能少活的年数(YPLL)。其意思是，对一个25岁的人来说，去做一件使自己五年后丧生的事要比做一佴：40年后丧生的事“代价高昂”得多。二者同样都具有危险因素即最终因从事某事而导致死亡的可能性相同但是，会马上引起伤害的危险，要比一个很长时间不需付出代价的危险要昂贵得多。在第一种情形下，他的正常寿命减少了约45年，而在第二种情形下，减少了约5年。从这种角度看问题必然会对威胁健康的许多因素进行重新评估。例如，心脏病是夺去美国人性命的头号杀手，远远超过癌症或中风。然而，老年人患心脏病的比例大大超出了年轻人。相比之下，癌症的死亡人数虽然要少于心脏病的死亡人数，
43、但患癌症的人群比较年轻。所以，尽管心脏病死亡率要大，但癌症损失的YPIfI要比心脏病多。具体来讲，与心脏病相比，癌症让人大约多损失了25的YPLL(如果我们将YPI_L定义为65岁以前寿命缩短的年头)。6 YPLL这一概念，尽管人们对它还有争议，却对保健经济学有着重要影响。人们经常争辩说，用于医学研究攻克疾病的资金应该按每种疾病死亡人数的多少来分配。因此，一些人士抨击将大量资金用于艾滋病研究。他们认为与其他致命的疾病如心脏病和癌症相比，艾滋病得到了不成比例的高额资助。该批评没有考虑到这样一个事实：由于艾滋病的主要受害者为二三十岁的年轻人，尽管每年只造成20，000人死亡该数字本身也不小了但是艾
44、滋病引起的YPLL要大得多，远比简单的死亡人数更值得我们重视。换句话说，找到治疗艾滋病的方法，将可能增加每位潜在的艾滋病患者25至30年的寿命。找到治疗心脏病的方法，虽然可能拯救更多人的生命，但对每位受害者来说只能增加平均5到10年的寿命。7对一种危险的严重程度的估算会有差异，这要看我们是关注它所引起的死亡人数还是它所导致的YPLL的多少。有些差异很令人吃惊。比如，如果我们只算引起的死亡人数的话，与癌症和心脏病相比，意外死亡就显得无足轻重。然而，一旦我们关注所损失的YPLL，意外事故却赫然位居美国杀手榜的榜首。这些数据显示，我们不仅要探究危险程度的大小，而且要探究危险什么时候要我们付出代价。在
45、其他因素都相等的情况下，危险所导致的损害或死亡来得越快，人们就越应该回避这种危险。Risks from Nature and TechnologyWe live in an age when natural has come to mean benign and anything made by humans seems both artificial and suspect. But actually the natural and the benign are not necessarily the same thing. Nature does a lot of nasty things
46、 to us. Floods, storms, earthquakes, hurricanes, volcanoes, and tornadoes are just the tip of the iceberg. Most diseases are natural. Many naturally occurring substances are poisonous. The single largest source of cancer-producing radiation is radon gas, a byproduct of the decay of radioactive eleme
47、nts in the earths crust. Other sources of cancer-causing radiation are cosmic rays and ordinary sunlight. Indeed, death itself is natural. If we have been able to prolong life beyond its traditional span of seventy years, that is because we have been clever enough to contrive ways of delaying the de
48、cay, disease, and destruction that is inflicted on us by nature. Think about it another way. All plants, including those we eat, contain many naturally occurring pesticides. They have evolved these toxicin many cases, carcinogenicdefenses against insects and other predators over millions of years. I
49、t has been estimated that we consume 10,000 times as many natural pesticides as artificial ones. In other words, nature is not benign. Other numbers prove this even more convincingly. It is a widely used rule of thumb among risk specialists that, in any given year, about 30 times as many people will die in natural disasters as in manmade ones. In addition to natural catastrophes, there are still plenty of ways in which our technological society poses major t