2012 Guestbook
Comments and Responses

name:	Ron This guestbook entry is categorized as:
field:	Communications executive
date:	May 9, 2012
location:	Canada

comment:

Pipeline companies used to be boring, regulated utilities that diligently proposed projects, walked them through the regulatory process, and got them approved without much fanfare. But these days Canadian pipeline projects such as the Northern Gateway to Prince Rupert, an expansion of the Transmountain pipeline from Alberta to Vancouver, and the Keystone XL pipeline from Canada into the U.S. have been the center of major public activist campaigns because of their connection to the “tar sands” industry, the source of heavy oil that is sometimes called “the most toxic substance on earth.”

There has been much talk about how foreign foundations such as the Tides Foundation and the Pew Charitable Trust, among others, have been funneling hundreds of millions of dollars into Canadian ENGOs to fund major anti-oilsands and anti-pipeline campaigns without having to disclose the sources of their funding. Canadian politicians and right-wing journalists have claimed that this foreign money is being used to unfairly influence our country’s business, and what looks like a huge grassroots movement is really a carefully orchestrated obstructionist campaign.

Some commentators even claim that U.S. vested interests, which stand to gain from slowing the development of Canada’s oilsands industry, are using the invisibility cloak available to anonymous donors to big foundations to exert huge influence on our political and regulatory systems. The most radical critics have said this amounts to a long-term, covert propaganda campaign that has used misinformation to turn the public against the Canadian energy industry.

In other words, in the name of conservationism, U.S. big business is spending big money to protect its interests without having to disclose its intent. Some hint that U.S. East Coast refining oligarchies are doing everything they can to prevent a change in the locus of the North American refining and distribution system; others suggest those who have invested big in alternative energy are successfully demonizing their competition.

Peter, here’s my question: If you were a pipeline or oilsands company, what would you do to respond to this? Is there a special category of outrage that is created by vested, undeclared business interests and a specific way to deal with it?

peter responds:

Before responding to your question, I need to acknowledge my prior connection to Vivian Krause, the person who has done the most to reveal U.S. funding of Canadian ENGOs’ anti-oilsands and anti-pipeline campaigns.

In 2006, I received an email from Vivian, then as now a self-employed writer/researcher living in Vancouver. She had run across my website the year before, and had decided that outrage management was crucial to several issues she cared about, especially salmon farming. (She had previously worked in that industry.) Vivian had drafted materials on how the Canadian aquaculture industry and the British Columbia government could better address environmental outrage about farmed salmon, and wondered if I would send her some comments.

I thought her work was wonderful, and a few months later I posted a revised version of her PowerPoint presentation   on this site, where it remains.

Vivian, however, moved on. While she stayed interested in outrage management (a 2010 generic PowerPoint presentation is on her website), she became more interested in investigative reporting, digging up a great deal of information on how U.S. foundations were funding ENGO campaigns to “demarket” Canadian farmed salmon, thereby greatly benefiting the Alaskan salmon fishing industry. She was also critical of some of the technical content of those campaigns, but what most interested third parties was her evidence about funding.

More recently, she has applied the same focus to U.S. funding of Canadian opposition to oilsands and oilsands-related pipelines. And she’s gotten a lot of attention. The issue has taken off in Canada’s mainstream media, and has been pushed hard by some supporters of oilsands and pipeline development. Vivian is still in the middle of the maelstrom, but these days she has lots of allies and lots of critics.

Readers interested in knowing more about Vivian’s work should check out her website.

Sauce for the goose

I see nothing wrong with giving money to organizations and issues you support. And I see nothing wrong with publicizing who gave how much money to which organizations and issues. Of course if the names of contributors aren’t publicly available, they can’t be publicized; in that case, I see nothing wrong with pointing out who stands to benefit from a particular campaign and speculating about whether those who stand to benefit might be funding the campaign.

Both the U.S. and Canada have laws governing who’s allowed to give how much money to whom for what purposes, and whether/when the names of contributors have to be reported or can be kept secret. The pros and cons of restricting contributions are hotly debated, as are the pros and cons of permitting those contributions to be anonymous.

At least one principle should be clear: What’s sauce for the goose is sauce for the gander.

If it’s legitimate for a corporation to contribute to an industry advocacy group, and legitimate for an environmentally concerned citizen to contribute to an ENGO, then it’s legitimate for a corporation to contribute to an ENGO – whether or not the corporation has a business interest in that ENGO’s cause.

And if it’s legitimate to comment on how much money an industry advocacy group spent on a campaign, and who benefited, and where the money came from (or might have come from), then it’s legitimate to comment on the same questions with regard to an ENGO.

As far as I know, there aren’t a lot of legal objections being raised to U.S. foundation support for Canadian ENGO campaigns against oilsands and pipelines (and salmon farming). For the most part, at least, it looks like the U.S. foundations got the money legally and gave the money away legally, and then the Canadian ENGOs spent the money legally.

One exception: In Canada, according to Krause, “the only type of political activity that charities are allowed to engage in are those that further a charitable purpose.” Her investigations have aroused new government interest in whether any Canadian ENGOs that are organized as charities might be crossing the line into partisan political activity that doesn’t qualify as charitable.

Some Canadian ENGOs have complained about the chilling effect of hostile publicity, and implied that since their contributions from the U.S. are legal criticizing them publicly is somehow wrong. I don’t deny that there is a chilling effect. In fact, the chilling effect is the point: Publicly criticizing legal behavior you object to is probably the best way to deter that behavior. It’s also a good way to raise questions about whether the behavior should be made illegal, or whether it might turn out to be illegal already if subjected to tougher regulatory scrutiny. Environmentalists use publicity for these purposes endlessly, effectively, and honorably. The principles are no different when they’re on the receiving end.

In fact, I think there’s a pretty good case to be made that the world especially needs that kind of public criticism of environmentalists, and of public interest causes generally. The decline of the mainstream media has decimated the ranks of investigative reporters; there are plenty of angry rants on the Web, but not so much muckraking journalism. What little investigative reporting still gets done is overwhelmingly focused on governments and corporations. Nonprofits, for the most part, get a free pass.

I have argued elsewhere that insufficient public scrutiny tends to make do-gooders simultaneously dishonest and self-righteous, whether they’re NGOs or NGO-like arms of government. See for example my 2009 speech on the need for nonprofits and public health agencies to “Trust the Public with More of the Truth” and my 2010 Guestbook entry on CDC misrepresentation of swine flu mortality data.

So I’m okay with lots of public discussion in Canada over issues like these:

• How much money U.S. ENGOs have given to Canadian ENGOs, First Nation tribes, and others to support their opposition to oilsands and pipelines.
• Whether all that money distorts the priorities of the Canadian recipients – that is, whether they’re fighting so hard on these issues in large measure because there’s money to subsidize the fight.
• Whether U.S. money should play such a hefty role in the resolution of Canadian controversies.
• Where the U.S. foundations got the money, and whether they’re passing through contributions from U.S. corporations that stand to make or lose huge sums depending on how these Canadian controversies are resolved.

The last question is the most inflammatory and the most speculative. The Machiavellian scenarios are endless. If the Keystone XL pipeline to the U.S. goes through but the Northern Gateway pipeline to British Columbia is defeated, for example, Alberta oil will have a clear path to the U.S. but not to Asia. Without Asian price competition, U.S. purchasers will be able to drive a harder bargain. So if a U.S. ENGO seems more deeply committed to defeating Northern Gateway than Keystone, commentators are entitled to wonder if it might be getting money from U.S. companies that want to buy Canadian oil cheap.

We’re all free to spend our money however we wish, as long as it’s legal. Contributions to NGOs (Canadian or American, pro-industry or anti-industry) may be motivated by intellectual conviction, or by ideology, or by outrage, or by self-interest. All these motives seem respectable to me.

If funding information is publicly available, discussing who funded what and speculating about why is legitimate. If funding information isn’t available, speculating about who might have funded what is also legitimate. If such speculation leads to greater transparency about funding sources, that’s fine by me. And if the speculation and the transparency deter some contributions altogether – if some contributors would rather not give than be suspected or known to have given – I’m okay with that too.

The strategy of arousing “counter-outrage”

So: Vivian Krause and others dig for whatever dirt they can find about who is funding Canadian anti-oilsands and anti-pipeline activist campaigns. And “politicians and rightwing journalists” (as you put it) and other supporters of the oilsands and the pipelines use the dirt to mobilize outrage against the activists.

The battle is symmetrical. It’s legitimate for activists to try to arouse outrage against oilsands and pipelines. It’s obviously just as legitimate for the targeted industries and their supporters to try to arouse outrage – let’s call it “counter-outrage” – against the activists.

It’s legitimate. But is it smart? I don’t think so.

Perhaps I’m underestimating the power of Canadian resentment of the behemoth to the south. Perhaps Canadian citizens with green leanings and grave reservations about Canada’s fossil fuel industry would feel compelled to change sides if only they realized that a lot of the funding for Canada’s ENGOs comes from the U.S. But I doubt it. I haven’t seen many letters-to-the-editor in Canadian newspapers asserting that “I hate oilsands and oil pipelines but I hate meddling American activists more.”

Nearly all the arguments I can find that U.S. funding undermines the legitimacy of Canadian ENGOs come from people who pretty obviously would be against the ENGOs’ position whether they had U.S. funding or not.

In other words, the funding argument might be a good way for oilsands and pipeline proponents to rally supporters. But it’s not a good way to win over those who are undecided or ambivalent. And it’s certainly not a good way reach out to those who are leaning the other way but potentially reachable.

There are moments when building solidarity really is the top-priority goal, when rallying supporters matters so much that alienating neutrals is a price worth paying. At those moments, working to arouse counter-outrage makes sense.

But not usually. In general, I think, what I am calling “counter-outrage” – trying to mobilize outrage against the outrage-purveyors – is not sound strategy. I think public health professionals are making a mistake when they try to mobilize outrage against anti-vaccination activists, for example. And I think oilsands and pipeline companies would be making a mistake to try to mobilize outrage against environmental activists.

It’s fighting on the activists’ turf. In most controversies between activists and industry, the activists own the moral high ground. They’re less wealthy and less profit-driven. They’re more altruistic and more ideological. It’s certainly debatable which value system ends up doing more good – but it’s not really debatable which is the do-gooder value system. When capitalists try voicing moral indignation against do-gooders, they’re fighting an uphill battle.

Similarly, I doubt that a large corporation can sustain a claim that it is the powerless oppressed victim of giant activist groups. I have worked with oil company executives who really feel that way, but I have never seen an oil company successfully convince the public that it’s David and the activists are Goliath.

Questioning the validity of economic ties to the U.S. is also a tough thing for most Canadian corporate executives to do with a straight face. Not all Canadian oil companies are the Canadian arms of U.S.-based multinationals. But nearly all have financial ties to the U.S. that run at least as deep as those of Canadian ENGOs. Do they really want to start a fight over who’s authentically Canadian and who’s a marionette dancing on strings made in the U.S.A.?

Nor are most of my industry clients in a position to criticize anyone else for making or receiving anonymous contributions to advocacy causes.

I might consider recommending a counter-outrage strategy to an industry client that had unequivocal evidence of inarguably dishonorable behavior on the part of an NGO – behavior so offensive it made the worst things the company had ever done, the worst things it was even accused of doing, look benign by comparison. And even then I’d hesitate. The public is quite capable of punishing the NGO for its misbehavior without thinking any better of the company that ratted it out.

If third parties want to raise hell about foreign funding of Canadian environmental groups, Canadian industry shouldn’t try to stop them from raising hell. But it shouldn’t join them in raising hell either.

If asked about the funding issue, I’d pivot on it: “We’ve read the evidence that much of the funding for the environmental groups that oppose us has come from foundations in the U.S. While some of our supporters may be outraged at this foreign funding, we think it’s really a side issue. The main question isn’t the source of their money; it’s the validity of their arguments. Let’s keep the focus on whether what we do is good or bad for Canada and the world.”

Counter-outrage is good for morale. Its internal appeal makes it potentially useful for rousing the troops. But its internal appeal is also dangerously seductive. Playing offense is more fun than playing defense. It’s a relief to be the outraged victim for a change instead of the accused perp. Since companies often feel genuine outrage at their critics, any excuse to voice their outrage is very tempting.

But counter-outrage rarely rings true to the public and rarely wins the day.

Good for Vivian Krause for raising the issue of U.S. foundation funding of Canadian ENGOs. Following the money is always a good idea, whether it’s ENGO money or corporate money. But while the funding issue is legitimate, I believe it is the wrong issue for Canadian oil companies and pipeline companies to emphasize.

Whenever a big company is under attack, it has four strategic options. In order from most to least fruitful, they are:

• Acknowledge and improve
• Defend
• Hide
• Counterattack

Internal morale aside, the most productive approach is almost always to address stakeholder concerns and try to reduce stakeholder outrage: to acknowledge your organization’s prior misbehaviors and current problems, find ways to improve, give your critics credit for the improvements, etc. Defending against the attack is less productive than this acknowledge-and-improve approach. Hiding and hoping the controversy will go away is less productive than defending. And counterattack is least productive of all.

I can’t blame the oilsands and pipeline companies for getting some pleasure out of seeing the ENGOs in hot water for a change. But they would be unwise to pile on.

name:	Frank This guestbook entry is categorized as:
field:	Business school professor
date:	May 9, 2012
location:	Virginia, U.S.

comment:

I’ve been looking for examples of ethical problems I can use in class that I think students will understand and relate to. The controversy over Scott Thompson, CEO of Yahoo, caught my attention.

Thompson was accused by activist shareholder group Third Point of padding his résumé, claiming a bachelor’s degree in computer science that he didn’t actually have, in addition to the accounting degree he did have. The accusation turned out true, and Thompson apologized.

I would be interested in your take on his apology.

For what it’s worth, here’s what I think. Within hours of the Third Point charge he should have issued a statement like this:

First, I want to thank Third Point for identifying an error in our records and calling this problem to my attention. This is an error and it was my fault. I don’t know when this got into my bio, but at some point a number of years ago I suspect I wanted my bio to look better than it did. That was foolish of me. I firmly believe today that what counts is the work you do, not the major on your college diploma.

But it was a mistake and I was responsible. Regardless of my contract I believe a CEO should only serve with the full support of his board of directors and if this error is of material concern to the board then I am prepared to resign. However, I believe the board hired me because of what I have accomplished after college and not because of courses I took in college.

Finally if Third Point is not happy with the way Yahoo is being managed then I suggest this may not be the right company for it to invest in.

What would you have advised Thompson to say?

peter responds:

Usually when my clients need to apologize, they have done something that did actual harm to actual victims. Under those circumstances, the basic steps toward forgiveness are as follows:

1. Admit you did it.
2. Give people a chance to berate you.
3. Say you’re sorry – making sure to express regret, show sympathy for those who were harmed, and above all take responsibility.
4. Explain why it happened – were you stupid, evil, or what?
5. Make it right if you can – compensate your victims and take steps so it won’t happen again.
6. Do a penance, a public humiliation that rubs your nose in your misdeed.

Order matters. People don’t pay much attention to an apology that preempts their need to berate you first. And they don’t respond well to offers of compensation before you have apologized.

The situation here is a little different. Scott Thompson didn’t exactly hurt anybody by padding his résumé, so there’s not much need to make it right (#5), other than correcting his résumé. But he still needs to admit what he did, sit still for the criticism, say he’s sorry, explain why it happened, and do a penance.

Thompson is stuck at step #1. He hasn’t really admitted he did it (intentionally padded his résumé) yet.

The article you cite quotes a memo from Thompson to Yahoo employees:

I want you to know how deeply I regret how this issue has affected the company and all of you…. We have all been working very hard to move the company forward, and this has had the opposite effect. For that, I take full responsibility, and I want to apologize to you.

As the article points out, “Thompson’s memo to Yahoo’s staff included no explanation for how the mistake happened. His apology was solely for the impact the scandal has had on the company, not for the act itself.”

Worse still, Yahoo’s statement, as quoted in the article, claimed it was all an “inadvertent error.” I think any apology that calls Thompson’s résumé-padding an error is a non-apology. I find it impossible to believe that he didn’t know what his degrees were in or that he didn’t know what his résumé said.

Your proposed apology also has this fatal defect.

I have two other problems with your draft:

• It focuses disingenuously on whether Thompson’s lack of a computer science degree affects his job performance. That’s not the issue. The issue is his lack of integrity.
• It starts with a saccharine, insincere thank you to Third Point and ends with a gratuitous swipe at Third Point.

What Thompson should have said depends a good deal on what the truth is. I’d have proposed something like the following (I’m making up some facts as I go along):

Many years ago, trying to look more qualified on paper for jobs I thought I could handle, I added a non-existent computer science degree to my résumé. This wasn’t a mistake. It was a lie.

Often since then I have tried to figure out a way to correct the record. I couldn’t just stop saying I had that degree. I had claimed it too many times already. People would naturally have asked why I wasn’t mentioning it anymore. I would have had to admit the lie, not just stop lying. That’s what I should have done, of course, but I just wasn’t brave enough to do it.

I kept telling myself that it no longer mattered what I studied in college back in the 1980s. My job record was what mattered now. That’s true, of course. But it’s also irrelevant. Nobody is questioning whether Yahoo should have a CEO who doesn’t have a computer science degree. Most people aren’t even questioning whether Yahoo should have a CEO who told a lie when he was a young man. But many are questioning whether Yahoo should have a CEO who lacked the courage and integrity to come clean right up until yesterday when Third Point did it for me.

That’s a fair question, and I’m frankly not sure of the answer. If I decide this means I can’t do my job properly, I will resign. If the Yahoo Board decides this means I can’t do my job properly, it will fire me. Much depends on whether our employees and our customers are prepared to forgive me. Even more depends on whether they are prepared to trust me. If they’re not, I will have no one to blame but myself.

Reactions?

Frank responds:

Frankly I like your version better, but I suspect it requires a degree of candor that a $26 million CEO is unlikely to muster. I guess I was trying to move the marker towards truth and you’re pointing out (fairly) that once you start towards truth you can’t go halfway.

I particularly like your point that the problem was not so much in making the error initially but in figuring out how to get out of it as time passed.

name:	“Avalanche”
field:	Disillusioned change agent
date:	May 4, 2012
location:	Georgia, U.S.

comment:

I’ve been thinking a lot about you these past few days, while listening to some reactionary podcasts, and some economics podcasts, and some “how can we save the country” podcasts.

There’s lots of whining about how soooo many people aren’t voting, have given up on voting, aren’t interested in voting, and how can we “make” people want to vote; and then there’s a whole slew urging people to quit voting because the game is so completely rigged, and it’s merely a shiny distraction for the “children” (i.e., childish Americans) to keep them from paying attention to what’s really going on.

But what keeps coming to mind is your seesaw, and the whole idea of people being frightened into denial. I think many folks (and maybe I’m too generous) have given up; they don't see any way to have any effect, to make any changes, to do anything to save themselves from the fast-approaching cliff edge. The “powers that be” with their loyalty to those who anointed/appointed them; our “foreign overlords” with their desires and plans (and actions!) for something other than the health and safety of America/Americans; our so-called “representatives” with their allegiance to their money-suppliers and their own careers (and not to America/Americans) – I think more and more people are realizing they really don’t have any effect on the “guardians of our future.”

I think people are in denial about our future because they do not see a way to have a preventative effect; they have a sense of hopelessness and helplessness (no action steps within their reach). I am certainly one-such.

But I have friends and associates who are still trying valiantly to “save America,” to “awaken the sheep” (which, to me, only gets you awakened sheep, not the necessary wolves (or even sheepdogs) that might have a salutary effect). They hope that by “educating” the sheep they can somehow “turn the flock” away from the disastrous cliff edge. (To change the metaphor, my late husband used to say: “no cowboys without cattle.” You can’t stampede wolves (or sheepdogs!), and if you have “herd” animals you’ll get cowboys!)

You don’t write much about recovery from denial. You caution against raising the fear of your audience so high that they tip over into denial. (I just finished reading Gladwell’s The Tipping Point.) But you don’t (that I’ve found) talk about trying to pull people back from denial. What advice would you give to those windmill-tilter friends of mine? How do you coax people lost in denial back into the possibility of action? How much of that recovery would be risk communication and how much risk (“hazard”) management?

Does one just write off the folks who’ve gone past appropriate fear into denial?

peter responds:

You don’t have to be a political extremist who talks readily about “foreign overlords” to worry about the issues you’re raising. These issues are so big and so amorphous that there’s a risk our dialogue may end up sounding like the sorts of things college sophomores say to each other late at night in the dorm. Even in my most vainglorious moments I don’t actually think risk communication can save the world. But I’ll try to suggest ways that might work to coax at least some people back into political involvement.

It seems to me that you are raising – and sometimes conflating – three issues:

• How to woo people back from denial.
• Why Americans are politically uninvolved – is it denial or something else? – and what to do about it.
• Why people act like sheep and what to do about that.

I’ll take them in that order.

How to woo people back from denial

Imagine a scale that measured the intensity of people’s interest and involvement in an issue. The various levels of interest are all arrayed on this scale, from mild to passionate. The part of the scale down near the bottom, below mild interest, is “apathy” territory, going down to a theoretical zero point of no interest at all. The area up near the top of the scale is more complicated. When someone’s interest in the issue gets very, very intense, a psychological circuit-breaker may be tripped. Now, instead of seeming very interested, he or she seems apathetic – and may actually feel apathetic on the conscious level. But unlike apathy, denial is unconsciously motivated. If I’m really “just not interested” in your issue, that’s apathy; your issue didn’t make my list. If I can’t bear to get interested (or remain interested), if the issue threatens my sense of how the world works or arouses emotions I cannot tolerate, that’s denial.

I like the circuit-breaker metaphor because it captures denial’s psychological role: to protect us from cognitive and emotional content we can’t handle. But the metaphor is misleading insofar as it implies that denial is dichotomous, that people are either “in” denial or not. People don’t usually click suddenly from intense interest to avoidance. Instead, we start to feel threatened so we get less interested.

That’s why the strategies for helping people recover from denial are pretty much the same as the strategies for keeping people out of denial. Please note: I’m not talking here about catatonia or other severe states of mind into which people sometimes retreat when reality is unbearable. Helping patients recover from these conditions is a subspecialty of psychiatry; it isn’t risk communication. But wooing people back from garden-variety issue-denial is a lot like preventing people from going into denial in the first place. It’s all about delicate adjustments in the fuzzy area where the issues that interest us start to threaten us as well.

If thinking about an issue makes people feel threatened – that is, if they’re in/near denial with regard to that issue – harping directly on the dire threat obviously isn’t a good strategy. You don’t want to say upsetting things to people who are already having trouble bearing how upset they are.

That doesn’t mean false reassurance is the answer. False reassurance should virtually never be on the communications menu between adults – and with people in denial, it would probably backfire anyway. Denial is defensive. People in denial tend toward paranoia. They’re hiding from themselves how they feel, trying to convince themselves that they’re just not interested or it really isn’t a big problem. They often project their self-deception into a generalized suspiciousness that others are lying to them. Their nose for hypocrisy is keen. So false reassurance, like dramatic warnings, can easily push them deeper into denial.

Here are some approaches that can help with people in or near denial:

• Legitimize the threat. Don’t try to make people feel more threatened, and don’t try to pretend they’re not feeling threatened. Instead, validate how threatened they feel. You usually can’t do that directly. “You look really upset” is unacceptably intrusive. So you deflect it: “A lot of people find this hard to think about.”
• Be a role model. There’s added value if you deflect the threat onto yourself instead of a third party: “I find this hard to think about.” Show that you are bearing the threat, even though you’re not finding it easy. The best crisis leaders don’t come across as fearless or happy; instead, they’re visibly bearing their fear and misery without going into denial. That can help the rest of us bear these feelings better ourselves.
• Provide action opportunities. People get less stuck in denial when they have things to do. Better yet, provide choices of things to do, so you’re not just keeping people busy but keeping their minds busy too. Both things to do and things to decide help give us a sense of control; if we can’t control the outcome, at least we can control how we respond to the problem.
• Focus on victims who need to be helped and potential victims who need to be protected. Most people are willing to tolerate more sense of threat while still staying “on task” if we’re working on behalf of those we love than if we’re working on behalf of ourselves alone.
• If appropriate, focus also on malefactors who need to be caught and punished. Unless it escalates into out-of-control rage or is itself denied, anger and even hate work a lot like love. These intense negative emotions can help us bear more psychological threat with less resultant denial.
• Stress determination but not necessarily optimism. Be candid – but gently candid – not just about how upsetting it is to think about the issue and keep working on it, but also about the barriers to actual progress. Instead of false optimism, set a tone of determination, rather like Winston Churchill in the dark days of early World War II: “We will fight them on the beaches….”

These are generic recommendations. But it always pays to diagnose the specific sources of denial in the specific case at hand. What exactly is psychologically threatening about this issue for these people? Then you can fine-tune the listed approaches based on your diagnosis. The bottom line: When people are feeling too threatened to keep working on the issue you want them to work on, find ways to help make the threat more bearable for them.

Why Americans are politically uninvolved

Although your comment focuses on denial, the situation that provoked the comment – the low political involvement of so many Americans – doesn’t strike me as mostly a problem of denial.

You say that many people, yourself among them, “have given up” on political change and are in denial because “they have a sense of hopelessness and helplessness.”

Hopelessness is thinking the problem probably can’t be solved; helplessness is thinking you probably can’t do much to solve it. When the problem is fixing what’s wrong with the world, or even the U.S., or even the U.S. political system or the U.S. economy, these strike me as pretty rational judgments. We need to find ways to keep trying despite our pessimism. But pessimism isn’t denial. If anybody’s in denial here, isn’t it the folks who are optimistic about hope and change?

It’s true that hopeless and helpless feelings can lead to denial. If you think you probably have cancer, for example, and feel hopeless/helpless about the prospect of remission, you may convince yourself that it’s not cancer. Or if you feel like your desire to become a lawyer or your affection for an acquaintance is likely to be thwarted, you may convince yourself that you never wanted to go to law school anyway or that you really don’t like him or her very much after all. The denial is a way of deep-sixing those hopeless/helpless feelings.

Similarly, people who have always been interested in politics sometimes suddenly announce to their friends that they’re not interested anymore. That could be denial. (It could also be that they’re not interested anymore.) Politics had come to seem hopeless; they had come to feel politically helpless; those feelings were uncomfortable. So they made an unconscious decision to “lose interest” to protect themselves from the discomfort.

But most people who don’t bother to get politically involved (or even vote) aren’t trying to convince themselves of anything. They’re not deep-sixing their hopeless/helpless feelings. Far from being unconscious, those feelings are front-and-center. When they say it’s a waste of effort to try to change the system, they mean what they say. I hope they’re wrong. But they might be right.

So let’s distinguish denial (“I can’t bear what I’m feeling”) from hopelessness/helplessness (“I believe there’s no point in trying”). And then let’s distinguish both from garden-variety apathy (“I’m really not interested anymore; I’ve got my own life to worry about”). I suspect that hopelessness, helplessness, and apathy all play crucial roles in people’s reluctance to get politically involved. I suspect that denial plays a comparatively minor role.

Low political involvement isn’t a new problem in the U.S. (or elsewhere). And it hasn’t gotten bigger, at least not in recent years. I accept that there is some truth to the “bowling alone” hypothesis that we’re all busy on our computers and smart phones instead of out participating in our communities and churches and local athletic groups; by many measures American civic involvement is down. But whether you agree with Occupy Wall Street or the Tea Party or neither, you should at least notice that both are upwellings of grassroots political involvement. It has never been easier to recruit people to become involved than now, in this age of social media.

I’m not going to say anything here about how to address political apathy. For my take on dealing with apathy, see this website’s Precaution Advocacy Index.

How do you address political hopelessness/helplessness – especially when it feels pretty justified? The obvious answer is to try to bolster your audience’s sense of self-efficacy. But I think that may be – in part, anyway – the wrong answer.

“Low self-efficacy” is a psychological term for what we’re calling hopelessness/helplessness. The psychology literature tends to see high self-efficacy as almost always a good thing, paying surprisingly little attention to the problem of over-confidence – that is, undue self-efficacy, a belief in oneself that exceeds one’s actual ability to get the job done. The literature focuses mostly on how to build people’s self-efficacy, especially in domain-specific ways – how to convince people they can quit smoking, learn math, etc.

According to the literature, the best way to increase people’s self-efficacy is to arrange for them to have mastery experiences; success breeds confidence. But there are other ways, most notably modeling (“if she can do it so can I”) and social support (“if he says I can do it, maybe I can”).

I don’t question any of that – but I think it’s probably close-to-irrelevant when someone’s low self-efficacy is mostly a rational response to reality. “It’s not that I lack self-confidence. I’m a pretty efficacious person in my own spheres. But the country is really screwed up and I’m just one person!”

Instead of cheerleading for efficacy, my hunch is that it will help more to get on the other side of the risk communication seesaw:

• “This feels almost futile, doesn’t it?”
• “At most we can only help a little – and maybe not even that!”
• “Even if we win a battle or two, we’re probably not going to change the world.”

The myth of Sisyphus – the Greek king compelled to roll a boulder uphill forever – is powerful precisely because so much effort really is Sisyphean. It can’t be good risk communication strategy to try to convince people that it isn’t … or, worse, that they should feel like it isn’t whether it is or not.

And yet things do change. Human nature and the human condition don’t change, but the specifics of life do. You can’t reach my age of 67 without noticing that lots of things you thought would never happen have happened, from the fall of the Soviet Union to the widespread acceptance of homosexuality to the breathtaking reduction in childhood infectious diseases. And you can’t reach 67 without noticing that people and nations keep falling into the same traps they fell into centuries ago.

I think it is good strategy to acknowledge and even proclaim that change and unchangeability are both characteristics of life; that it’s hard to tell which of our efforts might make a (probably small) difference and which efforts are doomed from the outset; and above all that it’s more fun (“fun” in the most serious sense) to take your best shot than to stand around watching.

Just as we can’t reliably tell when our efforts might make a difference, we also can’t reliably tell how horrific our problems are. Your comment refers to the “fast-approaching cliff edge.” I have that feeling too – but I don’t trust it. The fact that most people feel hopeless/helpless isn’t itself proof that disaster looms. Most people have always felt unable to change the course of events, and most people have always spotted a fast-approaching cliff edge or two. More often than not the cliff edge they saw (or looked away from) wasn’t as cataclysmic as they imagined.

Is the economy really in worse shape than ever before? Is the country really less governable or less well-governed than it used to be? Are these foolish questions because H5N1 or global climate change is gonna kill us all anyway? The answers are probably no and no and no. At least, many cliff edges of the past have turned out to be less close or less steep than people thought. Maybe ours are too – a point that’s probably worth making when people are in or near denial.

Why people act like sheep and what to do about that

I’m not comfortable calling people sheep or cattle (or “sheeple” – the derogatory portmanteau of “sheep” and “people” that gets a lot of use on Internet conspiracy sites). A big piece of what I do for a living is urge clients to listen harder to publics. Nobody listens to sheep.

But I agree that most people most of the time are focused on their own lives and not on the Big Issues, unless some big issue is their job or their lifework or at least their hobby. For most people, paying attention to big issues is an occasional thing.

And for most people, figuring out where they stand on big issues isn’t about reaching an independent judgment based on the data.

People’s convictions are typically grounded in four factors:

• Reference groups – what do the people whose opinions I care about think about this issue?
• Values – what long-term values of mine does this issue illustrate, or at least trigger?
• Emotions – how do the various positions on this issue make me feel?
• Precedent – what have I said or done that tells me that’s the side I’m already on?

Information? Evidence? Data? Sadly, they don’t make the list of the main determinants of our opinions. They do play a crucial role afterwards, however. We collect information as ammunition, not to figure out what we think but to tell ourselves and others why we’re right.

The most sheep-like of these four factors is of course our allegiance to reference groups. It can’t be coincidence that most people take the same position on most issues as the position their reference groups take – their friends and families, their coworkers and neighbors, the strangers they most admire. In part we pick our reference groups because we agree with them about most things. But to a far greater extent we choose to agree about most things with the people in our reference groups.

“Choose” is arguably the wrong word here. We don’t choose to agree with our reference groups as much as we find ourselves in agreement with them. This should come as no great surprise. We’re mostly reading the same columnists, watching the same TV shows, and checking the same websites. And we’re paying close attention to each other, picking up cues about what we all think.

Among other things, relying on reference groups is a shortcut. We don’t have time to study up on dozens of issues. We study up on a few – and our friends may absorb their opinions on those few mostly from us. For the rest, we absorb our opinions mostly from our friends.

Of course we may have a few opinions that diverge from reference group norms. We may display these areas of iconoclasm proudly to the group, or we may see them as shameful or dangerous secrets. Either way, if the areas of iconoclasm get too plentiful we need to find new reference groups.

For most people, iconoclasm is a pleasure (if it’s ever a pleasure) only when displayed to a group whose opinions we don’t value. Disagreeing with people whose opinions we value is painful, and we try to do it as seldom as we can. This is at least as true of people with unusual opinions as it is of people with conventional opinions. The more extreme and unpopular the viewpoint, the more intolerant its adherents are likely to be of apostasy. Those who are inclined to call everyone else sheeple are among the most insistent that their peers toe the ideological line. Anyone who spends much time surfing the Web knows that.

None of this makes us sheep or cattle or sheeple. It makes us, simply, people. We’re too busy in our lives to reach independent judgments about every issue. And we don’t want to be that independent, that autonomous, that lonely. We value our connections to other people, and adhering to reference group opinions most of the time doesn’t feel like too high a price to pay. Most of the time it doesn’t feel like a price at all; we don’t even notice we’re doing it.

What is to be done about our reliance on reference groups? Nothing.

Of the four determinants of opinions I listed – reference groups, values, emotions, and precedent – reference groups and values are exceedingly stable and resistant to change. So change efforts work on mobilizing the reference groups and values that are already there in your target audience. You appeal to people’s group allegiances and to their values. You try not to challenge either one.

It’s easier to mobilize people’s existing emotions than to change their emotions – but changing emotions is more feasible than changing reference groups or values. That’s why precaution advocacy tries to get people more upset about serious problems, while outrage management tries to get people less upset about small problems.

Precedent is the most changeable of the four factors. It’s relatively straightforward to persuade people to say or do something small that they haven’t said or done before (perhaps using reference groups, values, or emotions as your motivator). Then, having secured your foot-in-the-door, your “behavioral commitment,” you flood them with information validating what they just said or did: how wise and valuable it is, how grateful you are, above all how clearly it shows that they’re on your side! Suddenly you’re not urging them to change positions anymore; you’re urging them to stick to their (new) guns. This is what cognitive dissonance-based change strategies are all about: Get people to do/say something new that points in your direction, and then support the hell out of the new instead of challenging the old.

If you’re skillful and lucky, maybe your new supporters will bring their reference groups along with them.

name:	Eric Jens
field:	Risk communicator, Georgia Department of Public Health
date:	April 23, 2012
location:	Georgia, U.S.

comment:

Your recent articles have been most thought-provoking, especially to me this week as I have begun my new role as Risk Communicator for the Georgia Department of Public Health. I am in the process of meeting many of the professionals within our system and progress seems to be going well.

Is there any aspect of this role that someone in my position too often overlooks or should pay more attention to?

Whenever you have time for even a short answer, I would be interested to hear it.

peter responds:

What a wonderful question to ask yourself on your first week in a new job:  What do people in your job too often neglect to do?

As you probably know, 20 years ago there almost certainly wasn’t a job called “Risk Communicator” in the Georgia Department of Public Health or any state health department. There were public information people who publicized the agency’s achievements and responded to controversies, and there were health education people who produced factual materials about various diseases and other health problems.

Despite labels like “public information” and “health education,” these communicators often functioned as advocates. The health educators advocated on behalf of behaviors the health department considered healthful (from getting vaccinated to keeping spoilable foods in the refrigerator), while the public information people advocated on behalf of the health department itself (especially when it came under attack).

Some health departments have added job titles like “Risk Communicator” without really changing what their communication professionals do. Others really have tried to rethink the job, not just rename it.

Here are some of the things I think health department risk communicators should do that they sometimes don’t realize they should do … and sometimes aren’t permitted to do:

name:	Min Won Lee
field:	Student
date:	April 21, 2012
email:	mwmw0110@korea.ac.kt
location:	South Korea

comment:

I'm a student at Korea University majoring in health science.

Nowadays I’m learning about risk and crisis communication related to mad cow disease. In 2008, South Korea had a huge demonstration against the FTA, which allows importing USA cows including bone. And it’s still controversial.

In this case, I’d say the “hazard” is importing cow bone from the USA. However, I’m curious what the “outrage” is. Could I say the “outrage” is just the demonstration in 2008?

peter responds:

As you know, South Korea banned the importation of U.S. beef in 2003 after a case of mad cow disease was discovered here. An attempt to reopen the market failed in 2006 when the South Korean government found bone fragments in the U.S. beef. In 2008, the South Korean market for U.S. beef was reopened as part of the free trade agreement between the U.S. and South Korea; the U.S. made that a condition for the deal. Despite massive demonstrations in Korea, the deal stuck, and South Korea is now one of the world’s biggest importers of U.S. beef.

I don’t know whether it’s a significant hazard or not to eat beef imported to South Korea from the U.S. – though I very much doubt it.

Either way, I think I know where the outrage comes from. Among the factors at work:

• Mistrust of the U.S. government (and perhaps also their own government) by some South Koreans, who suspect that U.S. beef exporters are less careful than they should be, less careful than the U.S. government promised, and less careful than they are with meat sold domestically. The possible presence of too much bone is one issue. The possible export of older cows (which are likelier to have mad cow disease) is a bigger one.
• Dread at the prospect of mad cow disease. However unlikely Korean consumers are to get the disease from beef (wherever the beef comes from), the possibility of a little-understood disease that lies in wait for decades and then rots your brain is both terrifying and disgusting.
• Anger (and perhaps shame) that the U.S. government had the clout to force the deal on the South Korean government, against the interests of the country’s domestic beef industry and against the wishes of its consumers. After the 2008 demonstration, South Korean President Lee Myung-bak apologized for failing to take public opinion into consideration when negotiating the free trade agreement … but his government didn’t back off the agreement.
• Resentment of the contempt that many observers (in both Korea and the U.S.) showed for their resistance. One blog wrote about “Mad Korean Disease vs. Mad Cow Disease.” Others picked up on the fact that the demonstrators carried candles and labeled them “candle zombies.”

The demonstrations in 2008 were expressions of outrage by people who believed the hazard of imported U.S. beef was unacceptably high. Beyond doubt, those who were outraged thought they were outraged because of the hazard of BSE from U.S. beef. That’s equally true for those who are still outraged about the agreement.

But one of the linchpins of my hazard-versus-outrage model is my claim that outrage causes hazard perception far more than hazard perception causes outrage. Even though South Korean protesters thought they were outraged because the hazard was high, I would argue that in fact they thought the hazard was high because they were outraged (for the reasons I listed above, among others).

That’s true regardless of how high the hazard was (or is). For both serious hazards and trivial ones, outrage is mostly a cause of hazard perception, and only secondarily a result of hazard perception. That’s why activists who believe a particular hazard is serious need to work to increase public outrage (a task I call precaution advocacy), while those who think that hazard is trivial need to do what they can to reduce the outrage (a task I call outrage management). Neither side gets very far if it ignores outrage and focuses instead on providing data to demonstrate that the hazard is serious or trivial.

As a student trying to understand risk and crisis communication, you might want to practice designing a precaution advocacy campaign to arouse outrage about mad cow disease in Korea or an outrage management campaign to diminish mad cow disease outrage in Korea. Better yet, do both.

name:	Nicole Hunter This guestbook entry is categorized as:
field:	State government
date:	April 4, 2012
email:	nicolehunter1708@gmail.com
location:	Australia

comment:

I am wondering what you suggest to clients who need to apologise for their predecessors’ bad decisions or misbehaviour?

I come across a few clients myself who have to wear the decisions of previous Boards, staff or even different political parties. What if the decisions they made were poor in hindsight (or even in foresight?), and now the current staff, Board or others need to explain the situation? This is especially a problem if the decision cannot be reversed.

peter responds:

Companies and government agencies have no compunctions about taking credit for their predecessors’ accomplishments. “Protecting the environment for umpty-ump years” or “proudly serving the community since nineteen-whatever,” they boast. But when it’s a predecessor’s misdeed they’re being asked to own, they want no part of it. “That was a different management.” “Those were different times.” “I was in seventh grade when that happened.”

From the perspective of your stakeholders, of course, your company or your agency is the same company or agency it was back then. Continuity is the default assumption. If you want to challenge that assumption, you have to do so wholesale, announcing “a whole new philosophy” or at least a new approach to X or Y. You can’t simply cherry-pick the prior bad decisions you want to disavow.

In fact I advise clients to go to the opposite extreme – not only embracing responsibility for prior bad decisions but making a point of the fact that they’re doing so. That enables you to acknowledge that you’re tempted to disavow your predecessor’s actions, and counterproject people’s likely assumption that you’re trying to disavow your predecessor’s actions. “I wish I could say this has nothing to do with me or anyone who’s here now. Even though it’s true that nobody here now was here then, it’s also irrelevant. We’re here now, and we’re accountable for everything our company/agency did before we got here.”

In response, some of your stakeholders may get on the other side of the risk communication seesaw and tell you it’s not your fault. That’s fine. Your position should be steadfast: It’s your organization’s fault and you’re the current representative of your organization, so of course it’s your fault.

The same analysis applies, by the way, to the current unwise decisions or misbehaviors of other tentacles of your company or agency. As I have often had occasion to point out to clients, in many cases activists have been more successful at globalization than corporations have. Say you’re running the Belgian or Peruvian arm of a multinational, and have a meeting scheduled tomorrow with a hostile activist group. Chances are the group has been in touch with activists in other parts of the world who are fighting your company on their home turf; for weeks now the groups have been cross-posting on each other’s websites and exchanging tips and tactics. “Why should we trust your promises,” someone is likely to say at tomorrow’s meeting, “considering what you did just last month in Sri Lanka!” It will help for you to know what the Sri Lanka controversy is about. It won’t help for you to complain that you’re just the company’s Belgian or Peruvian plant manager and have nothing to do with its decisions in Sri Lanka.

There’s a partial exemption for governments – not government agencies, but actual governments. Especially when one political party takes over control of the government from another, the public really does see the new government as new. In the U.S., we’re now well into the fourth year of President Obama’s term, and there are still endless debates over which current problems Obama is responsible for and which he can blame on the Bush administration.

But even here, continuity takes precedence. Obama may be able to blame Bush for some of the problems he faces, but he still has to face them. They’re his problems now. And when he’s talking to people who have suffered as a result of a prior administration’s decisions, he doesn’t get to disavow those decisions. They were the decisions of the government he now heads; he has to own them even if he would have handled things differently … and yes, sometimes he has to apologize for them.

Apologizing, by the way, doesn’t necessarily mean admitting that your predecessor did something wrong. It just means admitting that what your predecessor did worked out badly for the people you’re talking to. You know this in your own life. If someone jostles you in a crowded elevator and makes you bump into someone else, you don’t turn and say: “It’s not my fault. I was jostled!” Instead, you say you’re sorry.

Of course if your predecessor really did do something wrong, you should own up to that. But apologies are appropriate for bad outcomes regardless of good motives.

I can think of one exception, one situation where you really needn’t apologize for a predecessor’s behavior – and that’s when you took over explicitly to put a stop to that behavior. Suppose dissatisfied shareholders kicked out the old management and made you CEO, for example, or suppose the prior government was overthrown and the rebels brought you in to clean up the mess. Assuming everybody knows you represent the new regime, you’re free to say nasty things about the old regime. You still have to make right the things your predecessor mishandled. But you don’t have to apologize.

With that exception, there are two positions that won’t work for a company or agency talking about a predecessor management’s bad acts or bad decisions. You can’t ignore what the former management did as if it had nothing to do with your current situation. And you can’t simply criticize what the former management did as if it had nothing to do with your current organization. It’s your liability now: yours to acknowledge; yours to correct (if you can) and compensate for; and yours to apologize for.

That still leaves a range of possible positions that can work. Here are some of the options:

All of these options, of course, are compatible with apologizing for what your predecessor did. If what your predecessor did worked out badly for the people you’re talking to, you apologize – period.

name:	Paul Holmes This guestbook entry is categorized as:
field:	Media
date:	March 30, 2012
location:	United Kingdom

comment:

Pink slime – what went wrong?

I am interested in what the industry/company could have done in advance of this crisis to insulate or prepare their business, and in what they could have done once the crisis went viral and mainstream to protect themselves.

peter responds:

Pink slime – usually referred to in the industry as “lean, finely textured beef” (LFTB) – is a beef byproduct widely added to hamburger meat. At least it was widely added until about a month ago, when the controversy went viral and supermarkets, fast-food restaurants, and school systems started abandoning the product.

LFTB is made from beef trimmings and connective tissue. The fat and meat are separated mechanically, using heat and centrifuges; then the fat is processed into tallow, and the remaining beef and connective tissue is squeezed through a tube and treated with ammonia to kill bacteria. Hamburger meat that contains LFTB at all may be as much as 25% LFTB.

Invented in the 1990s, LFTB was first labeled “pink slime” in 2002 by Gerald Zirnstein, then a microbiologist at the U.S. Department of Agriculture (USDA). He used the term in an email to a colleague, but the email soon became public and critics grabbed onto it for obvious reasons. Despite occasional news stories, the issue didn’t make much headway until 2011, when food activist Jamie Oliver featured it on his ABC television show, “Jamie Oliver’s Food Revolution.” By the end of 2011, McDonald’s and two other fast food chains had stopped using LFTB. The story went truly viral after a March 7, 2012 ABC News story featuring Zirnstein.

Although some have claimed that pink slime is dangerous, The USDA insists it isn’t. I’m not qualified to judge the question, but Zirnstein’s objection on ABC wasn’t health-based; he said the unlabeled use of a cheap meat byproduct is “economic fraud.” And pink slime passes muster with Doug Powell, the Kansas State University professor whose irreverent and influential food safety blog, “Barfblog,” addresses the issue at length, complaining only about the failure to label so people have a choice (a complaint with which I fervently agree).

In any case, food safety isn’t what turned the public against pink slime. Nor is economic fraud the key issue for the public. It’s disgust at the very idea of adding ammonia to highly processed meat waste and calling it hamburger – plus the disgust automatically aroused by the word “slime.” (Beyond doubt, the term “pink slime” is a brilliant piece of hostile jargon.)

Periodic outbursts of disgust

You ask what went wrong with regard to pink slime. I’m not sure anything went wrong. What happened is akin to a natural disaster. Here’s why I think so.

A lot of meat is icky. It’s icky in ways that are natural (think about excrement and bacteria) and in ways that are industrial (think about how food animals are housed and slaughtered).

People who live on farms know all that, and get used to it. People who live in cities and suburbs, where most of us live, sort-of know it too. But we’d rather not think about it. We like to pretend that meat is pristine, all the while knowing it isn’t. Our awareness is so close to the surface that “sausage factory” is a popular metaphor for places (like legislatures) where people do disgusting-but-useful things that should be done only behind closed doors.

So the meat industry has always had a choice. It could rub people’s noses in the ickiness – take school kids on slaughterhouse tours, for example. Or it could collude with the public in pretending that meat is pristine. This pretty much had to be an industry-wide decision, if not a society-wide decision; one company that came out of the closet alone would be crucified.

In the U.S., at least, the meat industry has always chosen to collude in the pretense.

An inevitable side-effect of that choice is that occasionally an especially vivid example of ickiness gets through people’s defenses, and we overreact. Our overreaction serves to protect us from further revelations; it preserves the pretense that the rest of the food supply is still pristine.

If this analysis is sound, there is literally nothing the meat industry could have done to prevent the pink slime debacle – other than coming out of the closet empathically but matter-of-factly about meat’s icky side. Coming out of the closet would also enable the industry to talk about various reductions in ickiness it has implemented (ideally giving full credit to the activists who forced the changes). It’s hard to point to improvements in a problem you’re not prepared to mention.

In short, periodic outbursts of disgust are the price the industry pays for its decision to prettify. It’s a price the industry is prepared to pay in preference to the only alternative. This time the product that got a shellacking is LFTB. Next time – and there’s sure to be a next time – it’ll be something else.

Handling the controversy

That said, I do think the meat industry and the LFTB corner of the meat industry could have handled the controversy a lot better than they did.

The industry (and USDA) responses I’ve seen run the gamut from defensive to offensive. Most of the responses are understandably but ineffectually outraged at the public’s outrage. Few if any are empathic with the public’s natural and understandable revulsion at the discovery that a significant portion of the hamburger we eat is salvaged meat waste sprayed with ammonia – perhaps a kind of meat technically (or perhaps not), but certainly not quite what we mean when we say “meat.”

Industry statements and pro-industry news commentaries are collected on a website launched by the biggest LFTB producer in the country, Beef Products, Inc. (BPI). Entitled “Get the Facts on Lean Beef Trimmings,” the website has the contentious URL “beefisbeef.com.” Much of what’s on the site really is facts, useful albeit one-sided. But too much of it is angry and unempathic. My favorite bad example is a March 23 open letter from CEO Eldon Roth, originally part of a BPI full-page ad in the Wall Street Journal. The letter’s headline captures its aggressive, unempathic tone: “‘Pink Slime’ Libel to Cost This Country Jobs.”

What would I do in Eldon Roth’s shoes?

He has basically two options. He can keep a low profile and try to hang onto as many customers as he can, hoping that the fuss will blow over without new regulations or permanent stigma and former customers will begin to return.

Or he can make his case, empathically, respectfully, and candidly.

That would mean using the term “pink slime” a lot, sometimes even without quotation marks. Euphemisms never cut it in controversies. The only path forward is to use the uncomfortable label critics are using to talk about the uncomfortable issues critics are raising.

Tougher still, it would mean conceding that millions of people understandably found the idea of pink slime – and the television footage that went with it – seriously disgusting. I don’t suppose Roth could honestly claim that even he finds it a bit disgusting, but maybe he can find a family member to quote to that effect. The price of admission for asserting the safety and value of LFTB is acknowledging the repulsiveness of pink slime.

Roth might even go a step further and say there are a lot of things about food in general and meat in particular that many people find disgusting … or would find disgusting if they knew about them. (He has to say this carefully, so as not to sound like he’s saying, “…so why pick on us?”) Normal people tend to lose their appetites when they visit the sausage factory, he could say – and courtesy of ABC, YouTube, and the rest of the media millions have visited his particular “sausage” factory in the past month. And at least for now, they want their hamburger without pink slime.

That is of course a disaster for Roth, his employees, and his shareholders; he’s free to say so. But he needs to talk far more about people’s normal “Oh, how gross!” adjustment reactions than about his and his employees’ private disaster.

People can and usually do get over their adjustment reactions. I have a hamburger-loving relative who decides to grind her own beef (for a few weeks anyway) every time she sees a “beef-yuck” story. But you can’t hurry people through an adjustment reaction. Instead, paradoxically, empathizing with how natural the reaction is helps people get through it more quickly.

It wouldn’t help for Roth to try to generate sympathy for his company’s and his employees’ financial distress. And it certainly doesn’t help when meat industry officials try to support the beleaguered LFTB industry by dissing the hysterical public. That just makes the adjustment reaction take longer, and you can go bankrupt waiting for the customers you misperceive and mislabel as hysterical to get over it.

Similarly, it didn’t help when three meat-state governors and two lieutenant governors got together in late March to try to rescue LFTB with a media event at which they toured an LFTB plant and then – predictably – scarfed down pink-slime-containing hamburgers for the cameras. This particular exercise in mockery of the public’s concerns is often called “doing a Gummer,” after the British agriculture official who famously tried to feed his daughter hamburger at the height of Britain’s mad cow disease crisis. For some other recent Gummer examples, see our December 2011 column on “Over-Reassuring Thai Crisis Communication about the Great Flood.”

From left, Iowa Gov. Terry Branstad, Texas Gov. Rick Perry, and Nebraska Lt. Gov.
Rick Sheehy eat hamburgers containing pink slime / LFTB, following a news
conference in South Sioux City, Neb. Photo from CBSnews.com.

Roth should also tell us about the downsides of living without pink slime, if there are any. Will it make hamburger less nutritious, less healthy, or less safe? Will it make hamburger more expensive? Will it require raising and slaughtering significantly more cattle to replace the LFTB that will now go uneaten – and if so will that have economic or environmental impacts worth mentioning? I don’t know the answers to these questions, and Roth should be leery of overstating the societal costs of his private disaster. But he should certainly point them out … all the while forthrightly acknowledging his ickiness problem.

Finally, Roth should express his hope – not confidence, just hope – that people will be able to get past their visceral reaction to pink slime. Toward that end, he might productively acknowledge that a big piece of the public’s reaction results from having been blindsided. So a commitment to labeling (and an apology for having resisted labeling previously) might make a difference. The label needn’t say “pink slime,” but “LFTB” won’t do the job, nor will “lean, finely textured beef.” How about: “Treated with ammonia to kill bacteria”?

Supermarkets that have been persuaded to remove products with pink slime from their shelves might be persuaded to restock them alongside LFTB-free products if there were appropriate labels that allowed consumers to make their own decisions, based on cost, safety, nutrition, disgust, and whatever other factors they found meaningful. That’s the compromise recently reached (under pressure from both sides) by the Iowa-based Hy-Vee grocery chain.

Is any of this – or even all of it – likely to resuscitate pink slime? I don’t know. Maybe the product is doomed. Adjustment reactions aside, people who have been intentionally blindsided don’t forgive easily.

Coming out of the closet is a gamble. But so is the alternative strategy, keeping a low profile. One is a gamble that the public will forget the truth; the other is a gamble that the public will accept the truth. Worse than either gamble is the industry’s current strategy: counterattacking with half the truth while pretending that the other half – that lots of people find pink slime disgusting – doesn’t exist.

name:	Jon This guestbook entry is categorized as:
field:	Epidemiologist
date:	March 16, 2012
location:	Connecticut, U.S.

comment:

While taking a FEMA course on the Incident Command System, I recalled your article “Speak with One Voice: Why I Disagree.”

What has been the response to your article?

peter responds:

As far as I can tell, I haven’t made a dent.

Most of the advice I give to clients is reasonably compatible with the advice other risk communication experts give. Our clients may not take our advice, but the advice itself doesn’t deviate that much from one consultant to the next.

“Speak with one voice” is an exception. Nearly all the experts advise that sources should synchronize their messaging, internally and externally – especially in crises and controversies. Message consistency is one of the principles underlying FEMA’s Incident Command System, so I’m sure it was covered in the course you took.

I am steadfast – and almost alone – in my view that this is bad advice. My view is:

• that people don’t freak out (even though they don’t like it) when officials or experts disagree, as long as it’s clear that the officials or experts are aware and respectful of each other’s opinions;
• that there are benefits to allowing opinion diversity to show, especially letting the public in on the reality that everyone isn’t necessarily on the same page on every issue; and
• that when dissenters are forced to adhere to a fake consensus, the disagreement almost invariably leaks, journalistically and psychologically, doing more damage to public confidence than if it had been candidly acknowledged from the outset.

When I present my view at seminars on crisis communication or outrage management, I get pushback chiefly on two grounds.

The first objection I typically hear is that management won’t permit anyone to express opinions that diverge even minutely from official policy. I know that’s often true. There are disagreements so fundamental that expressing them is worth some risk to your career – but that’s obviously the exception. Expressing routine disagreements isn’t worth that risk. “If your boss won’t let you explain that there’s more than one opinion on an issue, then don’t,” I tell seminar participants. “But try to let your subordinates do so when you’re the boss.” The incident commander in a crisis, of course, functions like any other boss.

The second common objection is that people in controversial or stressful situations are likely to seize on any divergence of opinion as evidence that your organization doesn’t know what it’s doing. There is some truth to this objection, I think.

Of course sometimes your organization really doesn’t know what it’s doing, and disagreements well out in a way that demonstrates that this is so. In my view it’s not a bad thing for the public to learn the truth, though I can understand why the top brass might think it is. Expressions of disagreement are especially likely to undermine your credibility and reputation – deservedly or not – when they come across as disorganized or disrespectful. When different officials insist that different positions are the official position, for example, the public rightly gets the impression that you don’t have your act together. The same is true when disagreement is expressed in a tone that sounds rebellious, surly, or contemptuous.

Sometimes there’s also a transition problem. If people are used to an agency or company that speaks with one voice, their ears will naturally prick up when someone unexpectedly departs from the party line, and they’ll start trying to figure out why.

But people quickly adjust when management stops trying to sound monolithic and matter-of-factly explains that of course many options were considered and of course there was robust debate and of course some of the “losers” in that debate still prefer the option they championed … when these realities are presented not just as natural and inevitable but as strengths that lead to better decisions.

That’s what I believe – but I’m still very much in the minority. I have examples I think prove my point (there are plenty in the article) – but so does the other side.

When I present this debate to seminar audiences, I usually conclude the discussion by pointing out that I haven’t tried to speak with one voice on the subject of speaking with one voice; instead, I have explicitly (but respectfully) disagreed with the majority view. “Did learning that risk communicators disagree on this issue make you trust risk communication as a field any less?” I ask. Nobody ever thinks it had that effect – a lesson I hope stays with some of them as they consider the pros and cons of speaking with one voice.

Let me finish with two examples, one discouraging and one that is at least partly encouraging, both drawn from my work on influenza controversies.

Together with my wife and colleague Jody Lanard, I have long been a connoisseur of the ways public health professionals distort and exaggerate the efficacy of flu vaccination in order to persuade the public to get vaccinated. (I share their goal, but I disapprove of their distortions and exaggerations.) Last year we interviewed a number of local health officials about some flu messages that had been generated on the national level and passed down – messages we considered less than honest. When we pointed out how the messages diverged from scientific evidence, some of our interviewees were surprised, even shocked and aghast.

But others gave us a verbal shrug. “Yeah, we know,” they told us, with varying degrees of candor. “But we really can’t afford to be out there alone saying something different from what CDC and HHS are saying. ‘Speak with one voice,’ you know.”

That was the discouraging example. Here’s the somewhat more encouraging one.

Since last December, flu scientists have been locked in a battle over two papers reporting successful bioengineering of the H5N1 flu virus. H5N1 (usually known as “bird flu”) is incredibly deadly to humans … but almost completely unable to transmit from human to human – which many think is the only reason why we have been spared a catastrophic H5N1 pandemic. The two research teams tinkered genetically with H5N1 to produce two new strains that are transmissible in ferrets and thus potentially transmissible in humans. The battle focuses on whether the two papers should be published with their methodologies intact, and on whether further research along the same lines should be permitted. Scientists on one side are worried about research autonomy and censorship, and excited about the possibility that continuing research could lead to breakthroughs that might help prevent a pandemic. Scientists on the other side are worried about laboratory accidents and human malevolence, fearful that continuing research could actually launch a pandemic.

It is a hard-fought battle on both sides – and it has been fought as fiercely in public as in private. To the best of my knowledge, no one on either side has suggested (at least publicly) that scientists should speak with one voice on this question.

But this second example has its discouraging elements too. In much of their H5N1 skirmishing, scientists on both sides have demonstrated nastiness toward each other and contempt for the public. The diversity of opinion hasn’t been suppressed, but it hasn’t been consistently respectful either. And while the two sides are openly making their cases – which is good in my judgment – each side has periodically tried to discipline its adherents into putting forward a united front. On H5N1 bioengineering, science seems to be trying to speak with two voices – better than one, but a far cry from the actual diversity of scientific opinion that’s out there.

name:	Knut This guestbook entry is categorized as:
field:	Master’s student
date:	March 6, 2012
location:	Norway

comment:

I am currently writing my master’s thesis on BP and the Deepwater Horizon incident.

I was wondering if you could shed light on the following:

• How was the crisis perceived by the stakeholders, and in what ways were BP attributed with the responsibility?
• How was BP’s crisis response adapted to #1?
• How has the relationship between #1 and #2 affected the reputation of the company?

With many thanks for your time.

peter responds:

This is the ninth commentary on this website about the 2010 Deepwater Horizon oil spill. The other eight were all written in 2010, as the crisis was ongoing. Here they are in chronological order:

• “BP’s Communication Response to the Deepwater Horizon Spill” (May 3)
• “Communicating about the BP Oil Spill: What to Say; Who Should Talk” (May 30)
• “Why We’re Vilifying BP” (June 4)
• “Jim Joyce, Tony Hayward, and how to apologize” (June 5)
• “The ethics of risk communication consulting and the BP oil spill” (June 6)
• “President Obama’s handling of the Deepwater Horizon oil spill” (August 8)
• “Did the BP spill in the Gulf of Mexico create a crisis for the oil and gas industry?” (September 12)
• “Risk Communication Lessons from the BP Spill” (September 13)

Now that some time has passed, I welcome the opportunity to reconsider the spill in the context of your three questions.

How did stakeholders see the crisis, and to what extent did they blame BP?

To answer this question properly I’d need to conduct a survey – or at least study the results of other people’s surveys.

But it’s pretty clear that most people in the U.S. – public and stakeholders alike – blamed BP for the Deepwater Horizon spill. Transocean, the owner of the rig, probably wasn’t well-known enough to be a satisfying villain. Halliburton, though well-known and much-disliked for other reasons, wasn’t closely enough tied to the accident. (It handled the cementing that may have contributed to the leak that led to the explosion that started the crisis.) BP was the biggest of the three companies. BP owned the oil that ended up fouling the Gulf and the shore. BP was responsible for hiring and supervising the other two companies. And BP had the principal legal liability; everybody sued BP, which then sued Transocean and Halliburton in hopes of recovering some of what it has paid out and will pay out.

Absent a smoking gun that made people feel like BP was the victim of an incompetent or dishonorable contractor, it was a foregone conclusion that Deepwater Horizon would be seen as BP’s spill.

U.S. President Barrack Obama was also at risk of being blamed. In the early years of his presidency, Obama established a regulatory regime favorable to oil development in the Gulf of Mexico (perhaps trying to balance his advocacy of climate change legislation). He inherited a regulatory agency, the Minerals Management Service, that made life easy for corporate interests in the Gulf, and did little to reform the agency until after the spill. But Obama successfully passed some of the blame to the Bush administration and ducked the rest by being aggressively hostile to BP. The latter strategy might have backfired if it had been seen as scapegoating, but he got away with it.

Arguably the blame ought to be shared by the rest of the oil industry. In the wake of the Deepwater Horizon accident, several of BP’s peer companies claimed they would never have made the mistakes BP made that led to the spill, but they acknowledged that they would have been just as unprepared to cope with it.

And of course we all deserve some of the blame for wanting cheap domestic oil, and thus tacitly accepting the risks that oil exploration and development entail.

But BP got the lion’s share of the blame.

How well did BP’s crisis communications respond to stakeholder perceptions?

Abysmally.

A lot has been written about BP’s crisis communication failures in the weeks and months after the initial blowout – some of it by me. But what’s most crucial in the context of your three questions is BP’s failure to take responsibility. Since most people blamed BP for Deepwater Horizon, BP needed to do one of two things in response: either credibly explain why it wasn’t at fault or contritely acknowledge that it was. There was no way BP could do the former, and it failed miserably to do the latter.

BP did take legal responsibility. It was obvious from the outset that the company would be legally responsible; as the relevant laws are written, it was BP’s accident regardless of what other organizations might have done wrong. So BP’s lawyers, communicators, and senior executives presumably saw no downside and considerable upside to accepting legal responsibility quickly.

It did so not just quickly but impressively. Within days, BP promised to establish a $20 billion fund out of which all legitimate claims would be paid … with more to come if needed. It’s testimony to how outraged Americans were at BP that it got no perceptible credit at all for this extraordinary concession. Instead, people caviled at the qualifier, “legitimate claims,” as if it were somehow stingy of the company to imply that it might actually check to see if a claim was legitimate.

But BP failed to take moral responsibility. In late May 2010, more than a month after the April 22 blowout that precipitated the Deepwater Horizon catastrophe, BP CEO Tony Hayward tried to apologize – and stumbled badly. Here’s what he said, easily the most memorable quote coming out of the crisis:

I’m sorry. We’re sorry for the massive disruption it’s caused their lives. There’s no one who wants this over more than I do. I’d like my life back.

Equally vivid in my mind is the memory of Hayward appearing before the U.S. House Energy and Commerce Committee in mid-June. Asked over and over again whether he could think of anything BP did or might have done that contributed or might have contributed to the catastrophe, Hayward consistently refused to go there, insisting that it was premature to try to assess blame since there were ongoing investigations. I don’t doubt that Hayward was following sound legal advice, and perhaps even sound technical advice; the blowout was less than two months in the past, after all, and there were still plenty of unanswered questions about what went wrong. But it was horrible risk communication advice. Hayward’s refusal to specify anything the company might have done wrong left an abiding sense that BP was evading its responsibility for the Deepwater Horizon explosion and spill.

Bob Dudley, Hayward’s successor as BP CEO, finally got around to apologizing for Deepwater Horizon in March 2011. He chose an oil industry conference as his venue, and began his apology by saying: “This is the first chance I have had to address such a large gathering of industry colleagues and the first thing I want to say is that I am sorry for what happened last year.” It was hard to escape the impression that he was apologizing to the industry for bringing offshore oil exploration into disrepute, not to the inhabitants of the Gulf region for damaging their ecosystem and their economy. Dudley also put a lot of stress on a promise that BP would in future be more careful to police the standards of contractors it worked with, leaving a sense that he was “apologizing” mostly for other companies’ misdeeds on BP’s watch.

Dudley’s apology was obviously an improvement on Hayward’s “I’d like my life back” – but it was far from the heartfelt acknowledgment of moral responsibility that was long overdue.

In taking legal responsibility but not moral responsibility for Deepwater Horizon, BP got the process of forgiveness exactly backwards. Forgiveness requires contrition before restitution. In fact, outraged people tend to get more outraged, not less, when a company tries to compensate them before (or instead of) apologizing; it feels like a bribe. I think that’s the main reason why BP got no credit for its $20 billion pledge. It was offering compensation without having properly apologized first.

BP once knew better. In 1991 the American Trader, a tanker carrying BP oil, had a major spill off the coast of Huntington Beach, California. BP America CEO James Ross flew to the scene, and was asked by reporters whether he considered the spill BP’s fault. Just as Deepwater Horizon wasn’t BP’s rig, American Trader wasn’t BP’s tanker, and Ross could have said, “No, we’re the victim here; that damn tanker spilled our oil!” Instead, what BP did in 1991 was the opposite of what BP did in 2010: It took moral responsibility but not legal responsibility. “Our lawyers tell us it’s not our fault,” Ross said. “But we feel like it’s our fault, and we’re going to act like it’s our fault.” (I have no source for this quote except my memory and my own prior publications; it’s best considered a paraphrase.) Whereas BP’s reputation was devastated in 2010, in 1991 the company’s reputation actually improved in the months after the American Trader spill.

Taking moral responsibility contributes to forgiveness, even without taking legal responsibility. By contrast, taking legal responsibility without taking moral responsibility has no reputational value whatever. Contrition must come before restitution.

Here’s an equally important point: Contrition must continue even after restitution is complete.

As we all know in our personal lives, saying you’re sorry isn’t something you do once and then move on. It’s something you must do again and again, until your victim allows you to move on.

Blogging recently about Whitney Houston, Bobby Brown, and Chris Brown on the website of the Canadian magazine Maclean’s, reporter Emma Teitel got it exactly right:

This latest case also highlighted the secondary sin of the Browns, the one that no one gets a free pass on, no matter how many Grammys he cops: not the abuse of a person, but the abuse of remorse. We might be able to one day forgive a celebrity for beating on a girl, that is – but not for acting like it didn’t happen. We might be able to forget – but only if he doesn’t.

Think of when a friend has done you wrong – when a person you’ve recently forgiven for something you previously thought unforgivable stops apologizing for everything he does and starts having guilt-free fun again, you begin to wonder how contrite he was to start with. In other words, even though you have forgiven him for the original sin, you can’t forgive him for forgiving himself….

What does genuine, effective remorse look like? When 22 Canadians died in the Maple Leaf Foods listeriosis outbreak in 2008, CEO Michael McCain delivered one of the best public apologies in recent history, and more importantly, he kept on delivering. A year after the outbreak, even though the company’s profits had improved since the inevitable drop, McCain took out a full page ad in three Canadian daily newspapers commemorating the anniversary of the tragedy. “On behalf of our 24,000 employees,” the ad read, “we will never forget.” What McCain understood, that the two Browns likely never will, is that the only way people can put the past behind them is if you do not. The option to forget applies only to the victim, or the audience; never the perpetrator. It’s only when this equation is satisfied, as F. Scott Fitzgerald wrote, that “forgotten is forgiven.”

To its credit, BP has continued to talk about the Deepwater Horizon blowout and oil spill; it runs lots of ads “reporting” on how the recovery is going. (After a decent hiatus, it now runs ordinary commercial ads as well.) That’s important: As Teitel points out, the rest of us can “forget” only if we can see that BP hasn’t forgotten. For the foreseeable future, BP should talk about Deepwater Horizon whenever it talks about corporate social responsibility or about issues of environment, health, and safety.

On this dimension, Exxon mishandled contrition after the 1989 Exxon Valdez spill even worse than BP mishandled contrition after Deepwater Horizon. A year or two after the Valdez spill, my family and I visited Exxon’s “Universe of Energy” pavilion at Epcot, part of Walt Disney World in Orlando, Florida. There were endless displays about the environment, but nothing about Valdez! It was an extraordinary icebreaker. Total strangers were commenting to each other, “Can you believe those bastards didn’t even mention Valdez?”

BP is doing a bit better than Exxon did; at least it’s not ignoring the spill and hoping people will forget. But it has still never properly apologized. An adequate apology has to show at least three things: regret, sympathy, and moral responsibility. You have to wish it hadn’t happened, feel bad for the victims it happened to (not for yourself), and acknowledge that you are at least in part to blame. Nearly two years after the Deepwater Horizon accident, BP has still achieved just one of the three: regret.

What has been the resulting impact on BP’s reputation?

Like your first question, this one really calls for survey data. I don’t have any of my own, and I haven’t studied most of the surveys that are available.

For years after Valdez I believed that Exxon was paying an ongoing reputational price for that spill – a price far higher than it would have paid if it had been properly contrite. Every time there’s an oil spill, I used to speculate, millions of people actively hope it’ll be an Exxon spill. Now I suspect they hope it’ll be a BP spill.

Similarly, I used to think Exxon probably had to offer higher salaries to engineers and other employees than its peer companies, a “stigma premium” to people who’d rather not have to tell disapproving friends and family that they took a job with Exxon. The alternative was to settle for less qualified new hires than it might otherwise have gotten … theoretically contributing to future accidents (among other costs). Now, I suspect, BP will have to pay a stigma premium or settle for second-best.

Please note that I have no proof for these speculations. I have shared them with lots of oil industry clients and audiences. Sometimes they tell me I’m right; sometimes they tell me I’m wrong. Odds are they don’t know either.

One difference between the two accidents is worth mentioning. After Valdez, my industry contacts often told me it was ironic that it was Exxon’s spill, because Exxon was considered a real safety leader. After Deepwater Horizon, by contrast, my industry contacts seemed unsurprised, sometimes suggesting that if something like this was going to happen to one of the majors it was pretty likely to be BP. I have no idea if this difference between Exxon’s and BP’s reputations inside the industry bears any resemblance to reality on the ground (and on the rig) – but the reputational difference is real.

Perhaps the most intriguing possible reputational impact of BP’s handling of Deepwater Horizon is the reluctance of many people to notice that the Gulf of Mexico seems to be recovering. Or let me say that more tentatively, because I have no expertise on the current and future health of Gulf ecosystems: People are reluctant to credit claims that the Gulf of Mexico is recovering.

Large numbers of Americans, I believe, are deeply committed to the view that the Deepwater Horizon accident was an irremediable environmental and public health disaster – and, moreover, that it was BP’s irremediable environmental and public health disaster, evidence of BP’s malfeasance. From the limited public opinion data I have seen, this view is held by a number of crucial stakeholder groups – especially environmentally conscious Americans who do not live or work near the Gulf Coast. It’s not just that that’s what they believe. That’s what they want to believe. They want Deepwater Horizon to have been a BP disaster. They will resist evidence to the contrary, even if the evidence might otherwise strike them as persuasive.

This is a classic outrage management problem. People who hate you want to keep on hating you. They don’t want to learn that what they hate you for didn’t turn out so bad after all (far less that it wasn’t entirely your fault in the first place). Logic says they’ll hate you less if they learn these things. “Psychologic” says they’re extremely resistant to learning these things until they hate you less.

In large measure because of BP’s failure to take moral responsibility, I believe, millions of people remain committed to blaming BP for perpetrating an irremediable disaster – and are therefore resistant to any evidence of Gulf recovery. If I’m right, then BP must find a way to help people feel entitled to keep blaming it for Deepwater Horizon even if Deepwater Horizon turns out not to have been so disastrous after all. Only by disentangling blame from disastrousness can BP open up its critics to evidence of recovery. Later, perhaps, that may open them up to blaming BP less.

Part of the problem, of course, is valid skepticism about conflicts of interest. Understanding that it would have no credibility on the topic of Gulf recovery, BP wisely set up a separate organization to fund research into impacts of the spill. But it’s still BP’s money funding the research. Does BP exercise undue influence that might contaminate the results? I don’t know. What I know is that many people assume it does, and want to assume it does – because they don’t want to believe that Deepwater Horizon wasn’t an irremediable disaster.

The animus against BP and the widespread desire not to believe that the Gulf is recovering well also affects researchers. I have heard credible stories about independent academics doing studies of spill impact, finding much less damage than they expected, and deciding not to publish, lest their colleagues think they were shilling for BP.

But there are ways to insulate BP from the research it is funding, ways that could make the results (however they turn out) credible to a skeptical but open-minded observer. The more fundamental problem is how to convert people who are determined to see Deepwater Horizon as a disaster into skeptical but open-minded observers. I don’t think that can be done without taking moral responsibility for the spill.

Conflict-of-Interest Note: I have consulted periodically for BP since the 1980s, including work on its 1990 American Trader oil spill in Huntington Beach, California. In 1992, BP published an admiring profile of me in its house magazine, Shield. My most recent work for BP was in 2003, on the Baku–Tbilisi–Ceyhan pipeline.

I would have liked to help with Deepwater Horizon, but I was never asked – so I commented publicly from the sidelines instead. But in the summer of 2011 I did have some discussions with the Gulf Coast Restoration Organization, a BP-funded operation, about what it would take to create a public that could experience good news about the Gulf as good news, rather than experiencing it as BP propaganda and refusing to credit it. I also wanted to help GCRO avoid overstating the good news, and help it fully acknowledge the bad news and the long-term ecological uncertainties. I did a preliminary consultation along those lines, and GCRO went so far as to get me under contract with its PR agency, so the paperwork was in place to bring me in. But they never brought me in.

name:	Gordon This guestbook entry is categorized as:
field:	Engineer
date:	March 2, 2012
location:	California, U.S.

comment:

I know this might be a little old but I am new to your site.

I am not sure if you were aware but during the Fukushima disaster there was a quite interesting phenomenon that took place in China – a run on table salt as a result of a comment on the Chinese equivalent to Twitter.

Have you followed this at all? If so, do you have any observations about how the Chinese handled the situation?

peter responds:

A devastating March 2011 tsunami led to serious problems at several of Japan’s nuclear power plants in and around Fukushima. The resulting radiation releases in Japan were significant and could have been far worse. Fears that under some scenarios significant radioactivity might reach other countries – including both China and the U.S. (especially Alaska) – were widespread.

That was the context for China’s now-famous run on salt. One measure of its fame: On February 28, 2012, nearly a year later, I googled “panic buying disease rumor.” Nine of the first ten listings were about the desperate efforts of Chinese consumers to stockpile salt during the Fukushima crisis.

The English edition of the official newspaper People’s Daily began its March 18 story this way:

Worried shoppers stripped stores of salt in Beijing, Shanghai and other parts of China on Thursday in the false belief that it can guard against radiation exposure, even though any fallout from a crippled Japanese nuclear power plant is unlikely to reach the country.

The panic buying was triggered by rumors that iodized salt could help ward off radiation poisoning – part of the swirl of misinformation crisscrossing the region in response to Japan’s nuclear emergency.

The decision to stockpile extra salt was grounded in two beliefs – that Japanese radiation might get to China, and that if it did salt might help. The first belief was credible if the situation in Fukushima had kept worsening. The second belief was mistaken, but it wasn’t foolish.

Radioactive Iodine-131 is one of the likely emissions from radiation emergencies of various sorts. I-131 bioconcentrates in the thyroid, where it can cause thyroid cancer. The best protection is to flood the thyroid with non-radioactive iodine, thus keeping the body from taking up so much I-131. The U.S. has had a recurring controversy for years over whether to advise people living near nuclear power plants to stockpile potassium iodide pills to take in the event of a nuclear emergency. The nays usually win, not because the potassium iodide wouldn’t be needed or wouldn’t work but because the authorities don’t want to frighten nuclear plant neighbors by urging preparedness.

In China as in the U.S., table salt is iodized. So it was rational to think it might help against Fukushima radiation. Unfortunately, there’s not enough iodine in table salt to do the job unless people consumed impossible (and quite possibly deadly) quantities of salt. The World Health Organization (WHO) was widely cited at the time to the effect that it would take 80 tablespoons of salt to achieve the prophylactic effect of one potassium iodide pill.

According to many sources, China’s run on salt was also provoked by a fear that Fukushima radiation might contaminate the salt in the ocean. That’s not so rational. For one thing, most Chinese table salt isn’t sea salt; it’s mined on land. For another, it would take an unimaginably huge radiation release to render sea salt unusable. At that point we’d all have far more urgent problems than finding a safe source of salt.

I don’t know what role the heavily censored Weibo (or perhaps another of China’s equivalents of Twitter) played in the rumors about salt and Fukushima radiation. Most news stories say the rumors traveled mostly via text messages on mobile telephones.

The word “rumor” is usually pejorative; it’s used mostly to describe rumors that are false. But many rumors aren’t false. In this case:

• Some of the rumors were true – e.g. that Fukushima radiation had leaked into the sea.
• Some were possible though they never materialized – e.g. that radiation plumes from Japan could reach China.
• Some were mistaken but rational – e.g. that the iodine in table salt could help protect against radiation-induced illness.
• And some were a little crazy – e.g. that people should stockpile salt in case Fukushima contaminated the world’s salt supply.

I’m even less comfortable with the term “panic buying,” though People’s Daily and nearly everyone else used it to describe China’s run on salt. In a crisis situation – or what looks like a possible crisis situation – people often overreact initially. Appropriating a term from psychiatry (and from my wife and colleague Jody Lanard), I often call this initial overreaction an “adjustment reaction.” Adjustment reactions are common, automatic, temporary, small, and useful; they are not panic. (See “Tsunami Risk Communication: Warnings and the Myth of Panic.”

One characteristic of adjustment reactions is looking for things to do to help protect yourself and your loved ones during the crisis. People need to do something to feel some control. And sometimes they choose unwisely – not because they’re panicking but because it’s hard to figure out what to do (and whom to trust) early on in a crisis.

So rumors rule the roost. And runs on commodities rumored to help are commonplace. That’s not really “panic buying.”

A few years ago, as our concern about bird flu increased, Jody and I convinced our doctor to give us prescriptions for Tamiflu. We filled the scrips, and ever since Tamiflu has been a component of our travel kits. You could argue that we’re over-cautious or even that we’re selfish – but not, I think, that we’re panicking. In January 2006 we wrote a long column on personal Tamiflu stockpiling, asserting among other things that “[i]t is clear that you’re better off with it than without it.”

Assume for a moment that table salt would have been useful if the Fukushima crisis had worsened and radiation has started drifting from Japan toward China. Given that (mistaken) assumption, it follows that the more Chinese families who already had an ample salt stockpile, the better. If salt had been useful, it would have been most useful already on people’s shelves.

Of course a run on any commodity can easily produce a temporary shortage. The ideal is for as many people as possible to buy as early as possible – before the crisis strikes – so there is time to replenish the supply for the next wave of stockpilers. What you don’t want is for everyone to wait (“stay calm” and take no precautions) till mid-crisis … and then all try to buy at the same time.

During Fukushima, some U.S. residents stocked up on potassium iodide. Supplies quickly ran out, and survivalist blogs were full of advice on how to process iodine from other, more available sources to make it usable for internal consumption. As far as I know we escaped the table salt mistake, but not the fear that Fukushima radiation might make it to our shores.

My advice to authorities for coping with adjustment reactions is not to try to prevent the adjustment reaction, but rather to try to guide it. If possible, offer people things to do that will help. Explain why what they’re tempted to do won’t help (if it won’t), even though it seems entirely rational to clear-thinking non-experts. Make sure your explanations are empathic rather than contemptuous. Tell people that you know they’re not panicking, you see the logic behind their impulse to stockpile iodized salt, but here’s why following that impulse won’t work, or isn’t needed, or both.

In addition to being empathic, arguments against stockpiling need to be sound. The arguments made by U.S. public health authorities against personal Tamiflu stockpiling were almost entirely specious.

Chinese government arguments against stockpiling salt were sound, but they certainly weren’t empathic. (And they almost certainly were highly distrusted.) Official statements and official newspapers emphasized that significant radiation was unlikely to reach China from Fukushima, that even if it did salt wouldn’t help, and that Chinese salt supplies were extensive and mostly land-based. I can’t find officials saying that it’s natural to be afraid, or suggesting other things Chinese citizens might do to protect themselves from possible radiation, or acknowledging that the iodine in table salt makes it seem like a sensible precaution until you know how much salt you’d need to consume to make a difference.

Instead, officials condemned the rumors. Here’s another passage from the March 18 People’s Daily story:

The Chinese government also weighed in Thursday, with Foreign Ministry spokeswoman Jiang Yu saying, “I do not see any necessity to panic.”

In its notice, the Development and Reform Commission also urged local authorities to take “immediate action to monitor the market prices and resolutely crack down on illegal acts, including spreading rumors to deceive the public.”

Michael O’Leary, WHO’s representative in China, called on governments and individuals to “take steps to halt these rumors, which are harmful to public morale.”

I don’t know if China has crisis-driven runs on products more than the U.S. and other countries do. But it makes sense that it might, because the Chinese government is so widely (and wisely) distrusted by its people – and especially distrusted in times of crisis.

This is, after all, the government that in 2003 had falsely claimed that there was no SARS in Beijing. Beijing officials juggled SARS patients in and out of hospital rooms, even hiding them in ambulances in order to keep a visiting World Health Organization team from finding them – an image worthy of French farce if it hadn’t been so deadly. When it came to assessing how serious the SARS outbreak was and what to do about it, the Chinese people were pretty much on their own. Rumor was all they had. So when a rumor circulated that boiling vinegar might kill the SARS virus, a lot of people in China boiled vinegar.

Are Chinese people also more superstitious than Americans? The stereotype says so, but it’s hard to judge. Their superstitions look more superstitious to us; our superstitions probably look more superstitious to them. What’s certainly true is that the (earned) mistrust of government in China is a higher than the (also earned) mistrust of government in the U.S. But ours is high enough; consider all the Americans who mistrust government reassurances about the safety of vaccines.

Bottom line: When your government tells you that salt won’t help, or that significant radiation won’t reach you, the question is whether you believe what you’re told. A lot of Chinese people didn’t.

Even the People’s Daily acknowledged the role of distrust in China’s run on salt, though just barely. The online version of the March 18 story runs 36 paragraphs without mentioning trust. The 37th and final paragraph reads in its entirety: “Others worry the phenomenon showed just how far people’s trust in official information has diminished.” You don’t have to be an experienced China-watcher to sense that the story must have contained more along these lines before the censors got to it.

Western news stories were predictably more willing to ascribe the run on salt to mistrust of government. Here’s the lede of a March 21 Time story:

Remember the great salt rush of China? For those who missed it, here’s a quick summary of what happened:

Following reports of radiation leaks at Fukushima’s Daiichi plant, Chinese consumers got nervous. Their rather understandable fear of radiation was compounded by doubts about their government’s willingness to share information. So they took their safety into their own hands – or tried.

There is also extensive evidence that the Japanese government suppressed a lot of alarming information (and even-more-alarming speculation) about Fukushima. If the Chinese government had wanted to be totally candid with its people, it would have had to say it had no answers to the most important questions.

The key to building trust is candor, especially admissions against interest. If you have told me in the past when something was dangerous, I’m likelier to believe you when you tell me later that something is safe.

Acknowledging uncertainty is also important – and even proclaiming uncertainty. If you sound overconfident and turn out wrong, trust is devastated.

Empathy is fundamental to trust as well. It’s possible to be coldly accurate and slowly build trust; some surgeons do that their whole careers. But trust builds a lot more quickly if you show some warmth, some humanity. Especially useful is acknowledging the validity of people’s fears. Even when those fears are technically mistaken, you still need to validate that they’re natural, normal, widespread, and rational before explaining why you think they’re incorrect. You can’t effectively tell people they’re mistaken if it sounds like you’re telling them they’re stupid.

Social media speed rumors, of course. Social media also speed corrections of false rumors. (Remember: Not all rumors are false! WHO finds out about infectious disease outbreaks in China largely by monitoring the rumor mill.) Twitter and Weibo don’t change the basics of crisis communication: Tell what you know; tell what you don’t know; tell how sure you are; do it all empathically.

It’s almost impossible to correct a false rumor you’re not willing to mention. At least the Chinese government acknowledged that people were buying up salt because they mistakenly thought it might help protect them from Fukushima radiation. My clients, both government and corporate, often hesitate to respond to rumors at all, for fear of spreading them in the process. That might make sense if you’re pretty sure the rumor is expiring, not expanding. But the protocol for correcting false rumors starts with acknowledging them. For the rest of the protocol, see my 2008 column, “Rumors: Information Is the Antidote.”

name:	Erich Janka
field:	Risk consultant
date:	February 24, 2012
location:	Austria

comment:

I just read your list of “outrage factors.”

Now I wonder if you consider the “extent of disfigurement of victims” as one of these factors and if you can provide some evidence for your judgment.

peter responds:

Disfigurement isn’t on my list of outrage factors, or on any such list I’ve seen. But it’s pretty obviously related to outrage.

If forced to locate it somewhere, I’d probably stick it in under dread (and dread’s close cousin disgust – also not explicitly on the list). Certainly a lot of people dread disfigurement more than death itself. And a lot of people have an extremely strong response to other people’s disfigurement. Some can’t look and others can’t look away; both groups are surely experiencing something in the outrage category.

It’s easy to come up with examples of hazards to which many people overreact because of the disfigurement factor. Leprosy comes immediately to mind. (On the other hand, the disfigurement potential of automobile accidents doesn’t seem to register for most people. We need to drive or like to drive, so we stay in denial about the danger.)

Having used terms like “obviously,” certainly,” and “surely,” I now need to acknowledge that I have no evidence whatever. There may be some; I haven’t scoured the literature. But I don’t have any.

It’s true that my judgments about outrage are grounded in 40 years of consulting. But accumulated experience and “anecdotal evidence” are a poor substitute for a cluster of methodologically sound studies. As researchers in medicine have come to realize, clinical experience – including mine – is usually overconfident and often mistaken. (A single unreplicated study isn’t very reliable either, of course.)

name:	Andrew This guestbook entry is categorized as:
field:	Risk management communications
date:	February 7, 2012
location:	Canada

comment:

We have permitted cell phone providers to install their antennae on a number of rooftops at our large college.

The top-floor occupants of one of the buildings have come forward with high levels of outrage over what they believe are dangerous levels of electromagnetic radiation in their offices. These are scientists and smart people and believe there is ample evidence to support their view.

We tested the area and found the levels are indeed measurably higher than background levels – but several thousand times lower than Health Canada guidelines.

There are things we can do to lower the levels of radiation (reflective paint, ceiling tiles, possibly repositioning the antennae) but they are expensive and eventually everyone will want them!

The university official in charge, my boss, believes we may have no choice but to say that we follow the guidelines and are well within range and so we are unable to do ANYTHING for you. Their outrage will, of course, grow, and sooner or later the media will attend (not that we couldn't manage it but it’s not desirable) and some individuals will surely refuse to come to work, and eventually other building occupants will likely become outraged.

Any advice on how to manage this would be appreciated!

peter responds:

I think your management rightly wants to stress that the EMFs produced by the cell phone towers/masts/antennae on your rooftops are way within government guidelines. I wouldn’t confine myself to just the Health Canada guidelines. Find out what the most stringent cell tower EMF guidelines in the world are, and point out (if it’s true) that the measured emissions from your antennae are well within those guidelines too.

Don’t make your worried stakeholders take your word for it! Encourage them to take their own measurements – both at the source (with due precautions against the risk of falling off the roof) and in the space they’re actually occupying.

In other words, you should establish that what’s going on at your college is going on pretty much everywhere in the world. If Canada’s standards are too lax, everybody’s standards are too lax. And if the antennae on your rooftops are a threat to health, we’re all in deep trouble.

Acknowledge, acknowledge, acknowledge

Then immediately acknowledge that this is possible – maybe not likely, but certainly possible.

You can and should insist that the weight of expert opinion says the risk from cell phone towers is either very low or nonexistent. That’s what it usually means when most studies find nothing but a few studies find a possible problem. The most serious cell phone risk almost certainly comes trying to drive or do other dangerous tasks while talking or texting.

You might also point out that some people think having cell towers nearby actually decreases the health risk to users because the phone that’s nestled next to people’s brains doesn’t have to work as hard to pull in a signal. But don’t lean heavily on this point; the science that suggests cell phones might be dangerous is as wobbly as the science that suggests cell phone antennae might be dangerous.

Despite the weight of expert opinion, a few experts do believe that the world is making a terrible mistake, or at least that the world might be making a terrible mistake and should be much more cautious about this new technology. This is the point you should stress most. There are some studies that point to a possible risk from cell phone antennae; there are some health effects with latencies so long they might not have shown up yet in the research; nothing is ever firmly and forever “settled” in science.

It does happen from time to time that mainstream expert opinion turns out wrong. Expert opinion about the risk of elemental mercury and ionizing radiation, to cite two famous examples, has changed radically over the years. In the 1950s children routinely played with mercury and had their shoes fitted with unshielded X-ray fluoroscopes.

Here are some other things you should acknowledge, if they’re true:

• “We made this decision without first inviting people in the buildings, and especially those nearest the proposed antenna locations, to get involved.”
• “When people started raising health concerns, we were initially unresponsive and sometimes came across as almost scornful.”
• “We’re making some money from hosting the antennae, so we have a conflict of interest when we start asserting that there’s no significant risk.”
• “The people who are expressing concern are facing this risk, if there is one, without sharing in the financial benefit. This is true even though the money is spent on college priorities, and even though many people do use their cell phones on campus and benefit from good reception.”

You should also acknowledge that anxiety about cell towers is a common concern around the world – so the people expressing such anxiety on your campus are in no way weird. And anxiety about any risk is itself a documented health hazard – so even if your concerned stakeholders turn out to be technically mistaken, they’re still right.

In your shoes I would go into considerable detail about the many ways in which cell phone antennae are a significant source of outrage, independent of the hazard. I have mentioned several already: the control issue implicit in the college making risk-related decisions without consulting affected stakeholders; the fairness issue implicit in the college benefiting from renting space on its rooftops without sharing the proceeds with those who will have to endure the resulting EMF exposure.

For a more detailed assessment of why cell towers arouse outrage, see “Not in Our Back Yard” by Simon Chapman and Sonia Wutzke, a 1997 application of my outrage components to mobile telephone tower controversies in Australia.

Also relevant is my 2010 Guestbook response to an inquiry about why people aren’t nearly as upset about the risk from cell phones as they are about the risk from cell phone towers. In a nutshell: Most people like their cell phones a lot and control their own cell phone use. But they dislike the towers that loom over their homes or workplaces, and they had little or no say in those towers’ placement. So they look for reasons to feel safe using their phones, but are wide open to reasons to resent the towers.

Another Guestbook entry may or may not be relevant to your situation. In 2003, I responded to a detailed Guestbook comment about the appearance of cell phone towers. As the author of the comment put it: “[T]here is certainly something about a lattice tower topped with angular forms and a dozen protruding antennas or high voltage insulators, that says ‘War of the Worlds’ to me.” Your antennae may be unobtrusive or even attractive; if they’re not, check out that comment as well.

All your acknowledgments should help reduce the outrage of the people already raising questions about antenna EMF risk, and help reduce the probable outrage of people hearing about the issue for the first time.

That’s a paradoxical prediction you may have trouble convincing your boss to accept. To people unfamiliar with risk communication, it’s far from obvious why telling people the ways in which they’re right calms their outrage instead of exacerbating it. We are all familiar with this phenomenon when we’re the ones who are outraged. We know how infuriated we get when corporations (or colleges) overstate the case for reassurance and deny or ignore the case for concern, and how substantially we calm down when they start empathically acknowledging our concerns and our good arguments instead. But it’s a tough sell to get the “reassurers” in a controversy to realize that it actually helps calm things down when they acknowledge that there are some valid arguments on the alarming side too.

My most fundamental point here is this: Even if your college isn’t going to do anything about people’s EMF concerns, it makes sense to talk to them about their concerns in ways that don’t add insult to injury – all the more so since a lot of potentially concerned people are watching the dialogue.

But better acknowledgment isn’t my only recommendation. I have two action recommendations as well.

I’m not going to recommend any engineering solutions to mitigate the risk – for three reasons:

• It’s not my field. You’ve got better people than me to advise you on ways to reduce the electromagnetic field from your rooftop antennae.
• If I’m reading your comment correctly, your college isn’t thinking seriously about an engineering solution anyway.
• Engineering solutions aren’t very good at mitigating outrage. In fact, sometimes they can exacerbate outrage (and perceived hazard) by implying that even you think the hazard is serious. For a detailed discussion of the complicated impact of precautions on outrage, see my 2003 essay, “Because People Are Concerned: How Should Public Outrage Affect Application of the Precautionary Principle?”

The two action recommendations that follow might have some impact on the hazard to which people are exposed. But I don’t see them as ways to reduce the hazard, or even as ways to reduce the outrage by reducing the hazard. I see them as ways to reduce the outrage directly.

Offer to move people

First, I would seriously consider a wide-open promise to move anybody who wants to be moved because of cell antenna EMF concerns.

Such a promise will obviously give concerned stakeholders ironclad control over their own risk exposure. That increase in control will significantly reduce their outrage.

Once the right to move is ironclad, each concerned individual can safely consider the benefits of moving (eliminated or at least much-reduced cell phone antenna risk) versus the inconvenience of moving (the hassles of the move itself; learning the ropes in a new location; losing their favorite parking place; being further from their favorite lunch spots; being further from colleagues, friends, and clerical assistants; etc.). Now that they’re in the driver’s seat, they can – and in fact they must – weigh a possible risk against a certain inconvenience. The antenna EMFs will no longer constitute a risk the college is unilaterally imposing on them. Instead, it will be a risk they’re deciding whether to accept voluntarily for the convenience of not having to move.

By shifting the locus of control, the offer to move people makes the antenna risk similar in outrage terms to the risk of the cell phone itself – and I’m guessing that most of the people objecting to the antennae continue to use their cell phones.

People can still object that they shouldn’t have to move; you should move the damn antennae instead. But how worried can they be about the health risk if the inconvenience of moving deters them from taking action to address the problem? Once they’re entitled to move, people will no longer have a reason to insist (and thereby convince themselves) that the risk is intolerable. Instead, they will have a reason to ask themselves whether it’s really bad enough that they need to take you up on your offer.

Bystanders – who are potential converts to the cause – will probably find your offer to move people fair and responsive. When nearly everybody who has expressed concern decides not to move (by far the likeliest outcome), bystanders will see this as pretty strong evidence that they don’t need to add cell phone antennae to their own worry lists.

I have helped several clients make this sort of offer. One example that comes to mind was a huge IAQ controversy in a U.S. government agency occupying a downtown office building. In that case, nobody opted to move.

If anybody does choose to move, you know he or she is really seriously worried about the risk – in which case accommodating the move is good health policy and good HR policy. Unless you’ve got scads of people looking for an excuse to get out of garrets under the eves, I think this offer will significantly defuse the controversy without significantly increasing administrative costs. It’s bound to be less costly than a big brouhaha.

Of course it can’t be a bluff; you must be willing to move people.

And it can’t be done in a nasty way: “If you’re stupid enough to be worried despite the data, we’ll move you, you jerk!”

Most importantly, it can’t be done belatedly. After outrage has taken on a life of its own, your offer may well be seen as too little too late. Eventually outraged people no longer want their concerns or grievances fairly addressed; they just want the source of their outrage punished. Outrage is much harder to ameliorate once it’s entrenched (though even a belated offer can help with bystanders).

Set up an advisory group

I would also think seriously about setting up some kind of advisory group on infrastructure risks.

If the college were seriously considering engineering steps to ameliorate the antenna EMF risk, I would suggest a narrowly focused advisory group on what to do about the antennae. That kind of narrow advisory committee was a key recommendation of my 2007 column on “Indoor Air Quality Risk Communication.” One of the most common mistakes landlords and employers make in IAQ controversies is to fix things without first consulting with the people who are most upset.

But it sounds like your college isn’t planning to “fix” anything. So a “cell phone antenna EMF risk mitigation advisory group” isn’t a good idea. You’re unlikely to accept any of its advice.

On the other hand, I think an “infrastructure risk advisory group” would make a lot of sense. Such a group would be tasked with considering a wide range of infrastructure risks – the cell phone antennae, of course, but also IAQ, fire, asbestos maybe, vulnerability to extreme weather events and other natural disasters, etc. The college administration would routinely seek its advice on various infrastructure risks, not only risks that administrators considered serious but also risks that were arousing stakeholder concern. Concerned stakeholders should also have direct access to the advisory group, so they could put an issue on the group’s agenda even if the administration preferred to avoid discussing it.

The big advantage of such a multi-risk group is its inevitable need to focus on comparative risk … and comparative everything else. With a dozen or more issues on its plate, the group would quickly see the importance of assessing each one on the various relevant metrics: the size of the risk; the size of the benefit; the cost of various mitigation options; the reliability of the data; etc. Are cell phone antennae really more dangerous than lab accidents? How much do we care about the money the college would lose if it abandoned those antenna contracts, not to mention all the complaints that would start pouring in about poor reception on campus?

Don’t make it a committee of worrywarts exclusively; involve some other folks too. But be sure to involve the most serious worrywarts – not just cell phone antenna worrywarts, but worrywarts about all sorts of infrastructure risks. It’s very instructive for people worried about X to spend time with colleagues who are just as worried about Y and Z (worries they’re likely to consider excessive or even silly).

You might even want to broaden the group’s purview beyond infrastructure risks to the full range of risks confronting college employees and students. A few hours talking about the campus rape rate or the threat of a severe flu pandemic can help put other risks in context. It would be fun and useful to ask the group to consider whether there ought to be campus safety rules restricting cell phone use, so members who are outraged about the antennae can come to terms with whether they’re strangely copasetic about their own phones.

I won’t repeat here all the additional advice about advisory groups in my October 2011 column on “Advice about Advisory Groups.”

name:	Jonathan C. Waldron This guestbook entry is categorized as:
field:	Dentist and retired naval officer
date:	January 19, 2012
location:	Georgia, U.S.

comment:

In the present information age that coincides with high-visibility media coverage of terror acts, reporting of various influenza genetic sequencing experiments – even in a limited way – carries a high risk. While knowledge and science cannot be kept in the dark, I believe that strict protocols need to be established at the national level to contain this information.

Of course the risk of a natural influenza pandemic is certain given enough time. Hopefully, the terror risk will raise the national priority of securing a more universal vaccine. This will not, however, end the threat as the vaccine will not be available in much of the world. Aside from the tragic loss of life, the potential for very significant economic and perhaps political change in the new service-based world economies is unpleasant to contemplate should there be a reoccurrence of the 1918 pandemic, or worse, spreading quickly via modern travel.

peter responds:

The event that provoked your comment is a December 2011 request by the U.S. government that two leading scientific journals edit some details out of papers they are planning to publish for fear that the original versions might help the bad guys intentionally launch a flu pandemic.

The risk communication issues this event raises are real – the need for dilemma-sharing, for example. But the risk perception issues it raises are especially fascinating – especially the contrast among three risks: the risk of an intentional attack, the risk of a laboratory accident, and the risk of a natural pandemic. I’m going to focus my response on risk perception.

Before addressing the differing risk perceptions of these three risks, let me start by summarizing the event itself.

And before I do that, here’s a necessary terminological clarification. The disease we’re going to be talking about is commonly called “bird flu” for short. There are many kinds of bird flu. The experts call this particular one HPAI H5N1. The “H5N1” part refers to one subtype of Influenza A; all subtypes of Influenza A, not just H5N1, can infect birds. The “HPAI” part stands for “highly pathogenic avian influenza”; some subtypes of bird flu, and some strains of H5N1, aren’t deadly enough to deserve that label, and are called “low pathogenic avian influenza” or LPAI instead.

The terminology gets more complicated still when a bird flu starts infecting other species. If it does so with great difficulty, it’s still “bird flu.” But if it starts spreading easily in a non-bird population, flu experts no longer think of it as avian influenza. (This helps explain the expert resistance to the term “swine flu” for a different flu strain that went pandemic in humans, notwithstanding its swine origins.)

In this article, I’m going to refer to HPAI H5N1 interchangeably as “bird flu” or “H5N1.” File away somewhere in your mind that it’s just one kind of H5N1, a particularly deadly kind; and that the whole reason we’re talking about it is because it may not be just a bird flu anymore. At the very least, it now exists as a ferret flu in two labs.

Making bird flu transmissible in humans

In December 2011, the U.S. government appealed to the editors of the journals Science and Nature to leave out certain key details in two research papers they had accepted for publication. This unprecedented request had been recommended by the National Science Advisory Board for Biosecurity (NSABB), an expert panel that had been asked by the U.S. National Institutes of Health (NIH) what should be done about the two studies.

Both papers reported successful efforts to create strains of the H5N1 influenza virus that were easily transmissible through the air between ferrets. Ferrets are considered the best animal model for studies of human influenza; the assumption is that a flu virus that passes easily from ferret to ferret will probably pass easily from human to human as well. So it’s likely (though not definite) that these two groups of scientists created a potentially pandemic strain of H5N1.

H5N1 – bird flu – is unprecedentedly virulent in humans. Since its first appearance in 1997, it has killed about 59% of the people known to have contracted it – compared to a mere 3% for the horrific 1918 flu pandemic, and an average of about 0.1% for the seasonal flu. But only a few hundred people have caught bird flu. H5N1 spreads easily from bird to bird (though not in all species), but only very rarely from bird to person, and vanishingly rarely from person to person … so far.

If the H5N1 virus out in the real world were ever to become capable of efficient human-to-human transmission while remaining just as deadly as it is now, the result would be a pandemic that would eclipse any other disaster in recorded history. It could theoretically kill billions before a vaccine could be developed, mass-manufactured, and distributed.

Obviously, nothing like that has happened so far. Scientists have seen bird flu mutations in the wild that moved the virus in the direction of human transmissibility, but they’ve never seen all the necessary mutations at once. Some scientists have speculated that the requisite combination of mutations might be impossible, or that any combination of mutations that would make the bird flu virus transmissible human-to-human would also make it less deadly to humans.

In 2011 two teams of scientists – one in the Netherlands and the other in the U.S. – successfully forced nature’s hand. Apparently, they took mutations that had occurred individually in the wild and made them happen simultaneously in the lab. Then they passed the mutated H5N1 virus through several cohorts of ferrets via nasal swabs – and discovered to their surprise that the ferrets had started transmitting the virus to other ferrets in nearby cages just by sneezing and coughing. Thus the scientists (and the ferrets) had created a bird flu virus that was easily transmissible from one ferret to another, and reportedly still deadly to the ferrets.

If ferrets are a reliable surrogate for humans, then the two 2011 studies proved that a cataclysmic H5N1 pandemic is a genuine possibility. They didn’t prove that such a pandemic is imminent, or even that it will ever happen – only that it isn’t impossible. Assuming the two unpublished studies did not yield identical mutations, they showed two ways it could happen.

The fact that H5N1 viruses in a lab can be made to do everything they need to do to launch a pandemic doesn’t mean they’ll ever do all the right things at the same time in nature. Monkeys can pound all the typewriter keys needed to write a Shakespeare sonnet. Billions of bird flu viruses have been mutating randomly for at least 14 years. So far they haven’t hit on the right combination of mutations. How likely are they to do so next week? How likely are they to do so sometime in the next 50 years? Nobody knows. But now we know it’s doable.

None of this is what the NSABB was asked to worry about. Its focus was on whether the two H5N1 papers might constitute a roadmap for someone intent on manufacturing a pandemic virus. The “someone” who might want to do that is usually referred to as a “terrorist,” and I will sometimes use this term as well. But the list of candidates includes not just terrorist groups, but also disgruntled or disturbed individuals and nations violating the Biological Weapons Convention.

To take this risk seriously, we must posit an individual, group, or government that intends to destroy the world, or that intends to blackmail the world with the threat of destruction, or that doesn’t mind devastating its supporters as well as its enemies, or that has secretly vaccinated its own people (or at least stockpiled some vaccine). None of these, sadly, is inconceivable.

To reduce the odds of facilitating such an attack, the NSABB recommended asking the two journals to omit methodological and technical details. The NIH agreed and the request was made. The NIH promised it would figure out a way to provide the omitted details to scientists judged to have a legitimate need for them. Science and Nature have the two articles on hold while they wait to see what the NIH comes up with.

The NSABB was apparently concerned as well about criticism that the two H5N1 studies had been allowed to proceed at all. It recommended adding more information to the papers about the goals and potential public health benefits of the research. And it recommended adding information about the measures taken by the two teams to try to ensure that the virus didn’t spread to lab workers or the general public.

It isn’t entirely clear whether the NSABB also recommended a moratorium on this sort of research while scientists and policymakers debate the pros and cons. Certainly its recommendations have launched such a debate.

Parsing the risks

The two ferret studies and their possible publication raise three quite different risks:

I’m not qualified to assess the relative size of these three risks. I’m not going to try. All three of these risks have the same potentially horrific outcome: an H5N1 pandemic. The question is which source of that outcome you think is likeliest – nature, malevolence, or human error. What you think should be done with the two papers depends largely on how you think an H5N1 pandemic is likeliest to start.

The other obviously relevant question is how useful you think access to the two research papers would be – to bioterrorists or to scientists. I’m not qualified to judge that either. (I wouldn’t be qualified even if I had access to the papers myself.) I have read arguments that enough is known already about how to bioengineer a pandemic strain that any terrorist with modest scientific acumen (and certainly any government with the resources to compel qualified scientists to do the necessary research) has no need for the papers. But I have also read arguments that that’s not so and the papers would be a huge leg-up for a would-be terrorist. I have read arguments that there’s not much to be gained for science or public health by following up on the research in the papers. But I have also read arguments that the papers could launch fruitful work on how to surveil for a pandemic strain and how to create a pandemic vaccine.

The NSABB inquiry poses five additional risks not posed by the two studies themselves:

I do have opinions about some of these risks.

The risk of scaring people is of course the risk most directly related to risk communication. And what risk communication teaches is that it’s hard to scare people, that it’s useful to scare people if the risk is serious (in proportion to its seriousness), and that most people can cope with being scared. See my column on “Adjustment Reactions” and my column with Jody Lanard on “Fear of Fear.”

So I’m not very worried about the risk of scaring people.

I am a lot more worried about the risk of distracting people’s attention from natural pandemics to bioterrorism.

Just do an outrage assessment of natural pandemics versus terrorist attacks, especially in the wake of the mild swine flu pandemic (widely misperceived as a false alarm) on the one hand and the 9/11 ten-year anniversary on the other.

Natural pandemics are, well, natural; terrorism isn’t. The same technical risk – in this case H5N1 – is a far bigger source of outrage if it’s intentional or even accidental than if it’s natural. Look at people’s strong reactions to oil spills compared to their unconcern about oil seeps. Look at the difference between radon emitted by uranium-bearing rock under your house and radon emitted by a mining company’s waste pile near your house. Look at methane in your drinking water before versus after a gas company starts fracking nearby.

In addition, terrorism is more memorable and more dreaded than a naturally occurring event. And terrorism is morally relevant, it’s “evil” as well as “dangerous.” In a battle to arouse outrage, bioterrorism beats nature hands-down.

It isn’t as easy as it once was to rev people up about a possible terrorist attack. The NSABB report wasn’t big front-page news either. But a new terrorist threat strikes journalists and the public as a lot more newsworthy than a bunch of scientists and public health professionals saying yet again that they’ve done a study and they’re worried about a pandemic. Been there, done that.

Your comment suggests you’re worried about both the natural pandemic risk and the bioterrorism risk. (You don’t mention lab accidents.) You express hope that the controversy over the NSABB report may help fuel public concern about an H5N1 pandemic, perhaps leading to a more urgent search for a universal flu vaccine. I am worried about the possibility of exactly the opposite effect: that concern about H5N1 bioterrorism will preempt concern about a natural H5N1 pandemic.

(My worry about bioterrorism and lab accidents is already high, but these studies didn’t increase it. The studies did increase my worry about a natural H5N1 pandemic.)

I’d have liked to see the two studies provoke a public debate over pandemic preparedness. Instead, they have provoked a public debate over the responsibility of scientists to avoid doing/publishing studies that might turn out dangerous.

The furor over whether flu experts should be permitted to conduct and publish research that increases the risk of bioterrorism may deter many experts from following up on opportunities to investigate the possibility of a natural pandemic. Yes, the questions raised are intellectually interesting, and they’re potentially enormously important to public health. But the research is going to be controversial. Funding may be hard to get and harder to sustain; external review of proposed methodologies is bound to be painstaking; security precautions are bound to be burdensome; if the research ever gets done, getting it published is bound to be a fight; along the way there’ll be endless meetings and media interviews. All that isn’t going to sound like an attractive package to the typical lab scientist.

Somehow, the two studies got hijacked. They are being used to raise questions about research responsibility, about bioterrorism, even about laboratory accidents. These are all important questions. But the questions the researchers meant to raise – about the risk of a natural H5N1 pandemic – may be getting lost in the shuffle.

I’m also worried, though not as worried, about the risk of distracting people from non-H5N1 risks (non-H5N1 lab accidents and non-H5N1 bioterrorism). I’m not claiming that it’s silly to worry about H5N1 when plague is out there, only that it’s silly to worry about H5N1 and not about plague – and a daunting list of other, comparable threats. I hope policymakers and the public will see the NSABB controversy as a window on those other threats, rather than a distraction from them.

But these communication-related risks – the risk of scaring people; the risk of distracting their attention from one risk to another – are sideshows. The big risk assessment question, obviously, is the comparative risk of three possible sources of a catastrophic H5N1 pandemic: naturally occurring mutation, bioterrorist attack, and laboratory accident. My “opinion” on that would be just a guess.

How flu experts see the risks

Flu experts are the people most entitled to an opinion about the probability of a devastating natural H5N1 pandemic. I haven’t seen any recent survey data showing whether expert opinion on this question has been influenced by the two new studies. But there are no signs yet of an upwelling of expert alarm – no new calls for a Universal Flu Vaccine Manhattan Project, no announcements that any of the top people are suspending their current research in order to focus on the urgent implications of the two studies. Maybe things like that have been happening behind the scenes. Or maybe they will begin happening after the two papers are published. But I don’t see any signs of it yet.

Highly-pathogenic H5N1 was first identified in Hong Kong in 1997 – but Hong Kong health officials killed every chicken they could find and the virus seemed to disappear. In 2004 it reappeared, and this time it spread widely in birds. It also spread to a small number of people, and killed more than half of them. Between 2004 and 2007 is when flu experts were most acutely worried about the possibility of an imminent H5N1 pandemic.

But their worry subsided as the pandemic failed to materialize. Bird flu continued to kill a terrifyingly high percentage of the few people it infected, but it showed no signs of acquiring the ability to sustain a chain of human-to-human transmission. Most flu experts continued to put a high priority on monitoring H5N1 carefully – both the virus itself and every single human case. But their public warnings about the possibility of an H5N1 pandemic became more and more tentative, almost pro forma. Before 2007, flu experts sometimes talked about H5N1 as a “terrifying” virus that “kept them up nights.” I haven’t heard them talking that way in the past few years.

Of course there’s a spectrum; flu experts don’t march in lockstep on the probability of a catastrophic H5N1 pandemic. And it’s possible that some experts are very worried but have decided to keep their worries to themselves. Maybe they’re afraid of frightening the public. Maybe they’re afraid of being accused of trying to frighten the public. Or maybe they’re afraid that influenza alarmism has lost credibility. They warned about a potential bird flu pandemic in 2004–2007 and it never happened. They finally got a flu pandemic in 2009–2010 – swine flu – and it was mild. So maybe they’re reluctant to let their new (or ongoing) worry show.

The two 2011 studies have undoubtedly reignited some H5N1 concern among some experts, but I doubt the overall level of expert anxiety is anywhere near as high today as it was in 2004–2007.

Whatever the current level of flu experts’ concern about a natural H5N1 pandemic, I’m certain it is higher than their concern about an H5N1 lab accident or an H5N1 terrorist attack – though here again there’s a spectrum of expert opinion.

This is not the place to review the extensive evidence that people who work in laboratories tend to underestimate the likelihood and magnitude of laboratory accidents. It’s a truism of risk perception – and of life – that familiarity breeds contempt; if you spend your days in labs you tend to lose your visceral sense that labs are dangerous places. The problem of insufficient concern (that is, insufficient outrage) is compounded by insufficient reporting and insufficient training.

Note this overconfident statement by a bird flu transmission researcher who works in a BSL-3 Enhanced lab:

In such labs, all workers wear full-body suits and breathe through powered respirators, said Daniel Perez, a virologist at the University of Maryland in College Park who studies interspecies transmission of a different kind of bird flu, H9N2, in the same kind of facility. Air is purified coming in and out.

“There’s no chance for the virus to escape,” Perez said.

Three weeks later, Dr. Perez was equally overconfident that there will be an H5N1 pandemic some day:

Individual mutations are already found in wild [H5N1] viruses, though none yet has all the mutations required for human-to-human transmission, Maryland’s Perez said in an interview.

“But it is not hard to imagine that nature will eventually find a way to do that. It’s not a question of if, but when,” he said.

As for an H5N1 terrorist attack, understandably and perhaps inevitably it’s mainly bioterrorism experts who are worried about that. Flu experts – much less so.

I don’t take much comfort from that fact. I remember all too well the U.S. battle over smallpox vaccination in 2002–2003. Intelligence experts insisted that terrorists might have or get the smallpox virus and launch a smallpox attack, so it was essential to vaccinate the population. But they said their evidence about the probability of an attack was classified and we’d just have to take their word for it. Public health experts insisted in return that a smallpox attack was vanishingly unlikely, and vaccinating millions of people would do more harm than good. But they had no evidence at all about the probability of an attack; their hunch seemed to be motivated largely by their pride in having “eliminated” smallpox, their nervousness about having saved a few virus samples in various labs, their distrust and dislike of intelligence agencies, and other nontechnical factors.

Also crucial, in my judgment, was what I later called public health’s “Blind Spot for Bad Guys.” My 2005 column with that title uses smallpox vaccination as one of several examples where public health officials have shrugged off – or simply not noticed – the risk of terrorism.

The dominant example in that column is an incident that passed almost unnoticed at the time (and since). Another potentially pandemic flu strain, H2N2, was erroneously included as an unidentified sample in hundreds of proficiency test kits sent to hospital laboratories around the world so they could test their lab workers’ ability to identify Influenza A in lab samples. Fearful that a lab accident might launch a pandemic, public health agencies okayed an urgent Friday afternoon fax to all the labs, telling them which sample was the potentially pandemic one and instructing them to destroy it. It’s not hard to imagine a disaffected weekend tech assistant somewhere in the world reading the fax and then spiriting the deadly sample out of the lab and into the hands of Al Qaida. But the public health experts involved seem not to have noticed that possibility.

When you consider that many health professionals are famously blasé about the risk of lab accidents, this is a remarkable story. Even a lab accident risk was sufficient to completely preempt the terrorism risk in the minds of the people who wrote and approved the fax. So I certainly don’t trust flu experts to take bioterrorism risk seriously enough.

Bioterrorism experts, on the other hand, may be inclined to overestimate and overstate bioterrorism risk … and to shrug off the risk of a natural influenza pandemic. They have their own blind spots.

And that is perhaps the most important point here. Everybody has blind spots.

Technical experts tend to imagine that their own risk assessments are purely data-driven. They may realize (and may even acknowledge) that there’s a lot of uncertainty in the data. But they’re unlikely to realize how much their interpretations of the data are driven by things like values, professional biases, self-interest, and even outrage – not to mention all the cognitive biases and universal distortions that Daniel Kahneman and Amos Tversky dubbed “heuristics.”

The term “risk perception” is almost always used to refer to somebody else’s risk perception, especially when we think that the perception in question is mistaken. I “analyze” or “assess” a risk. You merely “perceive” it – which is to say, you misperceive it. Technical experts in particular talk a lot more about the general public’s “risk perceptions” than about their own.

But we are all stuck in our perceptions.

I don’t know which path to a devastating H5N1 pandemic is likeliest – random mutation, intentional attack, or laboratory accident. I do know that opinions about the two 2011 H5N1 ferret papers depend largely on which path you think is likeliest. And I know that which path you think is likeliest – and which path I think is likeliest, and which path the NSABB members think is likeliest, and which path flu experts think is likeliest – depends largely on risk perception factors that have very little to do with the evidence.

name:	Anonymous This guestbook entry is categorized as:
field:	Health educator
date:	January 18, 2011
location:	New York, U.S.

comment:

I am working on a grant project with CDC and the Safe Injections Practices Coalition. The goal is to reduce the incidence of blood-borne disease transmission due to improper use of injection equipment, such as changing the needle but using the same syringe on multiple patients, accessing a multi-use vial with a syringe used on more than one patient, etc.

I’m sure you’re saying, “That doesn’t happen in the U.S., or only in rare circumstances.” The truth is, it DOES happen in an alarming number of instances, leading to outbreaks and the need for thousands of patients to get tested to determine their health status.

Anyway, that's the background.

I am trying to devise strategies to counter pervasive denial among providers who don’t think this is a problem. We’ve had training sessions where the chief clinician is insisting this is a waste of time – “we know what to do” – while his/her staff are telling us it definitely does occur.

Thus far I have recommended taking advantage of teachable moments (send reminder info when the issue is in the news; include recent headlines about injection-related outbreaks with educational communiqués). I have also suggested bringing the matter to the attention of malpractice insurers in the hope that they will help with educating their insureds and/or offer incentives for injection safety training.

We have also recruited representatives of professional societies whose members comprise the most likely offenders, and representatives of patient safety organizations onto a workgroup.

What am I missing? Can I play the cognitive dissonance card, and if so how? Any advice would be much appreciated!

peter responds:

The precaution advocacy recommendations you have come up with so far sound excellent to me. Let me elaborate on them a bit:

• I agree with you that teachable moments are crucial; they’re always crucial in precaution advocacy. (See #14 in my column on “How to Warn Apathetic People.”) In the case at hand, you need teachable moments not just to remind apathetic people of an issue they’re not paying much attention to, but also to persuade people in a kind of denial that the problem is real. (I’ll come back to denial later.) It might help if you could get some of the health professionals implicated in your “bad example” clips to say, “Yeah, we didn’t think we had a problem either. And then, this!”
• Insurers are a great advocate for you because they’re hard to dismiss as highfalutin experts endlessly and obsessively preaching the gospel of needle safety. When an insurer says “here’s how much we paid out in blood-borne disease transmission claims last year,” it sounds like business, not theory. If the insurer adds that it’ll cut the premium if the institution takes appropriate precautionary steps and hike the premium if the institution keeps on resisting, that sounds like business too.
• I really like putting “representatives of professional societies whose members comprise the most likely offenders” onto your workgroup. Their presence tells resisters that they have peers who think the issue is important. And of course they ought to have solid firsthand advice on how to pierce the resistance. Consider going a step further: Add a couple of victims to the workgroup, plus a couple of perpetrators (maybe administrators whose institutions messed up, or individual perps who feel terrible about what happened and want to be poster children for “Never again!”). Helping prevent future accidents should be cathartic for the victims; it’s a great penance for the perps, and reassures them that they’re not alone. And of course both victims and perps have a unique credibility you can’t possibly match.

I’m not sure how you can best “play the cognitive dissonance card,” but your mention of incentives raises one possibility. Big incentives motivate behavior change, but no dissonance; if you pay me a lot of money to do X, I’ll do it for the money, feel comfortable about doing it for the money, and therefore feel no particular need to reassess my attitude about the value of X when there’s no money to be made.

Tiny incentives, on the other hand, don’t motivate any behavior change or attitude change at all.

The ideal incentive is in the middle, enough that I change my behavior but not enough that I’m comfortable telling myself I did it for the incentive. So I’m left wondering why I bothered. This “why did I do that?” feeling is, of course, what Leon Festinger called cognitive dissonance; it leads me to seek out information that X is a smart thing to do. Assuming there is appropriate information there to be found – and it’s your job to make sure there is – my (incentivized) behavioral commitment makes me a lot likelier to find the information, absorb it, and build a long-lasting pro-X attitude out of it. Once I have a built-in pro-X attitude, I no longer need a steady stream of incentives or a steady stream of information to keep me doing X. Now I do it because I believe in it. (But occasional reminder campaigns are wise anyway; not everyone will have developed a solid pro-X attitude.)

Diagnosing the barriers

When I tried to think of other recommendations you might consider, I soon backed up to a more fundamental question: Why are your target clinicians and administrators resisting your message?

Your comment suggests a possible answer: Maybe they think “that doesn’t happen in the U.S.” “That” in this sentence could have at least two meanings.

Maybe your audience doesn’t think nosocomial blood-borne disease outbreaks happen in the U.S. In that case, of course, your job is straightforward and comparatively easy: Convince them that such outbreaks are far more common (and far more destructive) than they imagine. It would probably pay to start by acknowledging that their opinion is widespread and natural, perhaps because most of the outbreaks are insufficiently publicized. It’s always a good idea to validate that somebody’s opinion isn’t foolish before you present evidence that it’s mistaken. This is a key step in the risk communication game I call “donkey.”

Or maybe your audience knows that nosocomial blood-borne disease outbreaks happen in the U.S., but doesn’t think the errors that lead to the outbreaks happen. That would be a very different and much more interesting error. It implies a serious misperception about efficacy: a conviction that U.S. healthcare institutions are doing everything right and still the outbreaks keep happening, so obviously the precautions aren’t very effective. If that’s your precaution advocacy problem, there’s no point in documenting or dramatizing that the outbreaks happen; your audience knows that already. Instead, you need to demonstrate (and dramatize) that the precautions work when they’re implemented, but all too often they’re not implemented, or implemented incorrectly.

There are other possibilities.

This one strikes me as among the most likely: Your audience may believe the following:

1. Nosocomial outbreaks happen;
2. The precautions work;
3. Some other institutions don’t implement the precautions properly, which is why they get outbreaks; and
4. Our institution does implement the precautions properly, so we needn’t worry.

The first three beliefs are sound; it’s (d) that’s foiling your education efforts.

If that’s what’s going on, you shouldn’t misuse your own scarce resources by trying to sell (a), (b), and (c). They’re already sold, and your job is to unsell (d).

One possibility is to confront (d) head-on. For example, you could find a way to make it safe for staff to tell the boss what they’re telling you on the sly: “Those sorts of screw-ups happen here too.” But that’s pretty confrontational, and it might just exacerbate the resistance.

So consider deflecting your challenge. Instead of claiming directly that “you” get the precautions wrong sometimes, talk about peer institutions that overconfidently overestimated their own precautions … until the day they inadvertently launched an outbreak.

I have sometimes found it useful to skip (temporarily) both the effort to convince people that they’re vulnerable to X happening and the effort to teach them how to keep X from happening. Instead, I ask them to work on what they would do and say if X happened.

Ask your target clinicians and administrators to show you their plan for a big blood-borne outbreak – and a big blood-borne outbreak scandal – that traced back to them. If they haven’t got much of a plan, ask them to improvise one. Role-play not just rolling out their response, but also explaining how it happened, how sorry they are, and what they propose to do so it’ll never happen again.

After skeptics have spent a few hours imagining how they’d cope if X happened, they tend to be more receptive to the evidence that X might happen … and a lot more interested in hearing what additional steps they can take to make X less likely.

Of course you don’t want to imply that you think X – in this case, a blood-borne disease outbreak – is surely going to happen on their watch. You have no special reason to think it will; you only think it might – and they’re strongly defended against even that hypothesis. So put aside the questions of risk probability and risk prevention for a while, and focus first on risk response.

I have something more in mind here than any specific suggested intervention. My main point is that which interventions make sense depends on why you think your audience is resisting. It always pays to diagnose the barriers to your precaution advocacy efforts. Until you have figured out why your audience is resisting, you’re not likely to come up with the best ways to overcome their resistance.

Dealing with denial

So far I’ve focused mostly on ways to help convince clinicians and administrators that they really may have a problem (after analyzing why they think they don’t). But what if they already know they have a problem? What if they’re already aware that their institutions aren’t doing all that good a job of implementing the recommended precautions against blood-borne pathogen transmission – but they’re not willing to admit it, not to you and perhaps not even to themselves?

Your use of the phrase “pervasive denial among providers” in your comment suggests that this possibility is very much in your mind already.

So let’s take the word “denial” literally. Suppose the main barrier to your efforts isn’t apathy or overconfidence, but denial. Suppose you’re talking to people who can’t bear acknowledging, even to themselves, that they are not adequately protecting patients and staff against nosocomial blood-borne disease outbreaks.

Maybe they’re ashamed to admit they haven’t focused enough on training their people.

Maybe they’ve trained and retrained, their people keep making rookie mistakes anyway, and they’re ashamed to admit they haven’t a clue what else to try.

Maybe they’re pretty convinced there isn’t much they haven’t tried already without success. This is a different sort of efficacy problem than the one I discussed earlier. It’s not that they don’t think the precautions work. They don’t think they’ll ever be able to get their people to manage the precautions properly. That’s a pretty uncomfortable thing to admit, so they may go into denial about it, pretending even to themselves that their people are managing the precautions just fine.

When you’re talking to people in denial, insisting ever-more-emphatically and ever-more-dramatically that they have a problem isn’t the answer. That works if what you’re up against is apathy. If it’s denial, you’ll just push your audience more deeply into denial. Nor will it help to tell them they’re in denial; for obvious reasons, people in denial deny their denial too.

So how do you lure people out of denial?

The single most important strategy is to legitimize the emotions they’re denying, thus reducing the need to keep denying them. You don’t just validate that preventing blood-borne pathogen accidents is difficult; you validate that it’s upsetting to contemplate this risk and the difficulty of preventing it. And if necessary you deflect the validation. “You probably find this hard to think about” may be too intrusive. “A lot of lab directors find this hard to think about” is more empathic; it validates what listeners are feeling without directly accusing them of feeling it.

Offering people things to do also helps reduce their denial by giving them a greater sense of control. As psychiatrists sometimes put it: “Action binds anxiety.” Offering a choice of things to do works better still, since it mobilizes not just our ability to act but also our ability to decide. It’s a common mistake to try to convince an audience that action is needed before identifying what actions are worth considering. That’s good logic, but it’s not so good psychologic. If people are in denial, it’s easier for them to contemplate some things they could do before they confront the need to do something.

Take a look at my seminar handouts on “16 Reasons Why Employees Sometimes Ignore Safety Procedures” and “24 Reasons Why Employers Sometimes Ignore Safety Procedures.” And since these handouts are telegraphic, check out the related website articles at the bottom of each list.

A lot of the “Attitude Dimensions of Safety” on both lists are denial-related. Employees may ignore safety because thinking about the precautions frightens them, or because taking the precautions feels cowardly to them, or because they think their friends would laugh at them. Employers may ignore safety because taking precautions now would exacerbate their guilty feelings about prior accidents, or because contemplating possible safety deficiencies arouses their ego-defensiveness, or because they’re unconsciously hostile to their workforce and believe that careless employees deserve to have accidents.

Does anything on these two lists strike you as a potential reason why improper use of injection equipment continues to be a serious problem in so many healthcare settings?

When smart people are acting stupid about safety – failing to pay attention to a safety problem that’s crying out for their attention – sometimes the problem is just apathy. But sometimes something more psychologically complicated than apathy is at the root of their safety inattention. It’s motivated inattention. Assessing the underlying motives behind their resistance is the key to designing an effective intervention strategy.