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One of the things that baffles me about people is how they completely misunderstand risk. Lots of my friends panic about things that have no real chance of killing them, but ignore the things that will. This can lead us to make irrational decisions, and sometimes irrational policy. What really will kill us? Watch and learn.

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John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen - Graphics
Quick, what’s the number one killer of women in the United States? Did you say breast cancer? You’re not even close. What’s the number one killer of men? What about kids? The point here is that we as a people have no idea what’s gonna kill us. We’re afraid of things that have only a slim chance of hurting us and we ignore the real dangers. That’s the topic of this week’s Healthcare Triage.


In 2001, The American Academy of Pediatrics issued a policy statement that recommended that all kids less than two years of age sit in safety seats on airplanes, like they do in cars. This was a real problem for a lot of parents. You see, for those of you who don’t have kids, up until a child is two years old, they can ride in your lap on a plane. And you don’t have to buy them their own seat. While this may sound uncomfortable, I know any number of people including yours truly, who have flown holding an infant in their laps. When our first child was born, I was a fellow and my wife wasn’t working, so traveling to see family was a luxury. We couldn’t easily afford that extra ticket.

But the AAP wanted the FAA to require children to be restrained on aircraft. They also wanted me, as a parent, to buy a seat for my child. Finally, they informed me as a pediatrician, that it was my duty to tell all of my patients’ parents about this. Lots of people supported the AAP in this endeavor. They were scared to death of flying. They figured that if we were worried about protecting kids in cars, we damn well better protect them in airplanes.

But that fear of plane crashes is somewhat irrational. How much good would this policy actually do? Some enterprising researchers crunched the numbers and gave us more exact figures. They performed an econometric analysis to see what would happen if the FAA changed its rules. Here’s the first bit of awesomeness. The recommended policy would likely prevent about 0.4 child air crash deaths per year in the United States. Got that? Less than one child’s life might be saved in a whole year.

Now you may be thinking that this is still worth it. After all that child might be someone you know. There’s a problem though. If you make people buy seats for their children, they may not be able to afford to fly. Instead they might choose to drive. And driving is way more dangerous than flying. Driving is so unsafe that it turned out that this policy would increase the number of child deaths, if somewhere between five percent and ten percent of families decided to make a trip by car instead of by plane. Of course this calculation varied by the distance being driven, with longer trips incurring more car related danger. But if the average trip was 400 miles, and if just five percent of families chose to drive instead of fly, this policy would result in an increase in child deaths. Not so clear any more, is it?

Moreover this doesn’t take into account the cost of the policy. Lets say for the sake of argument that no families whatsoever would convert to a road trip. That’s not realistic, but go with it for a second. This means that we’d actually save lives under the mandatory restraint policy. Let’s also stipulate that the average cost of the policy would be about $200 for a seat for each small child flying. Sound OK? Under these simple and reasonable assumptions, the cost per each child death prevented would be 1.3 billion dollars. If you want to be precise, it was calculated to be $1,283,594,063. For comparison that’s about 33,000 times more per life year saved than the policies that mandate restraint in cars. It’s also pretty much the most expensive injury prevention policy imaginable.

All this because people panic about flying in a plane. They have no fear of driving though. Car accidents killed 895 five to fourteen year olds in 2010. Accidents in general killed more than 1,600 kids, which is more than were killed by all cancer, congenital malformations, suicide and homicide combined. Want to save kids’ lives? Prevent accidents, including car accidents.

So let’s move on. What’s the number two killer of kids and young adults aged 10 to 24? Ready? Suicide. You’d never know it by the way we minimize the importance of mental health. Close behind suicide is homicide. Think we’re doing a lot about that? Suicide and homicide each kill more than twice as many in this age group as cancer.

But most deaths occur in adults, so let’s talk about them. The number one killer of people overall in the United States is heart disease. Heart disease kills more people than all cancers combined. It kills more than four times as many people as respiratory diseases, and almost five times as many people as strokes. It’s heart disease, heart disease, heart disease. I know women are scared to death of breast cancer, but heart disease kills more women than all cancers combined. Breast cancer isn’t even the biggest cancer killer in women. In 2014 it’s expected that more than 72,000 women will die of lung cancer compared to only 40,000 from breast cancer. More than 300,000 women will die from heart disease.

Men are no better. They’re all panicked about prostrate cancer. And it’s expected that less than 30,000 men will die of prostrate cancer this year. Almost that many will die of colon and rectal cancer. Compare that to the more than 86,000 men that will die from lung cancer, or the more than 300,000 that will die from heart disease.

The tragedy here is that a lot of heart disease is preventable. We know what to do. A great deal of lung disease is preventable too if people would stop smoking. Breast cancer and prostrate cancer, there’s not nearly as much you can do. We obsess over organic food and artificial sweeteners and terrorist attacks and germs and whether cell phones will give us cancer. They won’t. And I’d wager tons of lives have been saved because they’re available to quickly get help in emergencies.

You know what kills adults? Heart disease. Wanna make that better? Take care of yourself, exercise and eat better. If you have to focus on cancer, then recognize that lung cancer is still far and away the biggest problem we face. You know what kills kids? Accidents. Then suicides, then homicides. Want to really make a difference in kids’ lives? Make those things more rare. We have the ability to act rationally. That will mean giving up our biases and refusing to fall prey to media campaigns and fads. We can do better.