These hidden costs can take the form of resources such as time and money. Most egregiously, they can infringe upon our rights. The quarantining of healthcare workers possibly exposed to Ebola was out of an abundance of caution. There is a cost to the scientific enterprise when we make decisions about our public and private health out of an abundance of caution. Often, caution is cited to overturn rational thought, to deny evidence-based choices because of fear.
But does it reduce fear or act as a bureaucratic means to hide a fear that we do not wish to divulge, a real fear? The power of an abundance of caution, meant to calm, ironically comes from the fear the phrase engenders. An abundance of caution can hide much mischief; after all, caution restricts us. Isn’t the present debate about immigration based upon an abundance of caution? And wouldn’t there be a significant overlap in the people who deny caution’s role in immigration while simultaneously promoting an abundance of caution in, say, using GMO foods?
The beneficiary of an abundance of caution is the general public. But the phrase disguises the most direct beneficiary, the speaker. The phrase is lawyerly, enfolding layers of protection and a halo of ‘studied judgment’ upon the speaker. First, there is the speaker’s beneficence in citing a remote concern that, given its outcome, is too large to contemplate or court. If it appears, then all actions were taken or at least advised. And when the risk fails to materialize and statistically speaking, it rarely does, the speaker maintains the halo of considered thought and judgment, safety above all.
Now, this is not to say that an abundance of caution is unnecessary. It is, especially when evidence is scant and fear of possible consequences is not. Not all choices can be rationally made; not all options fit easily into risk and benefit. The difficulty with an abundance of caution is in mistaking those words for our meaning. It is OK to be afraid, but caution is not the antidote. We confuse our visceral response to fear, that anxiety that touches everything and nothing specifically, with a narrative our mind chooses when bathed in that anxiety. Nor is caution the solution to not knowing. An abundance of caution does not reconcile our rational and emotional selves; it further divides them. Would it not be better to directly address our fears and say we just don’t know than to hide behind an abundance of caution?
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
