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Playing “Cassandra” or “Crying Wolf”? – a challenge to information management in managing the public’s risk perception to health threats
- Niyi Awofeso (7 November 2007)
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Alopecia areata following Polonium-210 exposure: a psychological trigger?
- Abby E Macbeth, Nick Levell, Consultant Dermatologist. (6 December 2007)
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Niyi Awofeso, A/Prof. School of Public Health University of New South Wales, Sydney, Australia.
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I’ll like to congratulate Rubin et al on their elegant and informative study of risk perception by the public following an apparently targeted assassination using a radiological agent. The authors emphasize the need for detailed information on risk exposure and the tests or treatments on offer, in order to moderate public perceptions to potential health threats. A major dilemma for public health workers with regards to bio- terrorism threats, pandemic influenza (and perhaps climate change) is getting the balance right between playing “Cassandra” (the Greek woman blessed by Apollo to accurately fore-see the future, and cursed by making her audience not to take her predictions seriously) and Crying Wolf”. When faced with the potential for a deadly flu pandemic, or atrocious acts of violence or terrorism, being not too eager to assume any cost for our preventive or response actions is a complicated process that requires considerable expertise in risk assessment and information management. The tendency so far has been for public health workers and disaster preparedness officials to be overly conservative and support most preventive measures, irrespective of cost-effectiveness, as is apparently currently the case with terrorism threats. It is impractical to continue fund unsustainable disaster prevention programs or to remind the public about the imminent danger of terrorism, avian flu and climate change, and not be associated with either of these stereotypes. Perhaps we should worry less about public perceptions for the time being and focus on workable prevention and response strategies. The public will cooperate and suffer minimal adverse effects if prevention and response strategies to public health threats are perceived to be realistic, sustainable, well coordinated, and effective. Readings • Rubin JB et al. Public information needs after the poisoning of Alexander Litvenko with plutonium-210 in London. URL: http://www.bmj.com/cgi/content/full/bmj.39367.455243.BEv1 • Sadique MZ. Precautionary Behavior in Response to Perceived Threat of Pandemic Influenza. URL: http://www.cdc.gov/eid/content/13/9/1307.htm?s_cid=eid1307_e • Haas CN. The role of risk analysis in understanding bioterrorism. URL: http://www.blackwell-synergy.com/doi/abs/10.1111/0272- 4332.00239?journalCode=risk • Gupta DK. International terrorism and the costs of over-reaction. Public Money and Management, 2006, 26: 274-5. Competing interests: None declared |
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Abby E Macbeth, Specialist Registrar in Dermatology Norfolk and Norwich University Hospital, Colney Road, Norwich, Norfolk, NR4 7UZ, Nick Levell, Consultant Dermatologist.
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We read with interest the article by Rubin et al. surveying public perception of the risk of polonium-210 (210 Po) exposure and the quality of information provided.1 We report a case of alopecia areata following 210Po exposure where the alopecia was incorrectly thought to be a direct radiation effect. Our patient nursed Mr Litvinenko after admission for four consecutive nights in November 2006. Protective rubber gloves and a plastic apron were worn. Her urine sample was analysed and urinary levels of 210Po were found to be less than 30mBq/L. She received a letter advising her not to be concerned. Seven months following exposure, she presented with a three-month history of localised alopecia over the occipital region of the scalp which she had considered might be related to 210Po exposure. An eight- centimetre patch of localised, non-scarring alopecia had clear exclamation marks hairs, which lead to the diagnosis of alopecia areata. Whilst the onset of alopecia areata may have been co-incidental, the condition has been attributed to psychological stress.2 Exposure to 210Po, the investigations and media furore constituted a significant life event for our patient. Radiation alopecia is due to a direct susceptibility of the hair follicle to radiation during the anagen phase of hair growth, with no exclamation mark hairs, making this diagnosis unlikely.3 Radiation is not a known direct trigger for alopecia areata. Many medical conditions may be precipitated or aggravated by psychological stress. A complete assessment of the effects of the 210Po incident will require medical follow up of the cohort of exposed individuals, regardless of the urinary level of the isotope. 1. Rubin GJ, Page L, Morgan O, Pinder R J, Riley P, Hatch S, et al. Public information needs after the poisoning of Alexander Litvinenko with polonium-210 in London: cross sectional telephone survey and qualitative analysis. BMJ 2007; 335: 1143 2. Manolache L, Benea V. Stress in patients with alopecia areata and vitiligo. J Eur Acad Dermatol Venereol. 2007 Aug; 21(7):921-8 3. Van Scott EJ, Reinertson RP. Detection of radiation effects on the hair roots of the human scalp. J Invest Dermatol 1957; 29: 205-16 Competing interests: None declared Editorial note
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