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1、Unit 6 RisksRisks and YouAt some time or other, all of us have played the part of a hypochondriac, imagining that we have some terrible disease on the strength of very minor symptoms. Some people just have to hear about a new disease and they begin checking themselves to see if they may be suffering

2、 from it. But fear of disease is not our only fear, and neither is risk of disease the only risk we run. Modern life is full of all manner of threats-to our lives, our peace of mind, our families, and our future. And from these threats come questions that we must pose to ourselves: Is the food I buy

3、 safe? Are toys for my children likely to hurt them? Should my family avoid smoked meats? Am I likely to be robbed on vacations? Our uncertainties multiply indefinitely. Anxiety about the risks of life is a bit like hypochondria; in both, the fear or anxiety feeds on partial information. But one sha

4、rp difference exists between the two. The hypochondriac can usually turn to a physician to get a definitive clarification of the situation-either you have the suspected disease or you don't. It is much more difficult when anxiety about other forms of risk is concerned, because with many risks, t

5、he situation is not as simple. Risks are almost always a matter of probability rather than certainty. You may ask, "Should I wear a seat belt?" If you' re going to have a head-on collision, of course. But what if you get hit from the side and end up trapped inside the vehicle, unable t

6、o escape because of a damaged seat belt mechanism? So does this mean that you should spend the extra money for an air bag? Again, in head-on collisions, it may well save your life. But what if the bag accidentally inflates while you are driving down the highway, thus causing an accident that would n

7、ever have occurred otherwise? All of this is another way of saying that nothing we do is completely safe. There are risks, often potentially serious ones, associated with every hobby we have, every job we take, every food we eat-in other words, with every action. But the fact that there are risks as

8、sociated with everything we are going to do does not, or should not, reduce us to trembling neurotics. Some actions are riskier than others. The point is to inform ourselves about the relevant risks and then act accordingly. For example, larger cars are generally safer than small ones in collisions.

9、 But how much safer? The answer is that you are roughly twice as likely to die in a serious crash in a small car than in a large one. Yet larger cars generally cost more than small ones (and also use more gas, thus increasing the environmental risks!), so how do we decide when the reduced risks are

10、worth the added costs? The ultimate risk avoider might, for instance, buy a tank or an armored car, thus minimizing the risk of death or injury in a collision. But is the added cost and inconvenience worth the difference in price, even supposing you could afford it? We cannot begin to answer such qu

11、estions until we have a feel for the level of risks in question. So how do we measure the level of a risk? Some people seem to think that the answer is a simple number. We know, for instance, that about 25,000 people per year die in automobile accidents. By contrast, only about 300 die per year in m

12、ine accidents and disasters. Does that mean that riding in a car is much riskier than mining? Not necessarily. The fact is that some 200 million Americans regularly ride in automobiles in the United States every year; perhaps 700,000 are involved in mining. The relevant figure that we need to assess

13、 a risk is a ratio or fraction. The numerator of the fraction tells us how many people were killed or harmed as the result of a particular activity over a certain period of time; the denominator tells us how many people were involved in that activity during that time. All risk levels are thus ratios

14、 or fractions, with values between 0 (no risk) and 1 (totally risky). By reducing all risks to ratios or fractions of this sort, we can begin to compare different sorts of risks-like mining versus riding in a car. The larger this ratio, that is, the closer it is to 1, the riskier the activity in que

15、stion. In the case just discussed, we would find the relative safety of car travel and coal mining by dividing the numbers of lives lost in each by the number of people participating in each. Here, it is clear that the riskiness of traveling by car is about 1 death per 10,000 passengers; with mining

16、, the risk level is about 4 deaths per 10,000 miners. So although far more people are killed in car accidents than in mining, the latter turns out to be four times riskier than the former. Those ratios enable us to compare the risks of activities or situations as different as apples and oranges. If

17、you are opposed to risks, you will want to choose your activities by focusing on the small-ratio exposures. If you are reckless, then you are not likely to be afraid of higher ratios unless they get uncomfortably large. Once we understand that risk can never be totally eliminated from any situation

18、and that, therefore, nothing is completely safe, we will then see that the issue is not one of avoiding risks altogether but rather one of managing risks in a sensible way. Risk management requires two things: common sense and information about the character and degree of the risks we may be running

19、. 風(fēng)險(xiǎn)與你1 在說不定的某個(gè)時(shí)候,我們大家都曾充當(dāng)過疑病癥患者的角色,只憑一些輕微的癥狀便懷疑自己得了某種可怕的病。有的人只要一聽說一種新的疾病,就會(huì)去檢查,看自己是否可能患了這種病。然而,對疾病的恐懼并非我們唯一的恐懼。同樣,患病的危險(xiǎn)也并非我們唯一會(huì)遇上的危險(xiǎn)?,F(xiàn)代生活中充滿了各種各樣的威脅,諸如對我們生命的威脅,對我們平和心境的威脅,對我們家人的威脅,對我們未來的威脅。從而產(chǎn)生了好些問題,我們不得不問自己:我買的食品安全嗎?給孩子們的玩具會(huì)傷害他們嗎?我們家的人是不是不該吃熏肉?我度假時(shí)會(huì)不會(huì)遭搶劫?我們的疑慮就無休止地增加。2 對生活中風(fēng)險(xiǎn)的擔(dān)憂與疑病癥有相似之處;二者的恐懼或憂慮皆

20、起因于信息不全面。但二者之間也存在一個(gè)明顯的差別。疑病癥患者通常可以求助于醫(yī)生,以便澄清疑慮要么你得了你所懷疑的疾病,要么你沒得。但當(dāng)涉及到其它形式的風(fēng)險(xiǎn)時(shí),事情就要困難得多,因?yàn)閷υS多風(fēng)險(xiǎn)來說,情況并不那么簡單。3 風(fēng)險(xiǎn)幾乎總是一個(gè)可能性的問題而無確定性可言。你也許會(huì)問:“我該不該系安全帶?”如果你坐的車要與其它車正面相撞,那當(dāng)然該系安全帶。倘若你的車側(cè)面被撞,結(jié)果你被困在車?yán)?,又因安全帶裝置遭破壞而無法掙脫,那怎么辦呢?這是否意味著你該再花些錢在車內(nèi)安一個(gè)保險(xiǎn)氣袋呢?同樣,在正面相撞的情況下,保險(xiǎn)氣袋完全可以救你一命。但是,萬一正當(dāng)你在高速公路上開車時(shí),保險(xiǎn)氣袋突然意外充氣膨脹,從而導(dǎo)致了

21、本來絕不會(huì)發(fā)生的事故,那又該如何是好?4 上面說的這一切,只是從另一角度說明我們所做的事沒有一件是百分之百安全的。有些風(fēng)險(xiǎn)常常是潛在的重大風(fēng)險(xiǎn)與我們的每個(gè)業(yè)余愛好、所做的每項(xiàng)工作、所吃的每種食物有關(guān),換句話說,與所進(jìn)行的任何活動(dòng)有關(guān)。但我們又不能,也不該因危險(xiǎn)存在于我們將要做的每件事,而變成戰(zhàn)戰(zhàn)兢兢的神經(jīng)癥患者。有些活動(dòng)是比其它活動(dòng)更危險(xiǎn)。關(guān)鍵在于要讓自己了解相應(yīng)的風(fēng)險(xiǎn),然后相機(jī)行事。5 例如,兩車相撞時(shí),大車總的說來要比小車安全些??删烤鼓馨踩嗌倌??答案是這樣:在一起嚴(yán)重的車禍中坐小車喪生的可能性是坐大車的兩倍左右。然而,大車通常比小車貴(并且消耗更多的汽油,由此給環(huán)境帶來了更大的風(fēng)險(xiǎn)?。?/p>

22、。那么我們該怎樣確定什么時(shí)候值得為降低風(fēng)險(xiǎn)增加花費(fèi)呢?例如,避免風(fēng)險(xiǎn)最保險(xiǎn)的做法也許是去買一輛坦克或裝甲車,從而把撞車時(shí)死亡或受傷的風(fēng)險(xiǎn)降到最小。然而,即便你買得起,這筆額外的費(fèi)用以及忍受坦克或裝甲車所帶來的不便是否值得呢?6 在我們尚不知所涉及的風(fēng)險(xiǎn)程度之前,我們還無法回答這些問題。那么,我們該如何去衡量風(fēng)險(xiǎn)程度呢?有些人似乎認(rèn)為答案只不過是一個(gè)簡單的數(shù)字。例如,我們知道每年大約有25,000 人死于車禍。相比之下,每年只有大約300人死于礦山事故和災(zāi)難。這難道就意味著乘坐汽車要比采礦危險(xiǎn)得多嗎?未必。事實(shí)是,在美國每年大約有兩億人經(jīng)常性地以車代步;而大概只有70萬人從事采礦作業(yè)。我們評估一

23、種風(fēng)險(xiǎn)時(shí),所需要的有關(guān)數(shù)字是一個(gè)比率或分?jǐn)?shù)。該分?jǐn)?shù)的分子告訴我們在某個(gè)特定時(shí)期由于從事某種特定活動(dòng)而喪生或受傷的人數(shù);其分母告訴我們在這一時(shí)期從事這種活動(dòng)的總?cè)藬?shù)。這樣,所有的風(fēng)險(xiǎn)程度都是由比率或分?jǐn)?shù)表示,其大小介于0(無風(fēng)險(xiǎn))到1(完全風(fēng)險(xiǎn))之間。7 通過把所有風(fēng)險(xiǎn)都簡化為這種比率或分?jǐn)?shù),我們便可以開始比較不同種類的風(fēng)險(xiǎn),如比較采礦與乘坐汽車。這個(gè)比率越大,也就是說它越接近1,那么有關(guān)活動(dòng)的風(fēng)險(xiǎn)就越大。在剛才討論的例子中,我們可以用每一活動(dòng)中死亡的人數(shù)除以參與該活動(dòng)的總?cè)藬?shù),從而找出汽車旅行與采煤的相對安全性。此處,我們可以很清楚地看到,乘坐汽車旅行的風(fēng)險(xiǎn)是每一萬人中大約有一人喪生;而就采礦

24、而言,其危險(xiǎn)程度是每一萬礦工中大約有四人死亡。所以,盡管在車禍中喪生的人遠(yuǎn)比采礦要多,其實(shí)后者的風(fēng)險(xiǎn)是前者的四倍。這些比率使我們能夠?qū)敛幌喔傻幕顒?dòng)或情形的危險(xiǎn)性加以比較,即便差別如蘋果與橘子那樣大也能比較。如果你反對冒險(xiǎn),你就會(huì)選擇風(fēng)險(xiǎn)比率較小的活動(dòng)。如果你無所畏懼,那么你往往會(huì)對高比率不太在乎,除非它們大得令人難以承受。8 我們一旦明白了風(fēng)險(xiǎn)是永遠(yuǎn)無法從任何情況中完全去除的,因而就沒有絕對安全的事,我們也就會(huì)明白問題的關(guān)鍵不是要徹底避免風(fēng)險(xiǎn),而是要理智地管理風(fēng)險(xiǎn)。風(fēng)險(xiǎn)管理需要兩大要素:常識以及與我們可能要承擔(dān)的風(fēng)險(xiǎn)的性質(zhì)和程度相關(guān)的信息。Health RisksOpinion polls

25、repeatedly tell us that the only thing Americans worry about more than the environment is their health. This is entirely understandable, for health is obviously preferable to illness. What makes today's preoccupation with health slightly surprising is that Americans are far healthier now than th

26、ey have ever been. Many diseases that once struck terror into hearts have either been completely eliminated or brought under control. Although AIDS is a notable exception, few new mass killers have come along to replace the ones that have been eliminated. Nonetheless, healthand the various threats t

27、o itremains everyone's permanent concern. After all, more than half of us (57 percent) will die from either heart disease or cancer, if current trends continue. One major problem with any comparison of health risksespecially life-threatening onesis that they differ enormously in their immediacy.

28、 For instance, AIDSif you get itwill probably be fatal after a number of years. Cancer induced by smoking or exposure to radiation, on the other hand, may take 20 to 30 years before its catastrophic effects show up. In making choices about health risks, therefore, it is important to bear in mind the

29、 likely time lag between taking a risk and suffering its consequences. Those with a mind to "live for today" are apt to be indifferent to health risks that have a very long incubation period. Although this is short-sighted, it does make sense to discount long-term risks more than short-ter

30、m ones. After all, when virtually any of us is confronted with the choice of doing something likely to kill us today versus doing something likely to kill us in two decades, the choice is going to be the lesser of the two evils. One commonly used measure to deal with such problems is a concept calle

31、d years of potential life lost (YPLL). The idea is that for a 25-year-old, doing something that will kill him in 5 years is much more "costly" than doing something that will kill him in 40 years. Both may involve the same element of riskthe same probability of eventually dying from that ac

32、tivitybut a risk that may cause immediate damage is much more costly than one for which the piper needn't be paid for a long time. In the first case, he will have his normal life span cut short by about 45 years; in the latter case, the deficit is about 5 years. Thinking about matters in this li

33、ght inevitably causes a reassessment of many of the threats to health. For instance, heart disease is the single largest killer of Americans, way in front of cancer or strokes. However, heart disease tends to strike the elderly in much greater proportions than younger people. Cancer, by contrast, ki

34、lls fewer people but tends to strike somewhat earlier than heart disease. Hence, more YPLLs are lost to cancer than to heart diseasedespite the greater incidence of fatal heart cases. Specifically, cancers claim about 25 percent more YPLLs than heart disease (if we define the YPLL as a year of life

35、lost before age 65). The concept of YPLLs has an important, if controversial, influence on issues in health care economics. It is frequently argued that money devoted to medical research on curing diseases should be divided up on the basis of the number of lives lost to each disease. Thus, some crit

36、ics of the massive levels of funding devoted to AIDS research claim thatcompared to killers such as heart disease and cancerAIDS receives a disproportionately high support. That criticism fails to consider the fact that AIDS, by virtue of striking people principally in their 20s and 30s, generates f

37、ar more YPLLs than the bare figure of 20,000 deaths per year, bad as that is, might suggest. 10 Put differently, finding a cure for AIDS would be likely to add about 25 to 30 years to the life of each potential victim. Finding a cure for heart disease, although it might save far more lives, would pr

38、obably add only another 5 to 10 years to the life of its average victim. The assessment of the seriousness of a risk changes, depending upon whether we ask how many lives it claims or how many YPLLs it involves. Some of the differences are quite striking. For instance, accidental deaths appear relat

39、ively insignificant compared to cancer and heart disease when we just count the deaths caused. But once we look at the number of lost years, accidents loom into first place among the killers of Americans. These data show that we need to ask not only how large a risk is but also when it becomes payab

40、le. Other things being equal, the sooner a risk causes damage or death, the more that risk is to be avoided. 健康威脅1民意調(diào)查一再告訴我們,美國人最為擔(dān)心的就是他們的健康,其次才是環(huán)境問題。這是完全可以理解的,因?yàn)樯眢w健康顯然比生病要好。美國人現(xiàn)在對健康如此關(guān)注,是有點(diǎn)令人吃驚,因?yàn)樗麄兡壳氨纫酝魏螘r(shí)候都要健康得多。許多曾令人恐懼的疾病現(xiàn)在或者已經(jīng)徹底根除,或者已得到控制。盡管艾滋病是個(gè)顯著的例外,但是現(xiàn)在幾乎沒有什么新的能置許多人于死地的疾病出現(xiàn),以取代那些已被根除的疾病。2然而,

41、健康以及對健康的各種威脅,仍然是人們永久關(guān)注的問題。畢竟,如果目前的趨勢無法制止的話,我們中將有不止一半(57)的人將死于心臟病或是癌癥。3將威脅健康的危險(xiǎn),特別是致命的危險(xiǎn),進(jìn)行比較時(shí),有一個(gè)主要的問題,就是這些危險(xiǎn)的緊迫性有很大差異。例如艾滋病,如果你染上的話,很可能幾年后就死亡。然而,由吸煙或輻射誘發(fā)的癌癥,也許要經(jīng)過20至30年的時(shí)間其災(zāi)難性的后果才會(huì)出現(xiàn)。因此,在對健康的各種危險(xiǎn)做出選擇時(shí),務(wù)必要考慮進(jìn)行冒險(xiǎn)與承受其后果之間的時(shí)間間隔。4那些一心要“今朝有酒今朝醉”的人們,往往對潛伏期較長的危害不放在心上。盡管這是一種目光短淺的行為,但不理會(huì)滯后期長的危險(xiǎn),重視近期危險(xiǎn)還是有道理的。

42、畢竟,如果我們真的面臨選擇,是去做今天就可能使我們喪命的事,還是去做20年后才可能使我們喪命的事,我們往往會(huì)兩害相比取其輕。5對待這類問題有種常用的計(jì)算方法,就是考慮可能少活的年數(shù)(YPLL)。其意思是,對一個(gè)25歲的人來說,去做一件使自己五年后喪生的事要比做一佴:40年后喪生的事“代價(jià)高昂”得多。二者同樣都具有危險(xiǎn)因素即最終因從事某事而導(dǎo)致死亡的可能性相同但是,會(huì)馬上引起傷害的危險(xiǎn),要比一個(gè)很長時(shí)間不需付出代價(jià)的危險(xiǎn)要昂貴得多。在第一種情形下,他的正常壽命減少了約45年,而在第二種情形下,減少了約5年。從這種角度看問題必然會(huì)對威脅健康的許多因素進(jìn)行重新評估。例如,心臟病是奪去美國人性命的頭號

43、殺手,遠(yuǎn)遠(yuǎn)超過癌癥或中風(fēng)。然而,老年人患心臟病的比例大大超出了年輕人。相比之下,癌癥的死亡人數(shù)雖然要少于心臟病的死亡人數(shù),但患癌癥的人群比較年輕。所以,盡管心臟病死亡率要大,但癌癥損失的YPIfI要比心臟病多。具體來講,與心臟病相比,癌癥讓人大約多損失了25的YPLL(如果我們將YPI_L定義為65歲以前壽命縮短的年頭)。6 YPLL這一概念,盡管人們對它還有爭議,卻對保健經(jīng)濟(jì)學(xué)有著重要影響。人們經(jīng)常爭辯說,用于醫(yī)學(xué)研究攻克疾病的資金應(yīng)該按每種疾病死亡人數(shù)的多少來分配。因此,一些人士抨擊將大量資金用于艾滋病研究。他們認(rèn)為與其他致命的疾病如心臟病和癌癥相比,艾滋病得到了不成比例的高額資助。該批評

44、沒有考慮到這樣一個(gè)事實(shí):由于艾滋病的主要受害者為二三十歲的年輕人,盡管每年只造成20,000人死亡該數(shù)字本身也不小了但是艾滋病引起的YPLL要大得多,遠(yuǎn)比簡單的死亡人數(shù)更值得我們重視。換句話說,找到治療艾滋病的方法,將可能增加每位潛在的艾滋病患者25至30年的壽命。找到治療心臟病的方法,雖然可能拯救更多人的生命,但對每位受害者來說只能增加平均5到10年的壽命。7對一種危險(xiǎn)的嚴(yán)重程度的估算會(huì)有差異,這要看我們是關(guān)注它所引起的死亡人數(shù)還是它所導(dǎo)致的YPLL的多少。有些差異很令人吃驚。比如,如果我們只算引起的死亡人數(shù)的話,與癌癥和心臟病相比,意外死亡就顯得無足輕重。然而,一旦我們關(guān)注所損失的YPLL

45、,意外事故卻赫然位居美國殺手榜的榜首。這些數(shù)據(jù)顯示,我們不僅要探究危險(xiǎn)程度的大小,而且要探究危險(xiǎn)什么時(shí)候要我們付出代價(jià)。在其他因素都相等的情況下,危險(xiǎn)所導(dǎo)致的損害或死亡來得越快,人們就越應(yīng)該回避這種危險(xiǎn)。Risks from Nature and TechnologyWe live in an age when natural has come to mean "benign" and anything made by humans seems both artificial and suspect. But actually the natural and the ben

46、ign are not necessarily the same thing. Nature does a lot of nasty things to us. Floods, storms, earthquakes, hurricanes, volcanoes, and tornadoes are just the tip of the iceberg. Most diseases are natural. Many naturally occurring substances are poisonous. The single largest source of cancer-produc

47、ing radiation is radon gas, a byproduct of the decay of radioactive elements in the earth's crust. Other sources of cancer-causing radiation are cosmic rays and ordinary sunlight. Indeed, death itself is natural. If we have been able to prolong life beyond its traditional span of seventy years,

48、that is because we have been clever enough to contrive ways of delaying the decay, disease, and destruction that is inflicted on us by nature. Think about it another way. All plants, including those we eat, contain many naturally occurring pesticides. They have evolved these toxicin many cases, carc

49、inogenicdefenses against insects and other predators over millions of years. It has been estimated that we consume 10,000 times as many natural pesticides as artificial ones. In other words, nature is not benign. Other numbers prove this even more convincingly. It is a widely used rule of thumb amon

50、g risk specialists that, in any given year, about 30 times as many people will die in natural disasters as in manmade ones. In addition to natural catastrophes, there are still plenty of ways in which our technological society poses major threats to our lives and health, especially through damage to

51、 the environment in which we live. The unhappy fact is that we have some grounds for thinking that many air and water pollutants may be risky, but we have as yet no dependable data on the size of the risk they pose. In other words, although we have a pretty good idea of the amount of the principal p

52、ollutants released into the air and water in the United States, there are very few studies on the health effects of specific concentrations of particular pollutants. Such studies are difficult to perform because there are too many variables outside our control. Is a certain oxide of nitrogen dangero

53、us in a particular amount? Usually the answer is that we do not know. Because everything is risky, it is meaningless to be told that this or that pollutant poses a "potential" riskuntil we know what the risk level is. Unless we know whether a certain pollutant in certain concentrations kil

54、ls 5,000 people a year or 1 person every decade, we cannot decide whether it poses an unacceptable risk. Scientists have generally not yet been able to identify the size of many of the risks posed by most of the pollutants in the environment. In fact, such studies as there are raise doubts about the

55、 commonly assumed risks of some pollutants. In New York City, for instance, levels of sulfur dioxide fell more than 90 percent between 1969 and 1976 in response to the Clean Air Act of 1970. Despite this major shift in one of the most common air pollutants, daily mortality rates in New York did not

56、change at all. No doubt New York City smells better, but it is unclear whether any lives were saved by the reduction in sulfur emissions. The problem of assessing environmental risks is made worse by the official doublespeak on the subject. Consider but one example. From time to time, a federal agen

57、cy will announce that it has identified a certain substance (natural or artificial) as a "possible human carcinogen". Such announcements are generally greeted with much wringing of hands from the general public, who suppose that one more item must be taken off their menus. The facts, howev

58、er, are quite otherwise. To qualify as a possible human carcinogen, there must be evidence that the substance in question produces cancer in rats when they receive doses of the substance that are often a million times stronger than a human being receives, even allowing for differences in body weight

59、. Even if we suppose that the likelihood of cancer varies directly with the level of exposure and that whatever is carcinogenic to rats is dangerous to humans (and both assumptions are dubious), these figures mean that the likelihood of a human being getting cancer from normal exposures to the substance is about a million times smaller than the rat's chances. If you reflect on the other risk statistics, it will become clear that such a risk is extraordinarily lowin fact, it is about as close to "safe" as we normally get in this life. Accordingly,

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