Age of angst (book excerpt: False Alarm)

In his first non-fiction book, False Alarm: The Truth About the Epidemic of Fear, New York internist Marc Siegel, MD, examines how disproportionate attention focused on some diseases creates a culture of fear.

By Marc Siegel, MD, amednews correspondent — Posted Feb. 27, 2006

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Book Excerpt

Book Excerpt

A peek inside what's new on the shelves on topics pertinent to physicians.
» More excerpts

I barely recognized the patient, though he had been coming to see me for almost 10 years and I knew him well. It wasn't just that his appearance had changed, though the baseball cap pulled low over his eyes and the workman's shoes were not his usual attire.

Under the lights of my examination room, I realized that it was his manner that had altered the most: formerly confident, even strident, now he leaned against the counter, not wanting to sit. He hunched over, wringing his hands, looking toward the window every few seconds.

Seeing me, he seemed to calm, and I reminded him that the visit was a simple follow-up for a prostate infection. He needed to leave a urine sample and he could go, and I would call him in a few days with the results. He could stop taking his Cipro.

"I've renewed it," he whispered, though his voice usually boomed.

"Why renew it? I gave you the refill in case the infection flared up again and you couldn't reach me right away."

"Why should I stop now?" And then came the words that were supposed to explain everything: "There's a war on."

I could see him eyeing the closets in the examination room. Was he wondering what medicines were there? I put my hand on his shoulder and we looked at each other. I realized that I had always treated this patient more like a friend. He knew my home phone number; he was free to page me when I wasn't on call. We liked to talk about sports. It was painful to consider this new source of tension that had come between us.

In my consultation room I explained to the patient that the risks of taking this expensive antibiotic for an extended period far outweighed any benefit against an unlikely microbe. With prolonged use of the medicine this patient might develop diarrhea, rash, or insomnia.

"Insomnia," he said. "So what? I already can't sleep."

I reviewed my office notes and saw that a few years before he'd had a brief spell of anxiety related to a problem at work. He had declined medication, and the problem had resolved on its own.

"How about something to calm your nerves and help you sleep?"

The patient readily agreed this time. He was 35 and lived alone in a walk-up apartment six blocks from the World Trade Center site. He worked uptown at a communications firm and had been at work when the planes hit, but he had since returned to a smoky, soot-covered existence downtown, where he had to keep the windows closed and his telephone hadn't worked for weeks. He told me he spent the night sitting in a chair, fully clothed, in case he had to leave at a moment's notice.

I tried my best to reassure him. "Nothing else is likely to happen right now. The risk of anthrax is extraordinarily low. Don't you believe me?"

"Sure I believe you, Doc. But I just can't stop thinking about it."

Across my desk I could see his bulky bag, bulging open with a gas mask. He said he carried it wherever he went. I tried not to look at it. "Would you agree to see a therapist?"

"Are you saying I'm crazy?"

"Of course not. I'm worried that your reaction is causing you pain."


In this next excerpt, Dr. Siegel discusses reaction to a flu vaccine shortage.

Each terror alert is like another bug du jour. We talk of sarin, which killed only 12 people in a Japanese subway in 1995 but panicked thousands, and can panic us here without so much as a single case. Anthrax infected 22 people through the U.S. mail in the fall of 2001, killing five unfortunate people, yet had 30,000 more taking the antibiotic Cipro, many indiscriminately and without a doctor's prescription. It's hard to believe that there hasn't been a case of smallpox here since the 1940s for all the attention it has received. If it is ever again introduced into the population, it is likely to spread slowly, by respiratory droplet. Meanwhile, in 2002, the fear of smallpox spread far more virulently through the public, transmitted by word of mouth.

In the fall of 2004, the sudden shortage of flu vaccine in the United States led to a stampede of people seeking the coveted elixir. During this vaccine shortage, multitudes of healthy people became convinced that they could be overcome with the flu and die at any time. In fact, the first flu-related death that year came not from the disease, but from an elderly woman who fell while waiting for the vaccine amidst a thronging crowd. I wrote an op-ed piece in the New York Post pointing out that the CDC had determined that the vaccine hadn't helped much the year before, was only 40% to 60% effective, and was intended mostly for high-risk groups. My message: Flu vaccine is not the health panacea that you think it is, you are not in great danger without it, and the sudden attention it is receiving has caused people to feel a sense of urgency out of proportion to the real danger.

I thought I'd accomplished something until I began to receive phone calls from patients who had read my piece. Almost as an afterthought I'd mentioned that I had five vials, or 50 doses, to give to my sickest patients.

"I saw your article," one call began.

"Are you reassured?" I asked.

The patient ignored me. "I understand you have some vaccine. Can I have a shot?"

Rather than worrying less after learning the facts, each patient wanted to be one of the lucky 50 and was calling me to beg for a dose.

Back to top


Author Q&A

What was your motivation for writing False Alarm?

I began to notice after Sept. 11, 2001, that my patients were starting to come in with new worries and these new worries were out of proportion with the real risk. I began to question, what is it that makes people personalize these fears? All the time they may be worrying about things that may not be personal risks. ... Fear is easier to turn on than it is to turn off. You want to use it as a warning system against imminent danger. It's loss of control that we fear the most. ... We think it's going to happen to us if we see it on cable news.

What do you say to patients who come to you with such fears?

I say to them, "Why are you afraid of this?" Then I explain, with rational thinking, why they shouldn't think that way. It's got to be put in perspective. ... I have a ton of patients who are coming in about bird flu [and asking] "Should I eat chicken? Should I have a bird feeder?" It's because of the way the information is put out to the public; it's not put in context properly. I say: Inform and prepare, but don't alarm.

Are fears about bird flu more justified now?

We're too concerned about H5N1; right now it's a virus to worry about in birds. ... We need more money in researching avian flu. ... Public health officials have been trying to make the point that we are underprepared for a bad pandemic. This is a good point to make, but unfortunately, in the attempt to shine more of a light on avian influenza in general, as a potential worldwide catastrophe, too much emphasis has been put on H5N1, a bad killer of birds that may mutate to a form that can routinely infect us, and may not. H5N1 should be taken very seriously, but it is not a given that it will be the cause of our next pandemic, a pandemic that may be either severe or relatively mild.

If there is a pandemic, would you feel that you downplayed the seriousness of such a possibility?

No. I have a second book on bird flu [Bird Flu: Everything You Need to Know About the Next Pandemic] and it shows both sides. If you want to more effectively worry, decrease the number of things to worry about to things that can really get to you. ... There is a danger to overreacting, just as there is a danger to underreacting. ... The best preparedness for a flu pandemic to me means upgrading how we make vaccines using modern genetic engineering and cell culture techniques, improving our hospital infrastructure and emergency response capabilities, and becoming food-, medicine- and energy-independent as a society. What I want to downplay is the need for a personal response right now. Personal stockpiles, or avoiding poultry and bird feeders, for example, are symptoms of the fear virus rather than the bird flu virus. Even if a worst case scenario occurs, fear will cause more viral spread than anything else because frightened people tend to take fewer precautions.

What should be done to put anthrax and other health threats in perspective and not create a climate of public fear?

Public health and the government have a problem figuring out a way to describe something that doesn't immediately hype it, and that's hard to do with cable news. ... We have to learn to communicate risks in a way that's more realistic. You create a scale that should include what number of people are likely to be affected and what is the risk of this actually happening. Our appraisals need to be more honest and less worst-case. ... Here's how you treat fear: You treat it with real information and you treat it with real preparation.

What is the message physicians and patients should take from your book?

That fear is an emotion and it's connected to a system of reason. ... Keep in mind that we are being bombarded by information these days about things that are not imminent. Let's stop turning on a fight-or-flight fear response. Let's keep our emergency reactions for real emergencies. ... One of the cures of fear is [having] more go-to people. They are people who let you see the larger picture. A doctor could be a go-to person. We need people we can trust to give us perspective and to provide information we can actually digest without being alarmed unnecessarily.

Interview by Damon Adams

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn