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
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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.