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On Making Decisions -- Personal and Public

By Richmond Shreve  Posted by Richmond Shreve (about the submitter)     Permalink       (Page 1 of 2 pages)
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Headlined to H4 10/16/09

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In my experience the most important decisions are always made on incomplete and conflicting information. So it is with the flu vaccination muddle that we see daily in these pages. The officials we have commissioned to guard our national health say certain people should absolutely get vaccinated, and that the rest of us would be smart to do so.

Yet others point to credible evidence that the effectiveness of flu vaccination may be marginal and some go so far as to accuse the vaccine makers of working a scam to enhance their profits.

Extreme groups oppose all vaccination programs for a host of reasons, though their arguments are often grounded in wrong information and fear mongering.

Various public figures have exploited the muddle to catapult themselves into the headlines with outspoken opinions. Rush Limbaugh said bluntly "screw you Miss Sebelius" underscoring his unwillingness to accept the Health Secretary's urging that everyone get vaccinated.

In the midst of all the emotion and controversy, how does one come to a decision? This is one of those situations where inaction is itself a decision. The flu epidemic will advance regardless of what we decide individually, and not deciding ends in not getting a vaccination before we are exposed.

My Decision Process


Business people often use models to alanyze important decisions. The aim is to quantify the elements that contribute to a rational decision and select a course that has the best chance of a good outcome with acceptable risk. Although these models may involve sophisticated statistical and mathematical constructs, the principles are applicable to less structured decision processes. The elements are these for a personal decision:
  • my perception of the risk for each possible outcome
  • my confidence in my assumptions based on the available information
  • the cost to me of alternative actions (money, opportunity, reputation, etc.)
By way of illustration. If I am thinking about buying a lottery ticket, I know the odds of winning. My downside risk is that I will likely not recover even the price of the ticket, but that's no big deal -- I know I won't miss any meals. The upside is that I could become fabulously wealthy overnight. Also there is an immediate gratification of enjoying that dream. It's not a tough decision to make because the costs and risks are very low.

With the flu vaccine the analysis becomes more difficult. The upside benefit is that by getting the shot I will make my immune system better able to repel H1N1 infection should I be exposed. (We'll get to the matter of confidence in these assumptions later.) There is also the societal benefit that I will be helping to prevent the spread of the virus to others.

The downside is that I may have some brief discomfort, and that society (Medicare) will be charged for the vaccine. I may also be exposing myself to risks of immediate adverse reactions and long term side effects.

I place a lot of confidence in health officials, and having read information from institutions I respect like Johns Hopkins and Mayo Clinic, I'm 90% sure that a vaccination will give me a better chance of avoiding Swine Flu. How much better is unclear. Also, I have received the seasonal flu vaccine every year, including this year, with no adverse reactions or other bad effects, and though I have had some nasty colds, I haven't come down with a dangerous case of flu so far as I know. The H1N1 vaccine is made in the same way as the seasonal vaccine, so I don't expect any new risks to emerge.

I don't place much confidence in the anti-vaccination information for a number of reasons. Firstly, the institutions that I trust say that the facts don't support claims that vaccines may cause autism, or that the ingredients of the vaccine are potentially toxic. Second, I perceive a conspicuous effort to make their case by denying or ignoring contrary information -- they lack objectivity. But most persuasive to me is the alarmist quality of their literature and their implicit distrust of science.

It comes down to this: the down-side risks of getting the vaccine are questionable and small, and the upside benefit, while of uncertain size, is still the best defense available against a virus that, this early in the season, is already causing serious illness and death . My decision? I'm getting the vaccination as soon as it is available to me.

Public Officials and Professionals

The decision process I describe here is one I have used with considerable success in business for most of my career. My decisions have been low profile. The outcomes would not likely affect my standing in my profession or the community. This is not true for public officials or members of a mature profession. These people are highly visible and accountable to their peers and the public. So there is more at stake for the Secretary of Health and Human Services, or the doctors at Hopkins or Mayo when they decide and recommend.

The downside of not recommending flu vaccination is the suffering and deaths that might otherwise have been avoided. If people are vaccinated and the vaccine proves inadequate to quell the epidemic, the officials at least haven't failed to provide the best defense possible. But if they side with those against vaccination and are wrong, people will have sufferd and died needlessly.

A year from now we still won't have certainty about the benefits of the vaccines. There will be no unambiguous verdict. There will be anecdotes of people who got sick or died suddenly after being vaccinated. Others will succumb to flu despite vaccination. So public accountability would tend to weight the decision toward vaccination for those who have so much to lose by making the opposite call.

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Thanks for an interesting piece, Richmond. May... by Richard Wise on Friday, Oct 16, 2009 at 6:20:50 PM
Thanks for your thoughtful and informed response. ... by Richmond Shreve on Saturday, Oct 17, 2009 at 12:26:31 PM
"Extreme groups oppose all vaccination programs fo... by Matt Stouler on Saturday, Oct 17, 2009 at 11:26:26 AM
Matt,You assert that these health care workers are... by Richmond Shreve on Saturday, Oct 17, 2009 at 12:55:39 PM
The Bush Cheney "preparedness" laws on the books i... by Matt Stouler on Saturday, Oct 17, 2009 at 11:28:35 AM
You have bought three things:That the health "offi... by Matt Stouler on Saturday, Oct 17, 2009 at 11:39:41 AM