Coronary Complacency and Cognitive Biases

Mimi Swartz had an excellent oped in last Friday’s New York Times exploring a paradox about the fear of disease. Although heart disease is the leading killer of Americans, she wrote, “it seems to generate less fear among the public than cancer.” Although Swartz did not use the term, this reaction can be explained by several well-known cognitive biases.

The salience heuristic, for example, causes us to focus on things that are striking and perceptible, creating a bias in favor of the most prominent phenomena, even if they are not the most important. Cancer is treated by surgery, chemotherapy, and radiation, which thus tends to be far more visible than chronic heart disease, which is treated by medication and lifestyle changes (heart attacks will be addressed shortly).

This brings us to the availability heuristic, which causes us to focus on those things that come to mind most easily. This tends to exaggerate our fear of cancer in two ways. First, there is simply more publicity about cancer, including an entire month devoted to breast cancer awareness, during which NFL players wear pink shoes on national television. There is no comparable campaign devoted to heart disease. Second, cancer is often a lingering illness, meaning that most of us know people who have lived with cancer for years, some of whom have died from it. In contrast, people tend to die suddenly from heart attacks, meaning that we are likely to have many fewer available images of terminal coronary patients.

Both salience and availability are closely related to the base-rate fallacy, which causes us to ignore the prevalence of a phenomenon in favor of a few vivid examples. This has been most obvious in recent political controversies, in which the horrific crimes of a few undocumented immigrants have overwhelmed the base-rate, which is that immigrants commit fewer crimes than the native-born.

The so-called clustering illusion also tends to emphasize fear of cancer, as we have heard of both real and imagined cancer clusters, while there is no such thing as a heart disease cluster.

Speaking of illusions, there is also the illusion of control, which causes us to exaggerate our control over future events. Heart disease seems to be more avoidable than cancer – through exercise and diet – which makes cancer more frightening.

There are no doubt other heuristics and biases at play, but even recognizing them may not result in greater rational understanding. For example, I am still more worried about cancer than heart disease, even after reading Swartz’s column and writing this post.

It is important for lawyers – and not only litigators – to understand cognitive biases, which exert powerful influence over decision-makers such as judges, jurors, opposing counsel, clients, counter-parties in negotiation and, of course, ourselves.

Comments

[Shawn]

Excellent article and commentary. I wonder if the disproportionate fear of cancer relative to heart disease can also be traced to the apparent randomness of a cancer diagnosis regardless of lifestyle choices, as compared with the years of voluntary lifestyle choices that often (though not always) precede heart disease. I certainly feel that way as someone with both cancer and heart disease in the family. I have made all the changes necessary to ward off heart disease, but other than not smoking or drinking and taking a couple other minimal precautions, there appears to be litte I can do to prevent the sudden cancer diagnosis. In a perverse way, I have analogized heart disease to a car accident after years of reckless driving and cancer to a terrorist attack - the former has been foreshadowed to some degree while the latter had no warning. Hence, the increased and outsized fear of cancer and terrrorist attacks.

[Scott Fruehwald]

Excellent post. As you know Steve, I have written a book on cognitive biases for lawyers: Understanding and Overcoming Cognitive Biases for Lawyers and Law Students: Becoming a Better Lawyer Through Cognitive Science (2018). Since I started studying cognitive biases, I see them everywhere. For example, I think that cognitive biases explain a large part of the political divide in this country.

[Steve L.]

Thanks, Scott. I own your book and refer to it often.

[Betsy DeVos Save our Kids Foundation]

Why is there a cognitive bias against paying lawyers a fee? Explain to me why my clients refuse to pay when their liberty is at stake? Why do clients feel it's okay to screw their lawyer out of an agreed fee? And, why are lawyers expected to give away their time and service as Pro Bono and doctors, teachers and electricians, not? Can I go and ask for a Pro Bono Toyota? Why do folks expect legal services for free?

[Bill Turnier]

Although heart disease and cancer draw most attention as the primary.causes of death third place belongs to a real silent killer, medical mistake which accounts for 9.5% of all deaths. It does not appear on any list of causes of death because death certificates only list the ultimate cause of death such as sepsis or hemorrhage. About .75% of all patients who enter a hospital for a procedure will die because of medical mistake. This should be contrasted with the fact that although about 900 million people board a scheduled airline each year to fly, it is a rather safe undertaking with only one person dying on a flight innthe last 8-9 years. I presume most would be flyers stand a much greater chance of dying in an automobile crash on the way to the airport than they do of dying on a flight, yet many people approach the car ride with ease but are white knuckled as their plane takes off.