What is a life without risk

Franz Porzsolt in an interview

brand eins: Mr. Porzsolt, what exactly is security?

Franz Porzsolt: I'm afraid there is no such thing as security, only the individual perception of risks. If you expose two people to the same risk, one will feel reasonably safe, the other considerably unsettled.

But researchers claim to be able to assess dangers.

That's not wrong either. We can assess many risks using two factors: the likelihood of a dangerous event occurring and the amount of damage. If you multiply both values, you have the risk. That is the scientific logic. But hardly anyone thinks that way, most people are unable to deal with probabilities. They judge by their feelings.

And they are often wrong.

That's the way it is. Human perception is a psychological reality that we should be aware of. Let me illustrate this with mammography for the early detection of breast cancer. Strictly scientifically no benefit of this method can be determined. In a long-term study, researchers investigated the proportion of women who participate in screening develop late-stage breast cancer: this rate has remained unchanged for 30 years. So it would be more economical to take other measures that could save more lives. However, if I support this thesis in a public discussion with women, I have to fear for my health. There are many who strongly disagree with me because they are convinced that mammography saves lives. A rational argument meets an emotional one that I also know from myself at home. My wife kept asking me: "Should I go to the next mammogram?" I told her what the disadvantages could be. But I also told her: "If you feel more secure with a mammogram, then have it done."

How did it end?

My wife decided against it at some point. But it took several years until then. That is understandable: Try to convince someone that their good feeling is nothing more than pseudo-security. It takes a long breath, and sometimes it's not worth the effort. Just think of the life jackets on board airliners: they haven't saved a single life. Nevertheless, it would be unthinkable to do without these vests, because they obviously give passengers a good feeling, including the mandatory instruction on their use.

Does that justify irrational measures?

Why not? A feeling of security is a great asset. The question, however, is who has to pay for it. It's a big topic in medicine. I am convinced that in the case of health services for which the solidarity community has to pay, the objective benefit must be clearly demonstrable. Comfort medicine that only makes the patient feel better subjectively is also okay - provided that he pays for it out of his own pocket.

However, this is not in the interests of those who earn money with dubious services and, as you yourself say, can rely on irrational fears of the patients.

Yeah yeah If I had a radiology practice with 15 people doing a hundred mammograms a day, and then there was a scientist who said mammograms were completely useless, I would also develop counter-strategies to save my business. An understandable reaction. One is the scientific knowledge, the other is the consequences. It takes a certain amount of time to change systems. The idea that you can simply pull a lever is unworldly.

They rely on the power of enlightenment. Isn't that just as naive?

The fact is that communication has a decisive influence on risk perception. Imagine you go to the doctor with stomach pain and he says to you: “With the complaints - have you already had an ultrasound of your upper abdomen?” The way he asks this question alone will make you feel like Create uncertainty. We doctors are very good at it, it's part of our business. Conversely, it is also possible to increase the perceived security through communication. If more people in positions of responsibility knew this and acted accordingly, a lot would be gained.

Like Chancellor Angela Merkel and her then Finance Minister Peer Steinbrück, who appeared in front of the press in October 2008, three weeks after the bankruptcy of Lehman Brothers, and claimed: "The savings are safe" - although they could not have known?

The trick apparently worked: people didn't run to the banks to withdraw their money. They felt safe, and that influenced their decisions - and helped to ease the situation.

So a legitimate white lie?

This is how you can see it. I would rather speak of a successful attempt to increase the feeling of subjective security in times of great uncertainty. If politicians and other decision-makers were honest, they would have to admit that they too are guided by such emotions. This in turn depends on the information that is currently determining the discussion. For example, with the Fukushima nuclear disaster four years ago. At that time, the federal government decided to phase out nuclear energy. One can argue that the time was simply ripe for this - but what was decisive was the news from Japan and the promise to eliminate the risk of a meltdown in this country. In fact, that wasn't even possible because our neighbors in the east and west operate a number of nuclear power plants near the border. So it was a purely gut decision.

Doesn't the example also show that the assessment of risks is culture-dependent? For example, nuclear power has a much better image in France than in Germany.

These differences are actually striking, so a lot can be learned from international comparisons about the relativity of one's own point of view. Another example from medicine: In Scandinavia, far fewer computer tomographies are created than in Germany; there it is not a question of money, but of attitude. And that is quite healthy: the more computed tomographies are performed, the greater the risk of unnecessary operations.

In general, however, there seems to be a tendency to protect people from more and more real or supposed risks: with warnings on cigarette packets and wine bottles up to and including the requirement for cyclists to wear helmets. What's your attitude?

The general rule is: A life without risk is not a risk. I am in favor of us in society agreeing which risks should absolutely be avoided and which we have to live with because the effort would be too great to get rid of them. The question of the benefit is helpful: Who benefits more from compulsory helmets, for example - cyclists or helmet manufacturers?

Do you yourself deal so strictly rationally with your own life risks?

Of course not, I'm only human too. I made an important decision years ago out of unfounded panic. I was a very heavy smoker until one night I had a bad experience: I thought I was going to have a heart attack and feared for my life. I haven't touched a cigarette since then. As it turned out later, it was a false alarm. But, as you can see, this can also be useful. ---