Making fun of people for (rationally) picking and choosing covid/monkeypox risks

There’s a lot of people who complain about how we have to mask at conferences, except during meals when we’re all eating at the same time.  Why mask at all?  Or why mask at the grocery store but not at a wedding?  Or why go to parties at all if you’re worried about covid?  Or why not go to parties if you’re not going to mask at work or if you have a child in daycare?  Why don’t people take the same level of caution at every moment of their lives?

Some of the argument is the same as when people make fun of people who order big macs and supersized fries along with a diet soda. From an economics standpoint that makes sense– they get utility from the fries and big mac that justify the extra calories but not from the soda. (Ignoring that from a health standpoint diet sodas may mess with how your body deals with sweet things.)

Going to Walmart because the cost/benefit ratio makes sense but not going to a wedding because it doesn’t *is* reasonable. There’s a lot more things besides risk that go into a cost/benefit ratio. I mean, I avoid amazon when it’s easy and I use it when it’s not easy to avoid. I boycott Nestle when it is easy but sometimes still buy Haagen dazs because it’s actually good and one of our grocery stores only has Ben and Jerry’s as an alternative, which we like, but sometimes you need something they don’t have. That is rational, not hypocritical. (And yes, I know my individual boycott means nothing to Nestle… but bigger boycotts do matter, and *I* care.  Just… not always enough.)

Maybe it is that people don’t understand risk, but maybe some of it is that risk is only part of the cost-benefit ratio but the most acceptable of the social excuses these days. Or that going to the gym is the only way to force yourself to exercise and you wear gloves to remind you not to touch your face after touching the equipment even if you know that the air is more likely to spread covid than surfaces. (And to be fair, I stopped touching doorknobs without sanitizing back when I was on the job market decades ago because I realized I no longer came back from travel sick! Covid isn’t the only bug out there.)

Are there rational choices that you make that seem wrong to people who don’t understand your cost-benefit calculus?

20 Responses to “Making fun of people for (rationally) picking and choosing covid/monkeypox risks”

  1. Mike Nitabach Says:

    In addition to your excellent analysis, I also think that the vast majority of people do not use the word “risk” in the way that economists & scientists do. The latter use risk as a probability, which must be multiplied by the value of the outcome if it occurs to obtain the expected actual outcome. Ordinary people IME use risk to refer to “danger”, and generally in some intuitive way are already multiplying likelihood by outcome value. And, of course, everyone’s intuitive assessment of likelihoods of events is grotesquely biased & almost always grossly incorrect.

  2. Michael N Nitabach Says:

    Oh, and to answer your direct question, yes. In fact, was just discussing this with ppl the other day. I choose to have my screening colonoscopies without anesthesia, because I am afraid of anesthesia & not afraid of the discomfort of the colonoscopy itself. So for me, it is absolutely rational to avoid dealing with fear of anesthesia (benefit) in exchange for dealing with the discomfort of the probe up my ass (cost). Everyone else found this tradeoff completely incomprehensible & statistically in the United States almost no one gets colonoscopy without propofol anesthesia.

    • Omdg Says:

      Anesthesiologist here (raises hand): Are you saying you got your colonoscopy without ANY sedation? Or that you had sedation provided by a nurse who gave you fentanyl and midazolam with an IV? It turns out many people do the latter even in the US, and I’ve even met people who prefer it because they remember feeling super high (whereas with propofol you are more likely to be totally unconscious and remember nothing). Or are you saying you got *literally nothing*? I’ve been taught and have observed that can be really difficult (and extremely uncomfortable for the patient) to get around the splenic flexure to view the transverse and ascending colon, and because of that *no* sedation for a colonoscopy is not recommended. Sigmoidoscopy, where you don’t have to go around the splenic flexure is a different story – those can be done with no sedation nothing in a family drs office. It’s a different test than a colonoscopy, though.

      Who knows though. My husband had an upper endoscopy done with literally no anesthesia when he was 15 in italy.

      • nicoleandmaggie Says:

        Interestingly one of the most famous experiments in behavioral economics was about tapering pain in colonoscopies without anesthesia (having a longer colonoscopy where they tapered it off was remembered as less painful than a faster one where they didn’t).

      • Michael N Nitabach Says:

        Literally no anxiolytics, anesthetics, sedatives, or analgesics for full colonoscopy including ascending & transverse. I watched on the video screen while he snipped a few polyps off for biopsy. It was a bit uncomfortable, but no pain in the slightest. The most intense sensation was tbh embarrassment at the continuous farting out of huge boluses of CO2 & saline that they were pumping in… 😹 😹 😹

      • Alice Says:

        I would’ve been fine with anesthesia, but am somewhat envious of you actually getting the colonoscopy. I tried to get one last month, but it was first delayed and then cancelled due to So Much Vomiting, even when they added Zofran. They want me to try to reschedule with an alternate prep plan in about 3 months, and I genuinely don’t know if I can overcome my current level of dread about the idea. I’m usually pretty good about doing uncomfortable things for the longer-term good, but this is a whole other level. (The alternate prep plan is supposed to be gentler… but would include 3 days of a clear liquid diet instead of just 1. And of course, no guarantee that I wouldn’t go into vomit mode at the 11th hour again.)

        Note to those of you who haven’t done a colonoscopy: I think my experience is an outlier at the bad end of things. They’re important for keeping colon cancer from becoming a big problem in your life. Just, for me… I so wish the process was not what it is.

    • nicoleandmaggie Says:

      How was it? (I have an irrational fear of anesthesiologists.)

      • Michael N Nitabach Says:

        It was absolutely fine! Somewhat uncomfortable, but not at all painful. Cystoscopy (endo-probe up my dickehole & into my urinary bladder) was MUCH worse. Supposedly, in some countries (such as Japan), colonoscopy is routinely without any sedation, anesthesia, or anxiolytics.

      • Michael N Nitabach Says:

        It was cool to see the inside of my colon on the video screen! Almost as cool (albeit much less uncomfortable) as seeing the inside of my dickehole & bladder! 😹 😹 😹

      • FF Says:

        I get extremely nauseated/vomit after anesthesia (even propofol). After having 3 rounds of vomiting upon coming home after my first colonoscopy, I tried to have my second colonoscopy without any anesthesia to avoid this, but I could not tolerate the pain. My research on this indicated that women were more likely than men to have pain during colonoscopy.

      • Lisa Says:

        My DH has regular colonoscopies and also prefers not to have any anesthesia or pain meds. Last time he went in, he had to have pain meds for some reason I can’t remember (needed a more invasive scan than usual or something) and he didn’t like it at all. He also loves watching the colon video. I will admit, the part of a colonoscopy that puts me off the most is the prep. I’ve given birth unmedicated so I assume I could handle the colonoscopy unmedicated if I wanted to go that route. But I’m not sure I can handle the prep. Luckily for me, I’m low risk and was able to do Cologuard instead.

      • Debbie M Says:

        My boyfriend gets them without anesthesia and he says he feels only mild discomfort. I’ve had only one and got it without anesthesia, and I had some pretty intense discomfort, where I was happy to be grabbing on to the bed rail and occasionally a tear escaped. I had a doctor who routinely does these without anesthesia and he is very gentle and warns you about that second turn in the colon.

        I’m less psyched to get my next one without anesthesia, but anesthesia is pricey and I feel unnecessarily invasive for what seems like a pretty mild procedure. (Anesthesia is not *perfectly* safe.) And also, I felt so much better afterwards, with just the bloating and the farting, and not dealing with getting over the anesthesia.

        I’ve heard that some recommend anesthesia only for tiny Asian women, who feel more pain. I am built sort of like a tiny Asian woman. My boyfriend is built almost nothing like a tiny Asian woman.

        One problem is no one will believe you when you say you want no anesthesia. They have real trouble separating out the parts of the prep that are about the colonoscopy versus the anesthesia. Without anesthesia, for example, you do not need someone to drive you home.

  3. EB Says:

    My decisions about when to mask and when not to, and my judgments about other peoples’ decisions, are partly based on the immediate situation (how many people, how enclosed, for how long) but also by my conviction that the amount of masking overall, by everybody, also matters. Except in totally outdoors environments, I think that the trend is as important as the case-by-case decisions. So if you mask at a conference but not at the meals, that’s still probably somewhat helpful in reducing spread.

    • nicoleandmaggie Says:

      A lot of why I was masking last year in classes was to make other people feel comfortable masking. I didn’t like it when one of my health economist colleagues was like, “Well, I got covid from daycare so I won’t mask in class anymore” because what happened was a bunch of students took that as a cue that it was safe to not mask because the health economist was no longer masking. Ditto when the *department head* doesn’t even bring a mask to crowded situations (I had to give hir one at the faculty retreat in December when Delta and Omicron were both going around and many of our junior faculty had unvaccinated kids).

  4. bogart Says:

    SIGH. Aside from your excellent points, I remain guided in the case of COVID by the thoughts that the risks are (a) additive — my masking (or not) in one setting doesn’t affect the risk (to me) in the next, well, except that (b) as I understand it, dose matters to the likelihood of getting really sick, plus of course the risks I take are (c) transmissible, i.e. if I get sick I can infect others. That last bit is sort of at odds with your point, but basically I totally agree that it’s complicated and not just “any level of risk is acceptable” vs. “no risk whatsoever is the only option.”

  5. Revanche @ A Gai Shan Life Says:

    It’s only been a few days and we’re tired of our school telling everyone “COVID is still with us” while all the teachers and principal run around unmasked both indoors and outdoors. It’s unsettling that they don’t seem to care about continuing the mitigation protocols that were really effective last year. I’m the one judging people choosing not to care at all.

    I don’t know if they’re judging me. Probably they are because we choose to mask indoors and out, but I don’t care. We’re doing the best we can to mitigate risk where we can.

  6. CG Says:

    Aaron Carroll (I think) wrote something a year or two ago that talked about how each risk is independent of every other risk. So, if you want to do something where you don’t wear a mask, that is its own event. It doesn’t mean that it doesn’t matter if you never wear a mask any other time, because each of those other times is also its own event. He wasn’t talking about masks at that point (this was pre-vaccine, I think), but doing things in person. He said going to school was absolutely worth doing in person, but that didn’t mean they would just totally throw caution to the wind and do everything else in person. I seem to be at the wildly inconsistent stage of masking/not masking. I’m not proud of it, but it’s just genuinely not top of mind all the time for me anymore. For example, if I start to go in a store and see that the employees are masked, I’ll put mine on. They don’t have a choice of whether or not to be in that space and if they are being careful, I will too. If they’re not masked and the store isn’t crowded and I’m not going to be there all that long, I might skip it. Or I might mask anyway. Wildly inconsistent. Once the kids start back to school and (probably) need to mask and also are indoors a lot more than they have been I’m sure I’ll be forced to think about it more again. I would certainly not judge anyone else for either thinking about it more than I am doing right now or being more cautious than I am being right now. I think your comment about the “live and let live” stage is spot on.

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