Puzzling Nature of Human Behavior

I’ve been reading this book called Deep Survival by Laurence Gonzales and I’m absolutely hooked. Gonzales weaves anecdotes of survival (or lack thereof), breaks them down, and analyzes human behavior from a conditional and neurological level. I found the book in a bookstore in West Yellowstone, where my sister and I were getting our morning coffee before driving into Yellowstone National Park for a hike in the canyon that day. I’ve always been somewhat of an adrenaline junkie, and although that thrill seeking was stifled by my development of an anxiety disorder, I still enjoy reading, watching, and engaging in thrillers. I instantly loved Gonzales’ writing style. Before even starting the book- from reading the reviews on the back- you learn that he is absolutely passionate and has dedicated his life to studying accidents, survival, and the mechanisms- human and environmental — that decide who lives and dies in terrible situations. He has done much research from both an academic and an experiential viewpoint, and the combination strengthens his stories.

I’ve been preoccupied with a particular concept that Gonzales presents in his book. And that is that sometimes the precautions and protective measures we take or put in place to prevent harm and damages might actually contribute to negative outcomes; they contribute and have a role in the system which produces the negative outcomes. Reading this with my public health background, I compared the concept to one of unintended consequences, which describes when we experience consequences not intended by the initiation of a public health intervention, and they can be either positive or negative. For example, when an intervention focused on the prevention of the spread of HIV unintentionally increases stigma about HIV, and causes less people to get tested at clinics. The intervention had good intentions, but showed unpredictable negative outcomes. There are countless examples of this. When vaccines, efforts to eradicate disease at the population level, kill or sicken certain individuals. When drugs have side-effects that are worse than their targeted symptoms. We can also see it in the way that antibiotics kill all- both good and bad- bacteria in your body and the in the same way chemotherapy kills your immune system.

So, in both the survival and public health contexts (which are arguably one in the same) how do we prevent things like harm and accidents, disease and death? We use rigorous, tightly controlled, largely powered research studies, analysis like cost-benefit and comparable effectiveness, literature reviews and cohort studies. We statistically analyze data and calculate and quantify risk. These studies lead us to implement large-scale interventions. However, the majority of these methods focus on published data and evidence. What about those research studies that don’t make it to publication, or don’t get approved because their results lack statistically significant findings?

Is there a way to study unintended consequences if we only analyze intended outcomes and use only journal approved research studies? And furthermore is there a way to prevent unintended consequences from happening, and from our interventions producing the outcomes we are trying to prevent. Looking at this dilemma from an individual standpoint, converse to a public or population level, do we ever take protective measures that actually contribute to our own downfall and harm? I believe we do, sometimes. Is there something to say here about humans interfering with things smarter and faster evolving than us- microorganisms and viruses that cause killer diseases? At what point does human intervention, or rather human precaution do more harm than good.

In public health we answer this question from an ethical standpoint. We accept and understand potential harm if the good outweighs the harm. If the benefits are marginal to the risks we implement that intervention or treatment protocol. However, from a meta viewpoint, although it seems rational to help when the good outweighs the harm, but nonetheless we are still inflicting harm. The harm principle might counteract intentionally pure efforts immediately and over time. What would happen if we didn’t intervene.