That Daily Shower Can Be a Killer

http://nytimes.com/2013/01/29/science/jared-diamonds-guide-to-reducing-lifes-risks.html

by danso • 13 years ago

371 245 13 years ago

Not discussed is how the author's hyper-vigilance impacts his life in the form of stress. Stress kills.

JoeAltmaier6• 13 years ago

Its possible to be careful and unstressed. I avoid caffeine. I don't even think about it any more; I just don't choose drinks containing caffeine.

feintruled• 13 years ago

Not so black and white though, caffeine may have health benefits, e.g.

http://www.webmd.com/alzheimers/news/20120607/coffee-may-hel...

abraininavat5• 13 years ago

"I don't even think about it any more" means you're not being "hypervigilant". I'm using the author's word-choice here.

tokenadult• 13 years ago

The author has already made it to age seventy-five. As he writes in the submitted article, "My hypervigilance doesn’t paralyze me or limit my life: I don’t skip my daily shower, I keep driving, and I keep going back to New Guinea. I enjoy all those dangerous things."

I think the author has actually made a very sound point, statistically speaking, that often incremental improvements in dealing with the little things has as much impact on health outcomes as heroic measures to deal with the big risks to health. All around the developed world, mortality from all causes is steadily declining at all ages,

http://www.scientificamerican.com/article.cfm?id=longevity-w...

and most of that decline in mortality (and consequent increase in life expectancy) has come about from incremental reductions in risk. Changing engineering standards for highway construction reduces risk of injury and of death from car crashes. Simple checklists can reduce the risk of surgical complications.

http://www.who.int/patientsafety/safesurgery/en/

http://www.amazon.com/Checklist-Manifesto-How-Things-Right/d...

A girl with my daughter's birth year in the United States has a better than even chance to live to be 100 years old,

http://www.prb.org/Journalists/Webcasts/2010/humanlongevity....

http://bmjopen.bmj.com/content/1/1/e000128.full

just from an accumulation of incremental improvements in health in the developed countries. The little things matter. We don't have to worry about the little things. Indeed, we can celebrate that so many little things are taken care of for us by societal changes.

mauvehaus4• 13 years ago

I think hyper-vigilance is a poor choice of words. It's more a habit of thinking than a constant state of conscious alertness. When you become aware of a hazard, it takes conscious effort to avoid putting yourself in the way of that hazard.

To take the author's example of sleeping in the jungle under dead trees, when you first become aware of the hazard, you have to stop and look at your campsite before deciding whether or not to pitch a tent there. Eventually it just becomes part of your background processing when checking a spot, and you would pass up an otherwise nice spot without stopping to think why. If asked, it might take you a moment of looking the spot over before realizing that it's because of the dead tree sitting over it.

If you think about it, it's a lot like developing good practices in coding. What at first is something you have to think about quickly becomes second nature. For example: why do you (possibly hypothetically) use curly braces around a single line block following an if statement in a C-like language?

Several reasons if you think about it. First, so that you can't forget to add them in when you need to add another line. Second, because it makes it unambiguous which if or else if an else belongs to if you have a big nasty chain. You don't spend a lot of time thinking and stressing about those reasons every day, but having the habit protects you anyway.

abraininavat5• 13 years ago

> I think hyper-vigilance is a poor choice of words

Well, it's his choice of words. You seem to be trying to redefine the article to your liking.

You're right, rules like the curly braces one you mentioned eventually become second nature, such that you don't think about them. That's a "habit of thinking", as you say. That's clearly not what the author is talking about. The author uses words like: "hypervigilant", "obsess about the wrong things", "verging on paranoia", "constructive paranoia", "I remain alert", "I try to think constantly", "being attentive to hazards".

He's talking about an attitude which might very well bring about stress. It beign second nature to add a curly brace after an if statement doesn't.

EwanG• 13 years ago

For those equally concerned, there are "shower chairs" that you can get that greatly reduce the risk of falls. Since my SO had her amputation it was the only way she could take a shower. However I've found it to be pretty convenient as well.

JoeAltmaier6• 13 years ago

A handy technique for evaluating situations is this: how many mistakes am I away from death/injury? If I drive without a seatbelt, I've put myself 1 accident away in many cases.

My Scouts are young, and love to climb things. I tell them, I know you're strong and skilled. But a loose rock or slippery foothold puts you at risk anyway. So wear the harness - now it takes two mistakes to kill you (e.g. loose rock + badly rigged harness). The risk goes down drastically.

So put some non-skid floor mat in your shower, or a chair as advised in this thread. The mis-step no longer carries the same risk.

mauvehaus4• 13 years ago

In the climbing example as presented, you should be at least three mistakes away from injury. The belayer should check the climber's harness and knots before allowing the climber to climb. Naturally the climber should check that the belayer's harness is fastened securely and that the belay device is rigged properly before climbing too.

Realistically, there are still several single points of failure in the system:

1) The space between the belayer's ears 2) the rope if it has become damaged since it was flaked and inspected or gets cut while catching a fall. Yes, that happened, though not to me [1]. 3) The protection on the wall, due to improper use. although depending on how high you are, the next piece down might still keep you off the deck. 4) The harness itself, although barring invisible damage this should be caught by the belayer/climber him/herself and the cross check. 5) The protection on the wall due to gear failure.

The above are listed in what I would consider descending probability, although 2 and 3 are pretty close, with 3 probably jumping 2 in trad climbing. I would rate the probability of 5 being negligible barring manufacturing defects, the prevention and possibly detection of which is probably outside the expertise of virtually all climbers.

Moral of the story: safety is complicated. (edited to add) I'd believe that trying to get people to apply a simple model of "how many mistakes" is better than none, but I wonder to what extent it reduces safety by making people complacent about having done a risk analysis when the system is too complicated to be analyzed that way.

[1] http://www.redriverclimbing.com/viewtopic.php?f=21&t=132...

JoeAltmaier6• 13 years ago

Thanks, yes, our climbing staff at camp is skilled at teaching correct climbing technique. I use this example to help 10-yr-olds understand why they cannot climb a random rock face during a hike.

phil4• 13 years ago

I'm pretty sure it's climber error and mis-rigging by at least 10x.

Gear failures of all kinds are extremely rare.

Edit: objective hazard is significant, too: rockfall, afternoon thunderstorms, etc.

jrockway• 13 years ago

Harnesses are redundant, too. About a year ago, I watched someone get half way up the wall and fall, only to have her harness come unbuckled. Fortunately, the leg loops kept her suspended and she just down-climbed and fixed her harness.

(Part of the problem in this case was not understanding how the mechanism worked, which is not a good idea when it's the mechanism that stops you from falling 30 feet onto the ground.)

kjackson2012• 13 years ago

Sometimes you hear things that instantly change your views on the world.

I have to say that this above post, in about 10 seconds of reading it, has completely changed my views on assessing risk.

The idea of quantifying risk by counting the number of mistakes you are away from catastrophic failure is an excellent way to visualize risk. It's a simple way to calculate risk, and an even easier way to teach my kids. Thank you.

gojomo3• 13 years ago

There's a similarly great passage in 'The Great Gatsby':

It was on that same house party that we had a curious conversation about driving a car. It started because she passed so close to some workmen that our fender flicked a button on one man's coat.

"You're a rotten driver," I protested. "Either you ought to be more careful or you oughtn't to drive at all."

"I am careful."

"No, you're not."

"Well, other people are," she said lightly.

"What's that got to do with it?"

"They'll keep out of my way," she insisted. "It takes two to make an accident."

"Suppose you met somebody just as careless as yourself."

"I hope I never will," she answered. "I hate careless people. That's why I like you."

robrenaud• 13 years ago

I am skeptical.

I am one street crossing away from death. You are one car ride with a seat belt away from death.

You really need to have some rough probabilities attached to things for this to be reasonable.

Evbn7• 13 years ago

Are you an engineer? Redundancy is basic stuff for websites.

HAVEACHILLDAY• 13 years ago

His life expectancy was 90, but they never say that this number is also accounting for people that fall in the shower.. Right?

So everyones risk goes down slightly too.

meddlepal• 13 years ago

It's a good way to design software too.

gfodor• 13 years ago

This is reminiscent of Benjamin Graham's "margin of safety" idea in investing. Get yourself in a position where you think the stock you want to buy is cheap and certainly worth buying. Then buy it if it only if it becomes even cheaper.

Put yourself in a position where you think you are unlikely to get hurt by a single mistake, and then insert an additional layer. So really it should be three :)

aqme28• 13 years ago

Reminds me of skydiving statistics. Something like 1 in 1000 chutes fail, so you pack two. The chance of both chutes failing is 1/1,000,000. Consider the fact that most skydiving accidents are due to human error and you can expect an accident roughly once every 100,000 jumps or more, which it turns out is pretty accurate.

eru• 13 years ago

That's a good metric. You can make it slightly more involved by not only counting mistakes, but also when those mistakes would have to occur.

For the climbing: The loose rock can occur while you are distracted. But you can tie up the harness at your leisure and with friends checking.

From a software development perspective, that's also why automated testing is better than manual testing. You can write the automated tests when you have time, and they will work even when you are under stress.

jessedhillon3• 13 years ago

Strangely not mentioned at all, so I'll put it here: Jared Diamond is the author of Guns, Germs and Steel, his most famous work. It addresses the question of how and why European societies were able to advance themselves so much farther ahead of all other civilizations. There is also an excellent four-part series streaming on Netflix.

roflc0ptic• 13 years ago

Guns, Germs, and Steel was most certainly not about "how and why European societies were able to advance themselves so much farther ahead of all other civilizations". The concept of "advanced", or being "ahead of" is inapplicable. It's a book about sociocultural evolution.

Additionally, Diamond is pretty ambivalent about the "winners". Diamond wrote an essay on the subject of agriculture called "The Worst Mistake in the History of the Human Race". He closes the essay with "As our second midnight approaches, will the plight of famine-stricken peasants gradually spread to engulf us all? Or will we somehow achieve those seductive blessings that we imagine behind agriculture's glittering facade, and that have so far eluded us?"

http://www.ditext.com/diamond/mistake.html

jessedhillon3• 13 years ago

No. I'm pretty sure it was about why and how European civilizations were able to conquer technology and the world, and specifically why many of the developments critical to the rise of European supremacy are not found in other societies. Yes, the judgments made in the book tend to be more fact-based and objective, e.g., a gun is more effective than a spear.

It is not a screed extolling the virtues of European civilization, nor a litany of the failings of other people. Sorry if that's how you understood my brief.

Gotta love HN-contrarianism. Oh have you also heard of Jared Diamond and would now like that knowledge recognized by pedantically contradicting me?

EDIT: actually let me update this. It is about sociocultural evolution. However if I had said "he wrote a book about sociocultural evolution," nobody would have understood the primary emphasis of his work. That book is specifically and primarily about identifying the key developments in Europe which allowed that civilization to rise in power. He has spent many years living among primitive societies around the world to explore his hypotheses. As much as possible, concepts like "primitive" and "advanced" are objective qualifiers and not value judgments.

When I say it that way, people understand what it's about and want to read the book.

blaze33• 13 years ago

Yeah it was more about why native Americans didn't invade Europe in 1492.

yk• 13 years ago

I think Collapse is better than Guns, Germs and Steel. It is about the end of isolated settlements, and the path which lead them to their demise.

And I think it should be mentioned that Guns, Germs and Steel is rather extreme in suggesting an 'geological determinism.' [1] While his arguments are generally quite good, there is simply quite a bit more happening. A nice book to balance this is Ian Morris, Why the West Rules--For Now.

[1] Jarred Diamond actually warns of this determinism fallacy, but the book certainly left me with the impression that such a determinism exists.

msellout• 13 years ago

I thought Diamond's comparison of Europe and China was especially weak. He wrote it off as that China had an emperor, and thus a single point of failure. He didn't do enough to explain why Europe did not become an empire, or to explain why China's immense bureaucracy did not avoid such a single point of failure.

anon1385• 13 years ago

GGS is the kind of book that makes academics despair [1]. I remember a Geography lecturer once relating how Diamond had been given honorary membership of some geographical society or other, and was giving an acceptance talk. It was a cause of supreme embarrassment for most of the people in the room; Diamond didn't seem to realise that he was addressing many senior academics who had spent most of their careers exploring why his ideas are unsound.

[1] http://onlinelibrary.wiley.com/doi/10.1111/j.1475-4959.2008.... (paywall)

guelo• 13 years ago

I think the reason Diamond's books are so popular and influencial is because academics do a poor job of relating to the public the consequences of their discoveries. By building on the latest scientific findings and filling in some gaps with speculative theories Diamond is able to astound readers with insights that the general public rarely hears. Even if the theories aren't the most accepted by academics the fact that the ideas are being discussed in a publicly digestible way is beneficial.

saraid2164• 13 years ago

Btw, I noticed that Diamond has another book out, for all of you who are interested in his work.

timruffles• 13 years ago

Reminds me a lot of Nassim Taleb's focus on payoff/cost (expected outcomes) vs probability. If the possible costs are high enough, it makes a lot of sense to take precautions. Hardly rocket science - seat-belts, hand-rails, smoking etc.

taeric• 13 years ago

Oddly, I'm not sure why one would not consider skipping the daily shower if you had these concerns. Though, I realize that is a highly personal decision. (Meaning that personal influences matter a lot. I've known folks who would go without a shower for upwards of a month with nobody noticing. Others, if a day was skipped it was obvious.)

hammock2• 13 years ago

Nothing against New Guineans, but the notion of attributing not sleeping under a dead tree to their specific culture is funny. It's basic risk management of anyone who camps frequently in the backcountry. In fact many learn the 4 W's of concern when picking a campsite- Wind/Weather, Water, Wildlife, and Widowmakers (i.e. a falling tree branch)

GiraffeNecktie• 13 years ago

I think you missed his point. He wasn't trying to establish that New Guineans somehow "invented" the idea of not sleeping under a dead tree, merely that the author wasn't personally tuned to the risks of being under trees until he spent time with the people there. That's all.

hammock2• 13 years ago

The point is not lost, but the author does attribute it to a specific culture:

>"I first became aware of the New Guineans’ attitude toward risk on a trip into a forest..."

>"I now think of New Guineans’ hypervigilant attitude..."

>"Traditional New Guineans have to think clearly about dangers....In contrast, Americans’ thinking about dangers is confused."

The truth is it's a common, learned attitude of anyone who spends a lot of time sporting in the outdoors - no matter where you live. The author himself points out the American/European pilot and raft guide, for example.

ahoyhere• 13 years ago

Heaven forbid an author write from his experience, and use a vivid illustration, instead of consulting the Compendium Of Facts Of What Every Person Knows and choosing the blandest and most local example.

adamio• 13 years ago

Where can I get that snake-head shower-head?

IsaacL• 13 years ago

One of the reasons falls are so fatal for old people is because elderly people in our society rarely stay active. Look at cultures like the Chinese, where you so elderly women up in the morning doing Taichi, or working out on those weird outdoor gym sets in the rest of the day. Maintaining strength and flexibility during old age helps mitigate damage from falls a lot.

Physical deterioration is often a self-fulfilling prophecy,

peeters2• 13 years ago

The real reason falls are so fatal for the elderly is because the victims become immobalized, causing them to become less active. After a fall, many elderly people are bed-ridden which causes a whole host of greater health problems which are the actual killers.

But then good health and daily activity are the best ways of preventing falls, (along with balance training and physiotherapy, especially after a surgery or stroke) so yes it is a cycle as you say.

I don't agree with it being primarily a cultural thing though. Daily exercise is an individual choice. There's a guy in my new building who I see all the time, he just walks to the end of the hall and back many times each day. Each lap probably takes him 10 minutes. But he chooses to stay active, even in very old age.

mfringel• 13 years ago

Daily exercise is an individual choice, but humans are social beings. An implicit societal framework for being physically active helps at the margins... and the margins are pretty large.

Angostura3• 13 years ago

Just to point out that according to: http://en.wikipedia.org/wiki/List_of_countries_by_life_expec...

the life expectancy at birth for China in 2011 was 73.47 years (CIA World Factbook (2011 estimates)) compared with 78.37 for the U.S and 80.05 for the UK.

So one reason that all those old Chinese people may appear so mobile is that they aren't quite as old as you might expect.

Evbn7• 13 years ago

There are a lot of killers between birth and elderly. Look at life expectancy at 65.

nathan_long2• 13 years ago

Yep. This is why every dollar spent on the TSA would be better spent on preventing car accidents, heart attacks, and falls in the shower.

http://www.schneier.com/blog/archives/2010/01/the_comparativ...

But I like the OP's more practical point: personal attention to normal activities that are actually risky, based on a realistic view of those risks.

davidroberts2• 13 years ago

Especially since the TSA actually accomplishes almost nothing in preventing deaths. All a terrorist about to be discovered at the airport security gate would have to do to complete his deadly mission would be to detonate his bomb right then and there. It would cause people to fear airports and security gates and mess up the whole system. Terrorism is all about sowing fear that the government can't protect you. The TSA just shifts some of the risk from the airplane to the airport. You can't security check everything in life. Better to figure out why people want to detonate bombs in the first place and solve that problem. But symbolic solutions are so much easier.

mikeash2• 13 years ago

Ironically, the fact that there haven't been any big successful airline-related terrorist attacks in the US for a long time is evidence that the TSA is useless, because of what you point out, despite the tendency for certain groups of clueless people to claim the opposite.

roc4• 13 years ago

Worse than that, the TSA nonsense encourages a non-trivial population to drive when they would have flown. Driving being far less safe, it's probable that Security Theatre has a body count.

davidroberts2• 13 years ago

Of course people interested in increasing government control over the population love security checks and any excuse to increase them.

sopooneo• 13 years ago

I am a little skeptical of this idea. We should spend no money fighting one threat until all greater threats (as measure by deaths/year) have been eliminated? I think rather we should spend money proportionally.

And I do not think that we should completely ignore the fears of irrational people. If our citizens are unhappy because they fear something, it is worth some expense to set them at ease. Though perhaps a careful placebo would be most fitting

nathan_long2• 13 years ago

>> Though perhaps a careful placebo would be most fitting

...which is exactly what the TSA is.

sp3322• 13 years ago

Well it's a little more complicated: you should always spend money where the most deaths prevented per dollar are achievable. So if you can save 1 life per $20 spent on thing A, and 1 life per $100 spent on thing B, you shouldn't spend any money on thing B. That's because each life saved via thing B means five people died from not having thing A (net loss of 4 lives).

shin_lao2• 13 years ago

Author doesn't understand how statistics/probabilities work and it ruins the article.

If you roll a dice six times, you have no guarantee to get a six. Each time you roll the dice, you have 1/6th chance of getting a six and this doesn't change no matter how many times you roll.

If you roll a dice six times, you have around 66,51% (1-(5/6)^6) chance of getting six at least once.

For the same reason, if you have 1/1000th chance of dying under the shower, and you take 5,000 showers, you won't die 5 times...

You will have 1-(999/1000)^5000 chance of dying, that 99,32%. That's not 1. So you won't die 5 times.

JumpCrisscross• 13 years ago

That's a relief, I prefer only dying once. Pedantic silliness aside, it was clearly an illustration of how frequency can amplify small probabilities to near-certainties, evidenced by the repetitive use of the one-in-a-thousand statistic.

confluence• 13 years ago

Just another name for Murphy's Law :)

Tichy3• 13 years ago

I guess to die 99,32% is not dying at all, so you actually die never. Taking a shower is perfectly save.

tomjen32• 13 years ago

And surprisingly enough, if you add the many-worlds quantum theory[1] that is exactly what you get. Non-death.

1)http://en.wikipedia.org/wiki/Multiverse#Level_III:_Many-worl...

sparky_z2• 13 years ago

You're apparently the one who doesn't understand how statistics/probability works. You're correct about his chance of dying once, but there's also a chance of dying twice, a chance of dying 3 times, etc. The expected value of the number of times he would die is 5000(1/1000), or 5.

If you replaced "deaths" in your post with "coin flips", this becomes obvious. I'll repeat your post with some different numbers so you can see how absurd your argument is.

    If you have a 1/2 chance of flipping heads and you flip 10 coins, you won't get 5 heads.

    You will have 1-(1/2)^10 of flipping heads, that [sic] 99.902%. That's not 1. So you won't get 5 heads.

See how that doesn't make sense?

Now, obviously a real person can't die more than once, but if you think he was mistaken about that then his supposed error has more to do with biology than statistics. Any reasonable reader would understand that it was just his rhetorical way of describing a large number of independent statistical events. If it helps, think of it as a population of 5000 equally-careless people taking 1 shower each, not a single person taking 5000.

shin_lao2• 13 years ago

Sorry, I understand what you're trying to say, but I don't think your example serves your point.

I don't think I mixed up expected value and probability of occurrence, if I did please point out where.

You don't care too much about expected value because once the event occurs (death), you can't play anymore...

If you were playing money, on the other hand, expected value would be much more interesting.

I think probability is interesting because if you say "I'll take the shower 2,500 times instead of 5,000" you drop the probability of death to 91.8 % (from 99.9%)...

If you say I'll die on average only 2.5 times you say nothing interesting.

bryanlarsen• 13 years ago

I'm willing to bet that Jared Diamond understands statistics. He just understands that most of the people reading his article don't. The inaccuracy doesn't affect the article so it's better to be more clear than completely inaccurate.

sparky_z2• 13 years ago

The thing is, it's not even an inaccuracy. He's entirely correct (statistically speaking). He's describing the concept of Expected Value* without explicitly using the term.

The only thing he could be said to "wrong" about is the idea that a person can die more than once, but everybody understands that that's not actually true. It certainly doesn't "ruin the article" like this poor fellow seems to think.

* http://en.wikipedia.org/wiki/Expected_value

chimeracoder• 13 years ago

> Life expectancy for a healthy American man of my age is about 90. (That’s not to be confused with American male life expectancy at birth, only about 78.)

It's interesting that Diamond literally describes the survival function[0], which is usually thought of as E[X|x>=a], but then conflates this with the expected value in the next breath.

I'm confident he understands the difference, but the notion of the survival function is so easy to understand without the underlying statistics (as he explains in two sentences), and provides a much more useful way of conceptualizing statistics. (Expected values of binomial distributions, on the other hand, are highly useful mathematically but difficult to conceptualize without the underlying statistics).

[0]http://en.wikipedia.org/wiki/Survival_function

stewbrew• 13 years ago

That's why they build special showers (that are on floor level) for elderly people. No reason to sleep under a dead tree.

patrickk3• 13 years ago

Not to mention hand rails, non-slip mats to stand on, chairs in the shower and other risk reduction strategies.

tomjen32• 13 years ago

Solution: a bathtub. I have some combination bathtub + shower so I sit down and wash myself -- it doesn't take longer and I can fall (since I am already at floor height.

kyberias• 13 years ago

I can easily think that climbing in and out of a bathtub is way more risky (wrt. falling) than merely stepping under a shower. I believe people don't fall when they stand in the shower. They fall when they step out of it on moist surface. Sorry if I ruined your day. :)

atdrummond• 13 years ago

They actually make such tubs that allow one to walk in: http://www.luxuryhousingtrends.com/walk-in-tub-with-massage-...

redwood• 13 years ago

I visited a friend in Slovenia and discovered this is the normal routine in Central Europe. In fact they have comfortable tubs which have a higher section for sitting on.

noname123• 13 years ago

In the derivatives world, there's a saying for trying to bet against highly unlikely events with catastrophic risk for small gains: "picking up nickels in front of a steamroller." The issue is when you pick up enough nickels and watch for the steamrollers vigilantly first few times, you grow complacent and think that you are the master of nickel pickers and steamrollers are slow mofo's. You try to pick more nickels and linger longer in front of incoming steamrollers.

See debacle of Long Term Capital Management. Options trader take profit/loss as soon as a humble target is hit. It's as in life, the biggest loss is the complete loss of your physical capital which takes you out permanently of the game. Gamblers focus on the potential profits and get high on how their luck evaded fate in one nick of time, traders focus on preservation of capital.

phil4• 13 years ago

I think LTCM's problem was more that they picked up all the nickels in front of steamrollers.

But it looked like there were some more nickels out in the middle of an 8-lane freeway...

sinnerswing• 13 years ago

Gutfreund to John Merriweather (LTCM's founder) "One hand, one million dollars, no tears."

To which Merriweather replied "if we’re going to play for those kind of numbers, I’d rather play for real money. Ten million dollars. No tears."

Gutfreund declined. In fact, he smiled his own brand of forced smile and said, “You’re crazy.”

No, thought Meriwether, just very, very good."

https://s3-ap-northeast-1.amazonaws.com/booksikindle/html/Li...

protomyth6• 13 years ago

The CDC has keeps statistics on how people in the USA die http://www.cdc.gov/nchs/fastats/lcod.htm

Looking at the 2011 prelims "Accidents (unintentional injuries)" comes in at #5 with 122,777 deaths and Intentional self-harm (suicide) is at #10 with 38,285. Assault (homicide) is no longer in the top 15.

Also, Assault (homicide) by discharge of firearms is 11,101 with all other Assault (homicide) totaling 4,852. To give some context to the Assault (homicide) numbers, "Accidental poisoning and exposure to noxious substances" totals 33,554 deaths or about 3x the Assault (homicide) firearm number or 2x the total.

Looking at the stats and what kills us, we spend a lot of time looking at the stuff that is actually going down versus the stuff that is increasing.

RyanMcGreal2• 13 years ago

> Looking at the stats and what kills us, we spend a lot of time looking at the stuff that is actually going down versus the stuff that is increasing.

We need to be careful: maybe things that are going down are going down because of how much time we have spent looking at them.

protomyth6• 13 years ago

Possible in some things. They do make a special not on HIV in the paper that should not be ignored.

On guns, we have more than we had before, so the liberalization (old school meaning) of gun laws has not increased any gun related violence. On the other hand, we spend a lot on educating the public on proper eating. I get the feeling our approach isn't correct given the changes, but I would have to look up some study data.

roc4• 13 years ago

It's important to remember that causes of death are often also activities which carry utility and even outright life-saving capability.

Accidental poisoning, for example, is often due to exposure to cleaning chemicals and drugs which have massively reduced illnesses and deaths. Spending more to make them less accessible may actually be self-defeating, in that it could well cause more deaths than it prevents, by making it harder to get and use those things for their intended purpose.

Further, many of the more prominent killers in society have already been the subject of safety campaigns. Cars are massively safer today than they were in the 70s and earlier, as a direct result of safety research and societal effort. As returns on such efforts have been diminishing for some time, the next dollar of safety research or societal effort is quite likely to impact more net lives when directed at a "lesser" killer that hasn't been the subject of as much study.

One must keep those two considerations in mind, when making judgements about whether we're spending an undue amount of time and money on a given threat.

Simply looking at a stack-rank of 'killers' isn't enough.

protomyth6• 13 years ago

Simply look at one line of data on anything isn't enough, but it isn't a bad place to start looking at what our actual risks are to see what the numbers on that risk are. Using that as a guide for the first things you should be concerned with helps quite a lot.

Looking at the auto stats http://en.wikipedia.org/wiki/List_of_motor_vehicle_deaths_in... I am not sure I would say massive.

But today, we are surrounded by "incident news" without looking at the trend lines. "Incident news" does not look at daily problems as its just noise and not headline friendly. It doesn't have a story narrative.

Risk vs reward is always going to matter. We watch TV and see "gun control" as the story. The long term trend lines for guns are more now than ever, more concealed carry, and less deaths.

brudgers2• 13 years ago

In 2010 most deaths by firearm were suicides [19,392]. There were 11,000+ homicides by firearm. And 412 deaths from legal intervention by any means.

In other words, the person you are most likely to kill with a gun is yourself.

gknoy2• 13 years ago

I imagine, also, that if one intends to kill oneself, having a gun or not is not a serious impediment to suicide.

mfsch• 13 years ago

It’s also important to remember that the total rate of death is constant at 1 death/person. Some death types going down will automatically result in others going up, so an increase or decrease in one type might not necessarily mean that the risk has changed.

I guess the goal is to reduce the deaths we can do something about.

Evbn7• 13 years ago

Or weight the stats by age or health death. Old people dying of cancer is better than young people dying in car crashes.

larrys• 13 years ago

The NYT headline is clearly link bait. If it had simply said "Some thoughts on everyday risks we underestimate" if would go nowhere.

That said there is a clear benefit and need to take a shower for many people as opposed to sleeping under a tree or crossing the street in the middle for which there is a work around.

teach• 13 years ago

A good headline is pretty much 'link bait' by definition. If a feature writer mistakenly wrote a terrible headline like yours, I would expect the newspaper editor to fix it before going to press.

Evbn7• 13 years ago

Some people have a more civilized education.

Florin_Andrei• 13 years ago

What is nowadays called "link bait" used to be called "headlines" back in the days of paperboys and rotary presses. It's simply an old journalistic practice.

stcredzero3• 13 years ago

The takeaway for programmers: every time you write a statement, the odds that you're introducing a bug are quite small, but you do this a lot, so the odds guarantee you will introduce a bug. The guys at NASA who came to TX/RX in Houston used to treat soldering defects as a statistical certainty. You empirically determine your solder failure rate, count the solder joins in the project, then look for your predicted number of failures. When they told me this, a light went off in my head. Why don't all programmers do this?

Think of it like this: if someone paid you $100 to take 2 steps balancing on a rail, you're certain to be able to do it. How about going 100 times as far for $10,000 over a 1000 foot drop? As they say: Quantity has a quality all its own.

dredmorbius3• 13 years ago

"They" in this instance was one Joseph Stalin.

stcredzero3• 13 years ago

Oh yeah! I've been watching too many WWII documentaries. Linus Torvalds also once said that there's a point after which a quantitative difference becomes a qualitative one. ( Back when the grumps were complaining that the world didn't need his stupid git thing.)

Evbn7• 13 years ago

Stalin worked at TX/RX?

brudgers2• 13 years ago

Mortality Data on Falls from the CDC shows the increase in risk as Americans age - and that is the direction of our demographics:

  Cause of death (based on ICD-10, 2004)        Falls (W00-W19)
  All ages                                      26,009
  Under 1 year                                  10
  1-4 years                                     24
  5-14 years                                    28
  15-24 years                                   211
  25-34 years                                   299
  35-44 years                                   493
  45-54 years                                   1,283
  55-64 years                                   2,011
  65-74 years                                   2,988
  75-84 years                                   7,249
  85 years and over                             11,412    
  Not stated                                    1

http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf

daeken3• 13 years ago

This is a bit of an aside, but I have to say this: even as a young person, take falls very seriously. I was 22 or so when I slipped in the shower. I was falling to the side and was going to hit my head, so I decided to twist so that I'd fall flat on my back, figuring I'd be fine. Well, I was, until a few hours later, when I started having chest pain and my left arm went numb and started getting shooting pains.

Thinking it was a heart attack, I went to the ER and was told I was fine, and it was probably just a pinched nerve from the fall. Three years later, the pain hasn't stopped -- the chest pain isn't so bad these days usually, but my left arm is almost continually numb and, well, the body doesn't really get used to the pins-and-needles feeling. If I had taken it more seriously, had a CT scan taken at the time, etc, it may have been caught early. Unfortunately, now that so much time has passed, doctors are at a loss as for what's going on.

I'm still finding new doctors and doing my own research into what's going on, but this process has been excruciating. So, please, if you have a fall: go to the doctor, and have them do a real examination immediately. When I went, they focused on my heart and didn't even so much as look at my neck or my shoulder; had I gone after the fall, they may have figured out what it was, and I wouldn't be in pain years later.

Hope this cautionary tale helps someone!

seestheday• 13 years ago

I some similar problems along with significant pain, also caused by falls (and a fairly serious injury that compounded things).

I had pain for years, until I stumbled onto a combination of things that completely resolve the issues as long as I stick to them.

I'm telling you in case they help. If nothing else it shouldn't hurt anything.

In order of importance:

1. Develop & maintain significant muscle mass, specifically in my upper & lower back. I'm not a huge musclehead by any stretch, but I can do 20+ pull-ups (not chin-ups) in a row and deadlift over 350 lbs. This had the biggest impact, and if I stop working out, the pain/symptoms come back. It literally took me years to get here, but is completely worth it to live pain/numb free. Health/aesthetics benefits are nice too.

2. Active Release Therapy - this broke up scar tissue that I had, may not be applicable to you.

3. Fish Oil Supplements - acts as a natural anti-inflammatory

4. Vitamin D/sunshine - Not sure if it's just because the sun & vitamin D makes me feel better overall, but I feel like it makes a small difference.

Edited to clean up paragraphs

mattdanger• 13 years ago

I highly recommend active release therapy to treat muscle and joint pain.

driverdan4• 13 years ago

Gaining strength / muscle mass and losing fat can help for many kinds of pain. My father had back pain for something like 20 years. He worked an office job and was 20-30 lbs overweight. After he started working out again, jogging on his lunch breaks, and lost the weight his back pain went away.

chimpingout• 13 years ago

what a load of balls...

the average man should be light and active enough to do a few chin ups with ease and run for a while

i have deadlifted over 350. it did nothing for my chronic neck pain and in fact only made it worse by over developing my traps.

neckbeard lifting gurus are so full of shit

temp453463343• 13 years ago

Word. I got hit by a car while biking 7 years ago and had all sorts of back problems afterwards. It wasn't like a sharp pain, but my back was always very tense and ache-y.

What has really helped me is doing handstand-pushups. You do a handstand against a wall, and then do a push up, lowering your head towards the floor. It really engages all the muscles in the shoulders/back. You'll probably start off by just doing a handstand and then go from there slowly. Once you are a bit more confident you can also arch your back away from the wall engaging muscles lower in your back.

Just like with any exercise, don't push yourself too much and make sure to keep proper form.

darkarmani4• 13 years ago

> Active Release Therapy - this broke up scar tissue that I had, may not be applicable to you

If this is comparable to the Graston technique, I think it works well, but it is far from comfortable. I had this after surgery for my Achilles rupture and it felt someone was carving my achilles out with a dull butter knife.

loceng3• 13 years ago

I will assume you tried chiropractor, acupuncture, and perhaps even yoga?

neotek2• 13 years ago

And pixie dust and sugar pills and wishes.

ollysb• 13 years ago

After a snowboarding accident I was left with a knee that I couldn't run on. I saw physios for 2 years and saw no improvement. 2 months of osteopathy(twice a week) and yoga(3 classes + 20 minutes at home on the other days per week) and I was good to go, running, snowboarding, the works. I find I still need to do some yoga every now and again(maybe once or twice a month) but apart from that it's forgotten.

driverdan4• 13 years ago

Yoga, perhaps, but it's on par with other low impact physical activity and stretching. The other two are just pseudoscience.

lloeki• 13 years ago

It does not even have to go that far: I was 26 when I was having a silly argument with my SO, and I tripped over while putting trousers on and fell forward. I had the bad reflex of putting my hands in front of me, but not fast enough so that my hands folded backwards, damaging wrist ligaments and cartilage.

Immediately examined by a doctor and a number of x-ray shots done, one of my left arm bone was slightly fractured which I was told will heal jsut fine, but cartilage had suffered permanent damage, that will only get worse with time. I had the habit to do regular Aikibudo wrist exercising (it helps prevent RSI), and this helps a lot in maintaining a status quo by strengthening ligaments and muscles, thus protecting the joint itself.

While I'm usually not in pain, I happen to be at seemingly random times, and I know what is the cause and that it will only get worse with time (it already does and I'm only 0x20)

Swizec• 13 years ago

You think that's bad? My sister broke her forearm in half, both bones, by tripping over her own leg (while getting ready to do a floor exercise at a gymnastics competition, that's the ironic part).

Seriously though, you should never fall straight on your arms. They're just there as a quick cushion before you do a roll over your shoulders. Learned that viable lesson spending my teenage years racing bikes down hills in the forest.

Has saved me multiple times, once in a head-on collision with a motorcycle. (I was on a mountain bike)

I have never had a broken bone in my life.

GigabyteCoin• 13 years ago

I fell on my tailbone delivering papers in the icy winters of Canada when I was about 10 years old. My tailbone still occasionally acts up 17 years later.

KVFinn• 13 years ago

Sounds like a herniated disc in your neck. Given the time frame it seems stable -- but the only way to fix it is probably years of difficult physiotherapy or surgery (and then physiotherapy).

daeken3• 13 years ago

My theory when I started seeing a spinal surgeon was a herniated disc at the C8 root. But an MRI ( http://demoseen.com/mri/ if you'd like to see the imagery) didn't show anything of the sort. At this point, it's looking likely to be either Thoracic Outlet Syndrome or another injury to the nerves there.

dwbutler• 13 years ago

I suspect whiplash from the fall caused trigger points in your neck and shoulders. I've had similar issues caused by RSI and stress. I highly recommend giving this book a try:

http://www.triggerpointbook.com/

Irregardless• 13 years ago

"Cause of injury: Lack of adhesive ducks." - Sheldon

I'm not sure what the takeaway from this article is supposed to be. Always be conscious of your safety but not to the point of constant paranoia?

Isn't that basically -- dare I say it -- common sense?

abraininavat5• 13 years ago

It remains to be shown that a hypervigilant attitude has any effect whatsoever on what you're being vigilant about, and in particular shower falls.

vickytnz• 13 years ago

This stuff particularly applies to machinery: the horror stories about people getting hair and clothing caught in machinery or looking away for a second when using a bandsaw are always a reminder to be careful no matter how many times you've used the machine before.

casca• 13 years ago

For a more detailed description of Jared Diamond's experience with the dead tree in New Guinea:

http://www.edge.org/conversation/tales-from-the-world-before...

And if you're in London, consider adding yourself to the waiting list: http://www.thersa.org/events/our-events/the-world-until-yest...

samspot2• 13 years ago

What else should we be vigilant about besides falling? I felt the article was a little incomplete w/o this information.

I've got one: * Lifting heavy things correctly.

eliben• 13 years ago

Boy, I love Jared Diamond's books. An absolute must read for any hacker.

ef4• 13 years ago

Speaking specifically about fall risk in older people: if you want to ensure a high quality of life when you're older, maintain strong muscles through exercise. This may seem like a no brainer, and yet almost nobody actually does it.

Balance and strength are highly dependent on exercise. Even fairly old people can maintain very good balance and strength if they don't let their muscles deteriorate through inactivity.

Being frail in old age is not inevitable. A sedentary person after age 50 loses something like 5% of muscle mass annually. But that same person can boost their muscle mass 20% in a single year if they just get serious about strength training, and then slow the deterioration to 1 or 2% thereafter. Run the numbers, it makes a dramatic difference in outcomes.

mattmaroon2• 13 years ago

Yes! Not to mention it makes you much more resilient even if you do fall.

darkarmani4• 13 years ago

Just as important bone density and minimizing bone loss through resistance training. Stressing the bones forces them to become stronger.

eridius• 13 years ago

Amusingly, Lonely Island's latest music video, just posted 5 days ago, expresses pretty much this precise sentiment. It's called YOLO and is available at https://www.youtube.com/watch?v=z5Otla5157c.

caf• 13 years ago

It's common knowledge in Australia that you don't pitch your tent under a tree, alive or dead. I imagine that's because Eucalyptus trees have a habit of dropping large limbs without warning (it's an adaptation to survive droughts).

waqf• 13 years ago

The other reason of course is because of the drop bears.

dredmorbius3• 13 years ago

Eucalyptus are rather notoriously bad about that, moreso than many other trees. I've witnessed them make a widow, or widower, in this case.

symmetricsaurus• 13 years ago

Angband(the roguelike) is an excellent teacher of the point made in the article.

The game is quite long and if you die you have to start over from the beginning. You can also be killed in one turn if you are unlucky and not careful. The only way to win is to lower the risk to die at each turn sufficiently that you can play through the 100 000 turns or so that it takes to win.

Playing it has really given me perspective on risks in a similar way to the author of the article. In real life you end up doing some things a lot of times and then the risk has to be damn low.

eagsalazar23• 13 years ago

Seriously showering 365 times/year is, while normal in the US, really pretty bizarre and definitely decadent. Put on some deodorant, shower every other day and this guy could cut down his risk massively. And save colossal amounts of water!

Does he sweat regularly? Play sports? If not, in the winter, shower twice per week. Doing otherwise is really falling into one of the weirdest forms of American prissiness.

In general I shower when my wife tells me I need to. On average that means every 2-3 days. How strange and wasteful would it be if someone washed their car every single morning regardless of whether it was dirty or had even been moved from the garage that day! (I work from home so the analogy frequently works)

I know he's making a broader point about risk but if you want to get over some crazy warped American perceptions to improve your life and the world, obsessive showering is as good a one as getting over delusions of risk of terrorist attacks.

abrichr• 13 years ago

In general I shower when my wife tells me I need to.

I'm not here to judge you or your lifestyle, but if I were to rely on my significant other to tell me when I needed to shower, I would feel as though I was taking advantage of their good will. I want to take care of myself and be attractive for them, not use them as a smell-o-metre.

eagsalazar23• 13 years ago

use your own heuristic but showering every day, when all you did was sit in front of the computer and walk your dog in 40 degree weather, is wasteful, pointless, and weird.

driverdan4• 13 years ago

This varies significantly from person to person. For me after 30-48 hours so I start getting itchy, my hair and face get obviously oily, and I start to smell. And that's assuming I'm not being very active.

peeters2• 13 years ago

> Put on some deodorant, shower every other day and this guy could cut down his risk massively

Yeah, if by "massively" you mean he'll only be expected to have a possibly-fatal fall twice instead of five times.

Your post is extremely ignorant. It not only offensively and incorrectly ascribes daily showering to "prissiness" and "obsessiveness" (as if that's the reason I shower every day, instead of, you know, wanting to smell nice, look nice, and feel refreshed), it also claims that this is an American phenomenon (I'm Canadian, and many/most people I know shower daily. The ones I know who don't, smell). It also assumes all people are the same. Personally, I'd feel pretty sorry for your wife if you smell like I do after not showering that morning.

It's no more "bizarre" than the Japanese are bizarre for using those funky toilets with built-in bidets. Cultures may be different. Let them be different without judging, and without projecting.

eagsalazar23• 13 years ago

Canadians are known to be one of the only cultures more prissy than Americans so you entire comment is invalid.

mattmaroon2• 13 years ago

I love it when people who don't understand the concept of expected value circle around it intuitively without quite getting there.

dhughes• 13 years ago

CBC.ca mentioned a study by Simon Fraser University in BC, Canada.

> "We show that the most common causes of falls are incorrect weight shifting and tripping, and the most common activities leading to falls are forward walking, standing quietly and sitting down,"

http://www.cbc.ca/news/health/story/2012/10/16/falls-elderly...

jokull• 13 years ago

Consider doing exercise that strains your bones and strengthens you in ways that will protect you when falling. Jiu-jitus is excellent at this. You will learn to structure your body, and creating frames with your limbs in many potitions, and you will fall to the ground multiple times. This prepares you.

ajaymehta• 13 years ago

I initially thought this was going to be about long-term health risks of showering every day. I've heard that long hot showers are bad for the skin and/or hair, is that true? Or might they be bad for the body in other ways?

(But good piece nonetheless, Jared Diamond is brilliant.)

zobzu• 13 years ago

I like how this article is written, with good english. This is refreshing. It might be that old people write better than we do. :)

doki_pen• 13 years ago

When I here a statistic like, your chance of falling and getting an injury in the shower is 1 in 1000, I assume they mean over my lifetime, not each day. There is not way in hell it's 1 in 1000 per day. I don't buy it. That said, I get the point of the article.

skittles• 13 years ago

I see someone on a motorcycle, and I think "idiot". I've known 7 people in my life who have had motorcycle accidents. One has had 2. He broke his neck in one of them. A couple spilled their bike on uneven pavement. A guy I met in college was like doctor House (dead bone in his leg causing great pain). Another guy was thrown 60 feet when he was rear-ended by a truck. And the last 2 are a father and son. The father has brain damage that destroyed his marriage. Go ahead and have your midlife crisis. I'll be in my car. I might die in a horrific accident someday, but a fender bender won't turn into road-rash and a concussion.

dr_• 13 years ago

The article ignores the fact that there is a variety of equipment available to further minimize the risk of falls in the elderly - and it's the elderly that really matter, because a fall, in their case, could very well turn out to be life threatening. There are shower mats to increase friction. There are bars in the shower to hold on to. There are even tub benches to sit on while showering. I don't really expect the sort of absurd headline grabbing articles like this from the NYTimes. I expect articles that responsibly describe the risks and ways to mitigate them.

bambax2• 13 years ago

> If I’m to achieve my statistical quota of 15 more years of life, that means about 15 times 365, or 5,475, more showers.

Or, take fewer showers. You don't need to shower every day in winter, do you?

lutusp2• 13 years ago

> Or, take less showers.

Would that be showers taken with reduced water pressure? Or do you perhaps mean fewer showers?

http://en.wikipedia.org/wiki/Fewer_vs._less

bambax2• 13 years ago

Yes, I meant fewer. Corrected in the post above, thanks. (I'm not a native speaker but this is no excuse, I should have known that! ;-)

Qantourisc• 13 years ago

You mean ... you people in the US don't all have rubber anti-slip mats in the showers ?

aneth4• 13 years ago

I've always been shocked at how wealthy people fly around in small private planes. At least once a year, I hear of a tragedy involving such a person, often wiping out all or most of their family.

While large aircraft are extremely safe, small ones have a significant chance of catastrophic crashes, particularly in inclement weather. While I'll fly in small aircraft, I will never make a habit of it - eventually the number will catch up with you.

Same goes for motorcycles. How many motorcyclists have driven for 30 years without a serious accident? None I know.

chiurox• 13 years ago

Shouldn't this problem be hugely mitigated by putting rubber or any non-slippery material on the shower floor?

known• 13 years ago

Interesting post for senior citizens. Thanks.

That Daily Shower Can Be a Killer

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