Out of an Abundance of Caution, Cautiously Interpreted

By Chuck Dinerstein, MD, MBA — Jul 06, 2017
An abundance of caution; we have all heard the phrase. And in what situations does that apply? For the most part, situations where there's a remote chance of a catastrophic outcome that puts its thumb on the scale.
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An abundance of caution, we have all heard the phrase. And while there are nuances, its gist is, for this particular situation we are extra careful. And in what situations does that apply? For the most part, situations in which there is a remote chance of a catastrophic outcome that puts its thumb on the scale when measuring risk and benefit. But like the thumb on the grocery scale, it throws off the whole enterprising of weighing choices and often has stealth costs of its own. These hidden costs can take the form of resources such as time and money. Most egregiously, they can infringe upon our rights. The quarantining of health care workers possibly exposed to Ebola was out of an abundance of caution. There is a cost to the scientific enterprise when we make decisions about our public and private health out of an abundance of caution. Often, caution is cited to overturn rational thought, to deny evidence-based decisions because of fear. But does it, in fact, reduce fear, or act to affirm, a bureaucratic means to hide a fear that we do not wish to divulge, a real fear? The power of an abundance of caution, meant to calm, ironically comes from the fear the phrase engenders. Much mischief can be hidden by an abundance of caution, after all, caution restricts us. Isn’t the present debate about immigration based upon an abundance of caution. And wouldn’t there by a significant overlap in the people who deny caution’s role in immigration while promoting an abundance of caution in say, using GMO foods?

The beneficiary of an abundance of caution is the general public. But the phrase disguises the most direct beneficiary, the speaker. The phrase is lawyerly, enfolding layers of protection and a halo of ‘studied judgment’ upon the speaker. First, there is the speaker’s beneficence in citing a concern, a remote concern, that given its outcome is too large to contemplate or court. If it appears, then all actions were taken or at least advised. And when the risk fails to materialize, and statistically speaking, it rarely does, the speaker maintains the halo of considered thought and judgment, safety above all.  

Now this is not to say that an abundance of caution is unnecessary. It is, especially when evidence is scant and fear of possible consequences is not. Not all choices can be rationally made, not all choices fit easily into risk and benefit. The difficulty with an abundance of caution is in mistaking those words for our meaning. It is OK to be afraid, but caution is not the antidote. We confuse our visceral response to fear, that anxiety that touches everything and nothing specifically, with a narrative our mind choses when bathed in the anxiety itself. Nor is caution the solution to not knowing. An abundance of caution does not reconcile our rational and emotional selves, it further divides them. Would it not somehow be better to directly address our fears and say we just don’t know than to hide behind an abundance of caution?

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Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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