From the British Medical Journal Christmas issue, a fine article by Thomas B Newman on the power of stories over statistics when stories are tragic and powerfully told and statistics are predictive but just not predictive enough to tell one the absolutely right thing to do in the unique situation. As the expert, the writer-of-guidelines, he reflects on his experience …

Ironically, the more of an expert on the evidence I have become, the more difficulty I have practising according to that evidence. This is because becoming a “jaundice expert” means becoming familiar with rare but tragic stories of children with kernicterus. These stories are so powerful that it is hard to keep them from trumping other evidence in determining practice.

The Lancet has recently produced a supplement on the subject of Extreme Medicine, containing a grab-bag of articles on medicine and physiology in hostile physical environments, medicine and psychology in times of threat, war and disease outbreak, and James Thompson’s dry and informed commentary on the subject of “Surviving a Disaster” …

Survival of extreme conditions involves many factors, some of them seemingly random … And yet, there is a fascination with the character of the survivor. We are reluctant to believe that their survival was random, and we seek a moral purpose, a redeeming virtue, or an easily applicable psychological trick that we can use in our own more humdrum lives.

… It is rarely a survival advantage to be well behaved. Compliant well-mannered people, awaiting instructions on what to do, often burn passively when a rush to the door could have got them out of the plane … What journalists describe as panic is usually a sensible flight from danger, a useful survival instinct only worth curbing in the special case of a confined space with a small exit … Gawping at an entertaining disaster is usually more common and more dangerous than panic, and the real challenge is to make bystanders recognise danger and run away.