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STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
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Patricia J. Murphy, PhD
Other topics that are treated sketchily or not at all: (1) emergency risk communication; (2) explaining risk data; (3) dealing with the mass media; (4) developing media of your own (from brochures to community advisory panels); and (5) the nitty-gritty logistics of planning and implementing risk communication programs bacteria 5 facts cheap 250 mg erythromycin amex. These topics are all important antibiotic 4 cs buy 500mg erythromycin otc, but in my judgment they are handled relatively well by companies and agencies already antibiotic natural erythromycin 500 mg low cost. Although the book is crowded with examples bacteria 1 in urinalysis generic 500mg erythromycin otc, most of them are anonymous: "A company," "an agency," or "a client" had trouble with "a community group" over "one of its products" or "its dimethylmeatloaf emissions. I assume it is obvious enough why the bad examples have to be anonymous, but what about the good examples It turns out that smart companies and agencies do not like to be found boasting about their risk communication and community relations successes. Suppose your local advisory board has become an effective outlet for community environmental concerns, calming the anger and replacing argument with discussion. Members of the advisory board may say so with pride, but if you make the same point, you risk sounding as though you think the board is just a gimmick to soothe ruffled community feathers. And so case studies of risk communication successes vi ii are a good deal rarer than the successes themselves. As applied to risk communication, the very concepts of "success" and "failure" might be premature. I do not know any companies or agencies that regularly do a good job of risk communication. Rather, I know a lot that sometimes handle a risk controversy well, other times bungle it badly. We are in a time of transition in how risk controversies are handled, progressing from intransigence toward openness, accountability, acknowledgment, and dialogue-but progressing slowly, hesitantly, and erratically. It is a mistake to assume that a company or agency has completed the transition just because it handles a particular problem adroitly, and it is a mistake to assume that it is a dinosaur just because it handles one badly. In hopes of learning together from our mistakes and our achievements, then: No names. It is flattering but embarrassing to be viewed by some practitioners as a risk communication "guru," when I see myself more as an extension agent, as a popularizer and integrator. It would be extremely difficult for me to trace the ideas in this book to individual sources, but the least I can do is acknowledge that most of them, at least, do have sources. I am greatly indebted to the Rutgers University colleagues with whom I have collaborated on risk communication research in the past decade. Caron Chess, Neil Weinstein, Michael Greenberg, Billie Jo Hance, Kandice Salomone, David Sachsman, Paul Miller, Emilie Schmeidler, and others have been endless sources of knowledge and wisdom. This book would be very different without what they have taught me and what we have learned together. I am grateful also to the growing roster of scholars at other institutions whose publications continue to point the way. It would be crazy to try to list them all, but I cannot avoid naming several whose influence on me (and on risk communication) is paramount: Paul Slovic, Baruch Fischhoff, Roger Kasperson, Aaron Wildavsky, Dorothy Nelkin, Sheldon Krimsky, Allan Mazur, Vincent Covello. I am fortunate to have worked with funders who also were col- ix leagues, whose intellectual contributions were as substantial as their financial and administrative ones. Environmental Protection Agency; Branden Johnson of the New Jersey Department of Environmental Protection and Energy; and Richard Magee of the Hazardous Substance Management Research Center at the New Jersey Institute of Technology. Above all, I am grateful to the hundreds of audiences and clients who continue to teach me what works in risk communication and what does not. How do you persuade people to test their homes for radon, to use a seat belt, to use a condom, to quit smoking What do you do when the experts tell you that the hazard is not all that serious, but the public is going crazy What do you do when anxiety about a risk is a greater threat to health than the risk itself So we have these two very different activities, both called risk communication: alerting people and reassuring them. I do not know whether dimethylmeatloaf in the air or water is going to kill people. As you look at these two kinds of risk communication, it also is important to notice that they are both difficult. That might come as a surprise if you have worked on only one of them for most of your career. Suppose, for example, you have spent a lot of time trying to reassure publics about risks they are exaggerating. You might think it would be a lot easier working to alarm people, working for Greenpeace, perhaps. Most people, most exercise, use seat belts, quit of the time, are apathetic smoking, install smoke detectors, about most risks, and it is or eat less fat. Most people, most of the time, are apathetic about most risks, and it is very hard to get them upset. But as many in industry and government know from personal experience, once people are upset it also is hard to get them apathetic again, to force the genie back into the bottle. This is a cardinal principle of risk communication: Alarming people and reassuring them are both very difficult. If you took a long list of hazards and rank-ordered them by something such as expected annual mortality (how many people they kill in a good year) and then rank-ordered the same list by how upsetting the various risks are to people, the correlation between the two rank orders would be approximately. You can square that correlation to get the percentage of variance accounted for, a depressing 4 percent of the variance. In other words, the risks that kill people and the risks that upset them are completely different. There are risks that upset millions of people even though they are not killing very many. If you focus on ecosystem risk instead of health risk, by the way, 2 Risk = Hazard + Outrage you come up with more or less the same correlation. That is, the risks that are most damaging to ecosystems are also very different from the risks that people consider most damaging. Environmental Protection Agency systematically examined the risks it was mandated to respond to , assessing them according to four criteria: health effect (cancer and noncancer), ecosystem effect, socioeconomic effect, and public concern. This book will focus especially on why people get upset about risks even when the experts do not see much basis for their concern. I am going to focus on the how-do-we-reassure-people half of risk communication not because it is the more important half-the more important half, obviously, is when people or ecosystems are endangered and no one is taking the risk seriously enough-but because it is tougher to comprehend. Government agencies, companies, and other organizations that manage risk generally understand apathy. We have a lot to learn about how to puncture it, but we are not surprised or bewildered when people underreact to a risk. When people overreact, on the other hand, risk managers typically have enormous difficulty understanding why. The Experts the question, then, is this: Why are people often frightened by risks the experts consider tiny Everyone has an answer to this question, and I believe most of the answers are wrong. Some environmental risks are gradual, delayed, geometrical, rare but cataclysmic, or made much worse by other risks; in such cases it might be appropriate to take action before the evidence of damage is strong. Nevertheless, I accept that the experts are right more often than they are wrong-or at least that when the experts and the public disagree about a technical issue, such as the size of a particular risk, the experts are more likely to be right. The explanation offered by most experts for their disagreements with the public-off the record-is quite different. It is true that this ignorance often extends to journalists, many of whom spent their college years trying to get out of the science requirement. In any case, as many in industry and government have learned the hard way, ignoring or misleading the public is a losing strategy. The traditional attitude of experts toward the public in risk controversies is beginning to change because it has stopped working. Little by little, 4 Risk = Hazard + Outrage agency after agency and company after company are discovering that when you leave people out of decisions about risk, they get more angry, they get more frightened, they interfere more in policy.
Aspirin and lowmolecular weight heparin combination therapy effectively prevents recurrent miscarriage in hyperhomocysteinemic women antibiotic resistance questions and answers 500mg erythromycin. Modulatory effects of vitamin D on peripheral cellular immunity in patients with recurrent miscarriage antibiotics for dogs after spaying buy erythromycin 250mg mastercard. Hyperprolactinemic recurrent miscarriage and results of randomized bromocriptine treatment trials antibiotics bronchitis order erythromycin 500 mg line. Recurrent spontaneous abortion and polycystic ovarian disease: comparison of two regimens to induce ovulation antibiotics for acne good or bad erythromycin 500 mg on-line. Current challenges in the pharmacological management of thyroid dysfunction in pregnancy. Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases. Use of human menopausal gonadotropins in the treatment of endometrial defects associated with recurrent miscarriage: preliminary report. McAree T, Jacobs B, Manickavasagar T, Sivalokanathan S, Brennan L, Bassett P, Rainbow S, Blair M. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study. Methylenetetrahydrofolate reductase polymorphism affects the change in homocysteine and folate concentrations resulting from low dose folic acid supplementation in women with unexplained recurrent miscarriages. Vitamin D deficiency may be a risk factor for recurrent pregnancy losses by increasing cellular immunity and autoimmunity. Vitamin supplementation and pregnancy outcome in women with recurrent early pregnancy loss and hyperhomocysteinemia. Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. Treatment of thyroid disorders before conception and in early pregnancy: a systematic review. Vitamin D administration during pregnancy as prevention for pregnancy, neonatal and postnatal complications. Septate uterus For a septate uterus, hysteroscopic metroplasty has become the indicated treatment of choice (Valle and Ekpo, 2013). Older studies have discussed abdominal metroplasty, but based on lower morbidity, ease of the procedure and the reduced risk of intrauterine adhesions, hysteroscopic metroplasty is the preferred option, and widely applied (Grimbizis et al. There were no significant differences in preterm birth, low birth weight or caesarean section. Non-controlled and observational studies have suggested a beneficial effect of surgery (Homer et al. A few studies have also reported on the live birth rate, and found an increase after surgery (Choe and Baggish, 1992, Valli et al. They found that surgery had a negative impact on fertility, with only 52% becoming pregnant in the first year after surgery. For those becoming pregnant, they found a reduction in the miscarriage rate (Venturoli et al. Hysteroscopic treatment of a symptomatic septate uterus can be accomplished via various methods including hysteroscopic scissors, and electrosurgical electrodes fitted through the hysteroscope (or resectoscope), which are the most common used methods. However, in cases of hemi-uterus with rudimentary horn and cavity, laparoscopic removal of the rudimentary horn should be considered to avoid "ectopic" pregnancy in this cavity and, in some cases, hematocavity (obstructive symptoms). Metroplasty (transabdominal or laparoscopically) is the only option for a bicornuate uterus (Papp et al. Justification Strong Conditional Women with (untreated) congenital uterine malformations have significantly impaired pregnancy outcome (see also chapter 8) (Grimbizis et al. Existing studies are difficult to summarize as they use different diagnostic criteria, various techniques, different endpoints, and a wide range of therapeutic options (transabdominal, hysteroscopic metroplasty by using monopolar, bipolar, loop, or scissors). The size-limit is derived from the observation that a significant proportion (27%) of endometrial polyps regressed spontaneously within one year, and that this was specifically seen in smaller polyps (<1 cm) (Lieng et al. In subfertile women with submucosal fibroids, myomectomy did not significantly improve live birth rate or miscarriage rate, as compared to controls with fibroids that did not have myomectomy (based on two observational studies) (Pritts et al. Pregnancy rates, live birth rates and miscarriage rates after myomectomy were similar to those in infertile patients without fibroids, indicating a benefit for surgery (based on three studies). Furthermore, women with fibroids not distorting the uterine cavity can achieve high live birth rates without intervention (Saravelos et al. There is insufficient evidence to recommend removing fibroids that distort the uterine cavity. Hysteroscopic myomectomy for fibroids may be associated with postoperative complications that can affect future pregnancies, including the formation of intrauterine adhesions and the risk of uterine rupture during pregnancy (Di Spiezio Sardo et al. In the absence of controlled trials, this conclusion is based on small observational studies comparing miscarriage rates before and after adhesiolysis. Recommendation There is insufficient evidence of benefit for surgical removal of intrauterine adhesions for pregnancy outcome. For severe adhesions, benefits with regard to pregnancy and pain symptoms may outweigh the potential harms of surgery In any case, uterine surgery is a known cause for adhesions, and treatment should attempt to prevent recurrence of adhesions. Additional information Non-surgical techniques for the removal of intrauterine adhesions (f. Cervical cerclage has been used in the prevention of preterm birth in women with previous second trimester pregnancy loss or risk factors such as short cervix revealed at ultrasound examination. Another recent review on cerclage (not specifically on pregnancy loss) concluded that the actual groups that benefit of cerclage are limited, but include women with three prior adverse events, and those with a short cervix (<25 mm) who have had a prior preterm birth (Story and Shennan, 2014). With regard to the technical aspects, a review reported no difference in the reproductive outcomes when the cerclage was performed before or during pregnancy. There was also no difference between laparotomy and laparoscopy, except that most complications, in particular excessive intraoperative blood loss, were reported with laparotomy (Tulandi et al. Of 23 women that received a history-indicated vaginal cerclage, six delivered preterm (<34 weeks), which was significantly more than the women under surveillance. Eight women receiving an abdominal elective cerclage had good outcomes (Hall et al. Laparoscopic metroplasty in bicornuate and didelphic uteri: feasibility and outcome. Minimally invasive surgical options for congenital and acquired uterine factors associated with recurrent pregnancy loss. Colacurci N, De Franciscis P, Mollo A, Litta P, Perino A, Cobellis L, De Placido G. Small-diameter hysteroscopy with Versapoint versus resectoscopy with a unipolar knife for the treatment of septate uterus: a prospective randomized study. Di Spiezio Sardo A, Mazzon I, Bramante S, Bettocchi S, Bifulco G, Guida M, Nappi C. Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus. Clinical implications of uterine malformations and hysteroscopic treatment results. Prevention of mid-trimester loss following full dilatation caesarean section: a potential role for transabdominal cervical cerclage. Metroplasty versus expectant management for women with recurrent miscarriage and a septate uterus Cochrane Database of Systematic Reviews. Prevalence, 1-year regression rate, and clinical significance of asymptomatic endometrial polyps: cross-sectional study. Mollo A, Nazzaro G, Granata M, Clarizia R, Fiore E, Cadente C, Castaldo G, Conforti S, Locci M, De Placido G. Combined hysteroscopic findings and 3-dimensional reconstructed coronal view of the uterus to avoid laparoscopic assessment for inpatient hysteroscopic metroplasty: pilot study. Not every subseptate uterus requires surgical correction to reduce poor reproductive outcome. Reproductive performance after transabdominal metroplasty: a review of 157 consecutive cases. Hysteroscopic metroplasty for septate uterus and repetitive abortions: reproductive outcome.
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Every extended shift scheduled in a month increased the monthly risk of a crash by 9 antibiotic kidney stones buy cheap erythromycin 500 mg on line. Effect of the stress of medical residency training on the overnight dexamethasone suppression test antimicrobial mouth rinses cheap erythromycin 250 mg on-line. There was no difference in suppression of plasma cortisol at the 2 time points (off-call vs antibiotics for sinus infection how long generic erythromycin 500mg overnight delivery. Residents who worked 24 hour overnight shifts demonstrated more negative mood and higher anxiety than those who were tested after a regular work day bacteria vs archaea erythromycin 250mg with mastercard. The investigators found no change in the rate of cesarean deliveries with implementation of the night shift system. Thirteen anesthesia residents at one academic program were each tested during 2 operative cases (one occurring during the night and one during the day). The day and night cases were matched based on type of operative case and patient complexity. The authors concluded that since residents were working extended shifts at night (21-24. A method to limit working hours and reduce sleep deprivation in an obstetrics and gynecology residency program. Reversal of diurnal cortisol rhythm and suppression of plasma testosterone in obstetric residents on call. Following a 36 hour extended overnight call shift, residents reported higher levels of stress, and anxiety, and possibly increased depression on validated scales. Cortisol levels demonstrated a reversal of the normal diurnal variation post-call. Half of near miss errors occurred when interns were on-call and half occurred when residents were working an extended shift (30 hours). The number of errors made per segment on the simulator was greater in the post-call group (after 24-hour shift) than the pre-call group. There was no difference between groups in the mean time to perform tasks on the surgical simulator. Effects of 24-h shift work in the emergency room on ambulatory blood pressure monitoring values of medical residents. The study shows increased 24-h ambulatory systolic and diastolic blood pressure among residents working a 24-hour shift compared to the same residents working a normal 8-hour work day. Mean diastolic blood pressure during sleep was also increased in residents during the 24-hour shift compared to the 8-hour shift, but there was no difference in mean systolic blood pressure during sleep. The authors conclude that extended work shifts may increase cardiovascular risks among residents. Interns in the study were working 30-hour shifts, however comparisons based on shift length were not performed. Effect of a change in house staff work schedule on resource utilization and patient care. The number of admissions to resident services and the average service census did not change. The night float rotation consisted of a 16 hour night shift once per week and one 30-hur shift once in 7 weeks, and was compared to a traditional overnight call system of 32 hour shifts every fourth night. Night float residents had statistically lower depression scores than traditional call residents, but thins finding may be confounded by time of year (March through May for night float versus January through February for traditional call). Mean patient satisfaction ratings were lower for patients admitted by night float and short call residents compared to traditional long call residents in multivariate linear regression adjusted for resident gender, patient age, and patient illness severity. The authors speculate that differences may be due to discontinuity of care and interns spending less time with patients when they are on night float or short call assignments. Complication rate was compared among cases where the resident surgeon was operating the day after being on-call for a 24-hour overnight shift versus operating during a call shift or during a shift when not on-call (regular day shift). No change in frequency of surgical complications occurred when the surgical resident was post-call (after a 24-hour overnight shift) vs. The error rate was increased for overnight and post-call (following a 32 hour extended overnight shift) orders compared to off-call orders (2. Effects of a Twenty-Four Hour Call Period on Resident Performance during Simulated Endoscopic Sinus Surgery in an Accreditation Council for Graduate Medical Education-Compliant Training Program. However, this was a very small study that may not have bee adequately powered to detect differences between groups. Residents working 9 hour shifts saw more patients per hour than those working 12 hour shifts (1. Findings included significant decreases in problems with the intervention schedule. Specifically, serious medical errors by interns and overall were reduced as were intercepted serious errors (for interns and unit-wide) and non-intercepted serious errors by interns. Medication and diagnostic errors by interns and unit-wide also decreased with the intervention. Laparoscopic skills suffer on the first shift of sequential night shifts: program directors beware and residents prepare. The design is a non-randomized 2-group post-test only with multiple methodological concerns related to incomplete reporting. The intervention schedule was marked by no shifts longer than 16 hours and fewer hours overall. The findings included significantly fewer hours for the intervention setting as well as more sleep per week for the interns in the intervention setting. The study showed fewer missed diagnoses by radiology residents on the night float rotation, and no difference in patient mortality or rework required by attendings. Residents and attendings believed the level of patient service was unchanged or improved with implementation of the night float system. Compared to faculty, a greater proportion of residents reported falling asleep at the wheel while stopped at traffic lights, traffic citation for moving violations, and motor vehicle accidents. Day-night pattern in accidental exposures to blood-borne pathogens among medical students and residents. Event rates were compared at night (among students and residents on 24-36 hour overnight call shifts) vs. The night float rotation consisted on 11 hour night shifts for 6 consecutive nights. Residents in this study reported either no change or improvement in their clinical judgment with the night float rotation as compared to traditional 24-hour call. Objective assessment of sleep and alertness in medical house staff and the impact of protected sleep time. The effects of this intervention on sleep time were compared with interns on a traditional call rotation with a similar workload. The investigators found that provision of protected sleep time did not increase total sleep time, but did increase sleep efficiency. Residents also subjectively rated their level of stress and fatigue on a non-validated numeric scale. The authors state that further study is needed to determine the significance of these findings. Effects of sleep deprivation on cognitive ability and skills of pediatrics residents. Lane position variance and speed variance on the driving simulator did not change based on shift status (overnight vs. Frequency of crashes on the driving simulator increased in men after 15 hour call shift compared to after regular day, but women showed no change in simulated crash frequency by call status. Teaching and learning in an 80-hour work week: a novel day-float rotation for medical residents. Educational outcomes of the day float were measured by cross-sectional survey of the 13 residents who participated as day float residents over a 1 year period. Residents reported adequate time to read on the day float rotation, and they indicated that their presence made the long-call ward teams more efficient, and the day float residents were able to provide articles or answer clinical questions for the long-call ward teams daily. Association of extended work shifts, vascular function, and inflammatory markers in internal medicine residents: a randomized crossover trial. The authors suggest that these findings could indicate increased long-term atherosclerosis risk.
Is it enough to hire an "independent" contractor to do the work fish antibiotics for acne erythromycin 500mg low price, an academic antibiotics for acne acne.org order 250mg erythromycin amex, perhaps treatment for dogs with flea allergies generic erythromycin 250 mg with visa, whose reputation for scientific integrity is solid Imagine that Greenpeace has hired an academic consultant to determine whether your plant is causing excess cancers in the community tween 80 bacteria purchase 250 mg erythromycin with mastercard. Better to supervise the study jointly, so neither of you has a chance to cheat and both are bound by the results. When companies and agencies refuse to be accountable, it looks to their critics like they are protecting their opportunity to be dishonest. A professional might understandably feel insulted when he or she is asked to submit to the oversight of some neighborhood committee. Companies accept, grudgingly, the oversight of regulatory agencies; agencies accept, grudgingly, the oversight of Congress or the state legislature; most of us accept, rather less grudgingly, the oversight of our peer professionals. In the aftermath of the Exxon Valdez oil spill, a coalition of environmental groups put together a document known as the Valdez Principles and began a concerted effort to persuade companies to sign a pledge to adhere to the principles. In the ensuing years, very few companies actually signed on, though scores announced their intention to adhere to the general thrust of the document and their support for the Valdez Principles "in principle. Doubtless some of the companies that did not sign were preserving their ability to cheat; doubtless others feared the legal implications of an independent audit. But many of the most progressive and responsible companies, I believe, shied away from the emotional implications of the audit, from the very idea of submitting to the judgment of activists. Once a company or agency makes the painful decision to be accountable, it may well have trouble finding someone to be accountable to . Usually, what activist-scientist, who soon rethey are protecting is their ported that the sample had killed a self-esteem. A furor of media coverage ensued, and the state attorney general announced an investigation. It is easy to understand why activists and politicians might be reluctant to participate in an industry accountability effort. They might be afraid that the hazard is genuinely tiny and want to avoid having to admit as much; they might be afraid that certifying the integrity of an industry judgment could cost them their own reputation for integrity; or they might be afraid that they will be technically outsmarted by slick industry scientists capable of making a serious risk look trivial and a dishonest study look objective. Even so, it usually is possible to find someone to keep you honest: a newspaper investigative reporter, perhaps, or a scientist whose sympathies are with your opponents. And as it becomes increasingly clear to all sides (and the public in the middle) that you are serious about making your testing accountable, it gets harder and more embarrassing for opponents to refuse to take part. Very few Americans trust regulatory law to keep them safe from harm, and even tort law feels like a crap shoot. But nearly everyone, no matter how radical or cynical, feels protected by a good contract. Encourage nearby residents to incorporate as a neighborhood association and appoint a bargaining team. Instead of promising that stack emissions will be "within the limits in the permit," work out a separate set of limits with the neighborhood, with shared oversight of the data and stipulated penalties each time a parameter is exceeded. If you can convert all your safety claims into enforceable contract provisions, neighborhood opposition should dwindle. Legal and political battles feed on exaggeration; those trying to stop your incinerator have every reason to exaggerate how bad it is, while you have every reason to exaggerate how good it is. Suppose you have insisted in the media that the facility will never emit detectable amounts of dimethylmeatloaf. The neighborhood must similarly abandon its claim that emissions will be sky-high and constant as it fights for a negotiated standard that is low and infrequent. Contracts are the gold standard in accountability, the diametrical opposite of relying on trust. If you cannot write a contract, at least look for ways to build a modicum of accountability into your efforts to resolve the controversy. It sought and secured the necessary permits to put the thorium in its own sanitary landfill. She later published an oped column noting that this time her nemesis had done right. There are at least five different components of a responsive process: (1) openness vs. Before subdividing the concept, though, consider an experiment that treated process as a cluster. Dispassion process component of outrage: whether the agency handling the cleanup was expressing compassion or contempt for local concerns, whether citizens were quoted as satisfied or angry, etc. Participants in the study read one article, then answered questions on whether they believed the risk was important, whether they would be worried about it, and so forth. And the relationship between the community and the agency had a substantial effect. Secrecy the first component of a responsive process is the distinction between telling unpleasant truths proactively and keeping secrets, withholding the information until it is finally revealed by a Freedom of Information Act complaint, a whistle-blower, an activist, or an investigative reporter. A wonderful example in the petroleum industry is hydrogen fluoride alkylation, a part of the refining process. High-level task forces 63 Responding to Community Outrage were convened immediately to continue the research and to explore mitigation approaches, including a possible shift to sulfuric acid (which has its own problems). The issue is the arrogance of not telling the community what you know about the risk. When a company or an agency is caught withholding information, the public understandably assumes the worst. So either the information they kept secret must be really damning (in which case the hazard and the culpability are huge) or the chances of getting caught must be really small (in which case the company presumably has hundreds of equally guilty secrets it has gotten away with). In reality, companies and agencies usually do not keep secrets because they calculate that the risk of telling the truth is greater than the risk of getting caught with the secret. Rather, they keep secrets because of a wide range of psychological, legal, eco- nomic, and organizational pressures; most fundament- ally, I believe, they keep secrets because it feels professionally humiliating to go public with a record that is less than perfect. Either you are willing to bet that no one will ever find out, or you are willing to bet that when they find out no one will mind that you did not tell them earlier. If you are not willing to bet "The bottom line for one or the other of these two, you secrecy is very had better release the information straightforward. These are all good reasons bet that when they find out for withholding information. But no one will mind that you they are not good enough, because did not tell them earlier. In all fairness, some secrets really are impossible to reveal, even though they might be technically trivial. The company agreed with me that getting caught with a secret of this sort could besmirch its reputation and damage its whole product line. So we developed an announcement, accompanied by testimonials from health experts (including some dioxin opponents). The next step was to plan focus groups on what would happen if the product already was in use when an activist group discovered and revealed the dioxin con- tamination. Would it suffice to protect the company (if not the product) that it had checked with scores of 65 Responding to Community Outrage technical experts in advance and received a unanimous go-ahead At this point, perhaps fortunately, the new product ran into other snags and was shelved. For one thing, the fact that it was kept secret makes it hard for people to recognize that it is benign. Exploring the neighborhood of a house we were about to buy, my wife and I once discovered that the immaculately kept home next door was a halfway house for disturbed and retarded teenagers. A little investigation convinced us that the halfway house was a good neighbor, not a threat to our security or quality of life, but we could not shake the feeling of having been betrayed by the sellers. The sellers probably could have saved the sale by apologizing for keeping us in the dark. Instead, they pretended it had never occurred to them we might want to know-a wonderful introduction to the next section. Stonewalling A second component of a responsive process is the distinction between apologizing for misbehavior and not apologizing for misbehavior. American society is very forgiving of the repentant sinner, but not of the unrepentant sinner.