Friday, May 31, 2013

Practical lessons in assessing exotic risks

I am having a few days of surfing lessons in Bali on the way home from a business trip. Its actually quite productive because I get back from two hours of lessons pretty close to wrecked at 9.30 AM and eat. Then it is work for a bit, have a massage, work for a bit more, go out and be a tourist, eat, work and sleep. I have taken to calling my room at the surf camp "the office" which horrifies the other guests (mostly younger European - especially German speaking backpackers).

Yesterday however was unproductive. I rode a motor-scooter to Tanah Lot - a kitsch bunch of markets and an unusual coastal Hindu Temple. Now riding a motor-scooter in Bali is not risk free - indeed it is exhilarating with risk. However I thought I could reasonably list all the risks.

I could not.

I rode past a horse-drawn cart and the horse lent over and bit my shoulder.

Lesson 1: Its the risks that you can't see that get you. No risk assessment is complete without leaving space for what Donald Rumsfeld called the "unknown unknowns".

Anyway a quick perusal of the internet raises my alarm. Bali was rabies free until 2008 when what was probably a single rabid dog came from Java. Bali being Hindu has dogs roaming around - symbols of good luck. They would not be tolerated like that in most of Moslem Indonesia. There have been well over 100 deaths from rabies in the past few years in Bali. A tourist recently died after being bitten by a monkey.

A further perusal of the internet suggests that it is possible to get rabies from horses - indeed several cases have been confirmed in Canada. Horses it seems are curious creatures and have been known to walk up to strange-acting foxes leaving them vulnerable.

After some advice from some regular Bali goers I wind up at the Bali Clinic in Seminyak (a suburb of the tourist-and-flesh haunt of Kuta). This clinic is run by a mix of Western and local trained doctors and the triage process sends infectious disease cases to one of the local doctors trained at Sriwijaya University in South Sumatra. Now I know nothing about that school and little about South Sumatra other than that it is a well known Petri-dish of infectious tropical diseases (and some very good surfing). My guess is that the average doctor coming out of a university in Sumatra knows more about infectious tropical diseases than all but a handful of Harvard graduates.

So with some discomfort I conclude I am in the right hands.

The doctor sends me home. He is aware that rabies is transmitted by horses sometimes (but rarely) in North America. He is also aware that bats are a vector in some parts of the world. But to his knowledge there has never been a case of rabies in Indonesia from any animal other than a dog, a cat or a monkey. He does however clean out the wound and gives me the expected superficial iodine treatment.

The doctor is almost certainly right. Indeed I would put the chance of him being right at over 99.99 percent.

But if he is wrong I die.

This is a risk I hate taking. Every piece of my being hates taking this risk. In financial markets if you take a risk no matter how seemingly small where an outcome is total failure if you are wrong and you are taking it at the advice of a so-called expert you are likely to blow up.

Partly that is because financial experts exist to make medical experts look good. And it is because financial experts are conflicted in a way that medical experts are not. Indeed it is often because most financial experts are really just salesmen selling you the risks that their employers do not want to take.

Finally it is also because financial risks are distributed so abnormally and in financial markets you take them repeatedly - day-in-day out. Where I only got bitten by a horse once. And things you do repeatedly will get you in the end - but things you do only once probably will not if the risk-level is low enough. If you get into the habit of taking repeated wipe-out risk in financial markets you will eventually be got. I guess if I got into the habit of being bitten by strange animals in Bali I would eventually be got too.

But here I am, lying in the "office" in Bali taking precisely a risk that I promise my clients I will never take: the risk of blow-up on the assurance of an "expert".

Maybe this is the hypochondria of exotic risks. I am flying home with Garuda Airlines - and some will tell me that is an unacceptable risk too. They are now quoted as an airline with a "much improved" safety record. Whatever. It is a plane. I am in the hands of "experts" and I do it all the time.




John

25 comments:

Anonymous said...

I might get a second opinion at least! But are 2 experts better than one?

Anonymous said...

Love it, great post.

Also what happened to FMCN? Care to give us a debrief on what went wrong with your call there?

Anonymous said...

What books did you bring with you?

Anonymous said...

Great post

nycerroll said...

Dude, please -- I like your writing. Go home and get shots.

The alternative is to figure out the nearest place for the Milwaukee Protocol:
http://en.wikipedia.org/wiki/Milwaukee_protocol

Anonymous said...

Great post! Are you a fan of Nassim Taleb?

comet52 said...

If you start making rabid posts, we'll know what happened.

ddd said...

Amusingly you're falling prey to one of my favorite risk 'paradoxes', what I like to call the 'scope problem'. Do you lump this risk in with all the other risks that you've sworn off? Or let it pass? If you let it pass, why don't you occasionally let yourself take a financial risk when you feel like it? What justifies any of this categorization?

BC said...

Will you please look at China Stationery Limited (CSL) on Malaysian stock exchange and tell me it is a fraud?

CrocodileChuck said...

JH

You ID'ed your biggest risk in your last para.

I lived/worked in Java in from '97/'98. Garuda crashed 2X, Merpati and another one no longer extant crashed once, and then there was the famous Silk Air 185:

http://en.wikipedia.org/wiki/SilkAir_Flight_185

Anonymous said...

John - I am in Bali as well reading the post you just wrote on Bali. What a random coincidence. Would be great to chat in person if you're free - I'm right on Kuta beach

Anonymous said...

Taleb tells the story of doing risk analysis for a casino in Las Vegas. The casino worried about people stealing their money; they should have worried about a lazy employee not filing important Nevada state reports leading to a huge fine. They worried about tigers escaping from a cage and attacking the audience; they should have worried about the tigers attacking the trainer.

A friend returned home from a trip abroad. Weeks later she developed flu-like symptoms. Eventually she made an appointment with her doctor's office. Since her regular doctor was out she got a new intern. He diagnosed malaria, and told her "You are lucky to get me; I'm the only person in the office that could recognize the symptoms, since I trained in the back woods of Asia."

Always a tough choice with rabies shots, hope the doctor's risk assessment is correct.
Rich

gv said...

Good reply from ddd
Sometimes we WEIRD people attach too much importance to the wrong risks. Aren't some daily actions like driving a car more risky?
Jared Diamond has an interesting chapter on risk too in his latest book The World until Yesterday (comparisons between traditional societies and ours).

Anonymous said...

Horse nipping is actually quite common, its usually a social/play thing with other horses, but will happily engage a person with a bite unaware that human skin isn't anywhere near as thick. But I can relate, I had a bat land on my shirt in the middle of the day while golfing, and after watching videos online of people with untreated rabies, spent 30 minutes quizing my doctor if hes sure i would have felt a bat bite.
So the good news is you don't have rabies and the bad news is that horse does not think of you as an alpha.

david welsh said...

Don't forget the equally miniscule risk of fatal reactions to the treatment.

No doubt your excellent doctor took this in to account in telling you to do nothing.

In my experience most doctors will tend to recomend the treatment, especially when confronted by an internet induced medical neurotic.

Their is financial gain in selling the treament, and it is good for business to flatter the patient, by telling them they did the right thing to come, could have died, and please tell all your friends I saved your life...

John Hempton said...

I accidentally deleted a comment just then - and alas Google does not allow me to retrieve it. No idea what it said - to my commentator - sorry.

Kris said...

Got bit by a dog while riding motorbike in Chile. Traveled on to Equador before understanding the risk. Turned out it was no western vaccines available in Equador, only the old ones you get around your belly button with risk of a lot of side effects.

Went back to the US 10 days after the bite, got the modern vaccine, combined with antibodies that would keep me alive (if I was infected) until the vaccine allowed me to create my own.

It was all covered by my travel insurance.

Guessing you have the same good stuff in Australia.

My tip, call your travel insurance, surf on, and take some shots to make shure you stay alive when you get home.

PS: What is the probability of a Horse biting you. What is the probability of a Horse biting you if he has rabies..? I'm no horse man..

Anonymous said...

watch 60 minutes on rabies

Ken Taylor said...

I got bit by a monkey at Ubud and took the punt. It's a horrible death I read, and once you get the symptoms death is inevitable.

Against that, the cost of the treatment is high and the risk is low. I've forgotten the exact numbers but it wasn't that many locals that had been unlucky either. It is just a dramatic way to go and the risk is not nil so all advice will be to take the shots. The death rate on the roads is about 5 times Australia and hugely above rabies. You are probably not very experienced on motorbikes and definitely are unfamiliar with the road conditions, making your risk higher than average. Why take the high risk but protect against the low at great bother and expense?

I was surprised when you said "If you get into the habit of taking repeated wipe-out risk in financial markets you will eventually be got" because you inevitably do that. There is no safe haven. The best you can hope for is to minimise those risks.

Anonymous said...

John,
i used to go to Bali annually; have not been for some years and am thinking about going back; but before i go I have to find out: how is the air? all of india and thailand are covered with the asian brown cloud -- visible to the naked eye if you know what to look for; smellable at times, too; certainly ppl prone to asthma can feel it: have you noticed anything?
bitten by a horse? sucks. but better than either snake or scorpion. how close did you get to the horse? 50 cm? 1m?

John Hempton said...

The air was fine in Bali - Southern Hemisphere still - its the stuff in the sweep of China-India air that is irksome.

--------

For Ken bitten by a monkey at Ubud - I would not have taken that risk. Especially as if you got back to Darwin it would all be covered on Medicare in Australia.

But the odds are still long even there - about 700 thousand people visit the monkey temples each year - and maybe 700 get bitten at a very minimum.

About half those would take the shots.

At least one person has died after a visit to the monkey temples - possibly a few.

Upper bound for the risk - one in two hundred. Can't lower bound it.

Sorry - not a risk I would take.

---

Road toll is high - but nothing like that risk.

---

Still considerable effort has gone into immunizing the animals in Bali's tourist areas and around the monkey temples. Once you get a critical mass of immunized animals you effectively eliminate the disease - like a critical mass of immunized humans and some diseases.

If you were bitten by a monkey NOT in the monkey temples - then I would be VERY scared.


J

Anonymous said...

Two entirely different types of risks:

If you get rabies and die, then you have nothing further to worry about and can rest in peace. Death solves all life's problems.

If you lose all your money, then you have to live with the shame of failure and the day-to-day irritations of poverty and low social status. That is a horrible fate.

Anonymous said...

From the investors' viewpoint the downsides here are very different.

If you are hit by a 'tail risk' and die of rabies or a plane crash, their money is still safe.

If your fund is hit by a 'tail risk' then they lose their money.

The rabies risk is genuinely compartmentalised. Now quit worrying and get back to work :)

John Hempton said...

I am truly glad my investors money is safe if I die.

John

anabundantworld.com said...

Interesting on Garuda. I recently traveled in Indonesia and apart from a dodgy landing in Medan, all was fine. Apparently, the executives of a listed Australian company are happier traveling Garuda ahead of Qantas to Indonesia. A stunningly positive signal!

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