Tuesday, April 26, 2005

Doc, what are my chances?

NYT: Mix Math and Medicine and Create Confusion
Patients may not know it, but there are two questions that make doctors cringe. The most common is, "If you were me, which treatment option would you pick?" The tougher one is, "What are the chances that this treatment will help me?"

Both questions cut to the heart of medical decision making and involve assessing risk and probability, which does not come naturally to many people.
Dr. Bob Shmerling, at Harvard Medical School's Intelihealth, explains the use of statistics in medical decision-making:
How To Understand When Your Doctor Talks Statistics

Although you are an individual and each person is different, it is helpful to know about information collected from hundreds or thousands of people like you in a similar situation. The most likely diagnosis, the meaning of a test result, the reason for an examination finding, even how much you should weigh are based on statistical measures that often become a routine part of what your doctor is saying...

What Are The Odds? Understanding Risk

One of the most common areas of confusion comes with the difference between absolute risk and relative risk. Imagine that you are offered a choice of two medications to reduce your risk of a heart attack:

* Medication A will decrease your risk of heart attack by 20 percent.
* Medication B reduces your risk from 5 percent to 4 percent.

If you think that Medication A sounds better, you are not alone. Relative risk is described by comparing the new risk with the risk before treatment. Although vitally important, the actual risk with and without the medicine is not mentioned for Medication A. If you thought Medication B sounds less impressive, perhaps it’s because knowing that the starting and ending risks are similar — that is, knowing the actual, or absolute, risks — makes the change seem less dramatic. This is particularly true when overall risk is very low or very high in the first place. Although they provide a more accurate assessment of risk, expressions of absolute risk are often missing from news or ads.

Most of us would think that Medication A is better. But actually the two medications are equally effective. Both have a one-percent absolute risk reduction because reducing a risk of 5 in 100 to 4 in 100 is identical to a 20-percent relative risk reduction...

One more! Medical Doctors Versus Spin Doctors: Sorting Through Conflicting Information

Have you ever noticed that what your doctor says about a medicine is different from what you hear in advertisements or in the news? The differences may be subtle, perhaps the choice of words, or something more dramatic. In fact, it may seem like one of the sources of information — whether the media or your doctor — must be wrong. When these differences arise, it’s natural to wonder: If one medicine is clearly best in the television ads, why is a different course of treatment being recommended by your doctor? There are several possible explanations, and sorting them out may be helpful to you in understanding what your doctor is saying and how to make better health care choices.
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