I beseech you, in the bowels of Christ, think it possible you may be mistaken. ~ Oliver Cromwell
It is alarmingly common for patients to be prescribed medical treatments that science has shown are ineffective or even dangerous (see: speed, efficiency, and positive patient outcomes: can we have all three?). This might prompt us to ponder a few questions: How can one make informed decisions about medical care? And how should we process non-emergency treatment recommendations?
Here are my own thoughts, when faced with decisions for myself or my family. Please note, this is not meant to be taken as medical advice.
Consider the statistics
When it comes to medical care it’s completely understandable we’d all like to operate with certainties. Whether it’s a pill we’ve been prescribed or the procedure we’ve been recommended, it sure would be nice to know it is, in fact, going to fix the problem. Unfortunately, medicine doesn’t deal in certainties, it only deals in probabilities. With every recommended treatment comes a statistical likelihood of success and failure. As such, when making a decision with your healthcare provider, it’s critical you inquire and take those probabilities into account when deciding upon a treatment.
Be wary of relative vs. absolute numbers
Years ago I recall reading an advertisement for a name brand statin that claimed to reduce the risk of heart attacks by ~ 25 percent (in males). An impressive claim for sure, however, because it was a relative percentage the claim was a highly misleading one and I’ll explain why.
Let’s use a hypothetical population of 100,000 males as an example. Absent of any treatment, assume for the sake of this blog 1000 of those males are statistically likely to have a heart attack. Now, if we were to prescribe those same 100,000 males the name brand statin and after, say, five years of treatment, 750 of them had heart attacks, one could in fact legitimately claim a 25 percent (relative) reduction in heart attacks. However, the number of heart attacks prevented was only 250 out of 100,000 males, an absolute reduction in risk of only ¼ of one percent.
Of course, it sounds a whole heck of a lot better to claim a 25 percent reduction in heart attacks than to say that a statin reduced heart attack risks in a population of males from 1 to .75 percent. It is up to us to parse these details.
Don’t forget the why
After it was shown to reduce blood pressure, the beta-blocker atenolol was approved as a medicine to prevent heart attacks. This is fantastic news for the pharmaceutical company and its investors, but as it turns out, while it does reduce blood pressure, it does not reduce heart attacks or deaths (when compared with using no treatment at all). In other words, as noted in ProPublica, “patients on atenolol just had better blood-pressure numbers when they died.”
Just because a treatment moves numbers or allows one to temporarily feel better, it doesn’t necessarily translate to better outcomes. If it weren’t for the unintended risks (e.g., side effects, infections, etc.) associated with treatments, perhaps this wouldn’t be a big deal.
Unfortunately, when we take a treatment, regardless of how innocuous one may think that treatment is (e.g., aspirin), there is always a probability that something unexpected may go wrong. As such, if that treatment isn’t going to affect the outcome you’re trying to achieve, it sure seems worthwhile to question the treatment in the first place.
The challenge lies in determining what the risks are and whether or not treatments are effective. Indeed, with pharmaceutical and device companies spending millions to promote their treatments and medical professionals often getting their information from those same companies, it’s frankly quite difficult to know what is the right thing to do. There are, however, some resources I’ll introduce you to next week that will hopefully make it a little easier to assess the efficacy and risk of a number of common medical treatments.
Until then, how about some music for our Manufacturing Peace of Mind™ Spotify playlist? Here then is up and coming British artist Jade Bird with her new song “Side Effects.”
Twisting big themes of disillusionment, divorce, cheating, sorrow into the realities of an independent-minded, modern British 21-year-old, Jade’s music transcends genre with a wealth of influence from everywhere, and anywhere. Classic, contemporary, and a total breath of fresh air in the current musical landscape, Jade Bird is that rare, next-generation artist who appears as clued up on the past as she is determined to learn from its lessons: in control, sometimes in your face, and in possession of gifts beyond her years.
I listened to her new eponymous album while I wrote this blog and I couldn’t agree more. Hope you like it as much as I did.
Video not displaying properly? Chttps://youtu.be/pZFWHWhsSFslick here.
Having said that, I am interested to hear from you. Good, bad, or otherwise, please feel free to drop me a line at firstname.lastname@example.org. I’m the only person who will read your email and, as time allows, I’ll do my best, at a minimum, to personally acknowledge receipt.