Newsletters

Fall 2011

Benefit and Risk

Hippocrates is credited with the statement, “Extreme remedies are very appropriate for extreme diseases.” This is an early example of a benefit-risk analysis applied to medical care. All of us assess benefit and risk every day. If the alarm goes off in the morning, we must make a decision to get out of bed or sleep a little longer. There are benefits and risks either way. Sleeping longer may feel good and give us more rest, but lead to being rushed when we finally get up and perhaps being late for work. When approaching a stoplight turning yellow, we must decide whether to stop, risking a delay in our progress and irritating the driver behind us, or proceed, risking a ticket for a traffic violation. With investments, it is generally accepted that a chance of greater rewards usually involves taking greater risk Conservative investments are less risky but the return is usually small.

So it is with medical care. If you have an extreme disease, such as some types of cancer, you may be willing to accept a very risky treatment with a small chance of success, because the consequences of no treatment could be very severe. If you have a minor problem, such as a cold, you may be happy with chicken soup and plenty of fluids, knowing that the symptoms will soon pass.

Unfortunately, many medical concerns fall into a “gray zone” of uncertainty, where the balance of benefit and risk is less clear. Take prostate cancer in men, for instance.This can be a fatal disease, but many men have a very slow growing type of tumor that may never cause a serious problem. It is not always known in advance who has which kind of tumor. Choices for treatment include surgery, radiation implants, external radiation, and no treatment at all. It is a tough decision that is often made on the basis of patient preference and physician experience rather than “hard science.”

With osteoporosis, we evaluate the risk of breaking bones (having a fracture) and the consequences, which include disability, loss of independence, and death. When the risk of fracture is high, treatment with drugs to improve bone strength and reduce fracture risk is often recommended. In this situation, the benefits of treatment usually far outweigh the risks, although the risk is never zero. Each drug has its pros and cons, and the choice of treatment
needs to be individualized. To fully understand the potential risks, we need reliable sources of information. Reports on the Internet, newspapers, and TV may or may not be accurate, and the information provided may be “one-sided.” That is, it may present only one side of the story- the risks, without the other side- the benefits. This may be because something scary that happens to someone taking a drug may be considered more newsworthy than something that does not happen, such as a fracture. To learn more about the balance between benefits and risks, talk to a knowledgeable healthcare provider and find the real scoop.

E. Michael Lewiecki, MD                                    
Lance A. Rudolph, MD

This page update 09/30/11