The average person considering taking medicines or undergoing a medical procedure is exposed to both a best-case scenario advertising by those who want to sell their product and make money, and a daunting worst case scenario list of possible risks required by law to protect consumers. You have probably seen some of those drug advertisements on TV where people have a disease, they take the advertised drug, and their problems are reduced or go away. The advertisement features actors portraying patients once again able to go about their daily activities with smiles on their faces having rid themselves of their afflictions. But in the background of these advertisements a voice comes along (with captions) warning would be users of the drug about all the possible risks of taking the drug. I recently watched one of those commercials for an FDA-approved drug and made a list of all the risks involved in taking this drug. These included:
Allergic reactions, rash, hives, blisters, muscle pains, fever, blurry vision, trouble breathing, dizziness, sleepiness, changes in behavior, worsening mood, depression, and suicidal thoughts.
After reading this list, some people may wonder who in their right mind would take this drug and expose themselves to all these risks! It is really a stark contrast between seeing all those handsome actors portraying smiling patients relieved of their maladies, and the voice warning consumers of these ghastly possible outcomes and side effects. What is a person to do with these schizoid scenarios?
The public has to understand two things about drugs and medical procedures.
1) These lists of risks are comprehensive enumerations of every possible negative outcome that can happen. These lists do not offer any detail as to the percentage of patients that experienced these negative outcomes. Was it 0.5% of patients that experienced these bad things, or was it 50%? Additionally, these risks may be more prevalent in a subclass of patients (say those with some pre-existing conditions) and may not affect all patients equally. Before taking the drug, or having the procedure, prospective patients need to find out what the actual frequency of side effects is, their intensity, and what type of patients are more prone to having them.
2) Even if a drug or a procedure has sizable risks, these risks may be justified if the patient considers that the chance that the drug, or the procedure, has in treating the disease is a better tradeoff than living with the disease or dying from it. There are drugs with terrible side effects that may even kill, which are nevertheless applied to patients who would otherwise die. On the other hand, a person afflicted with a milder disease may forgo taking a drug with nasty side effects, and choose instead to live with the disease and manage its symptoms by other means.
Essentially, it all boils down to asking what do you want, and what risks are you willing to accept in exchange for an opportunity at having what you want. Let me give you an example.
Consider the following procedure that is carried out in the United States. What are the risks of this procedure? This procedure may produce feelings of weakness, tiredness, dizziness, and faintness, with accompanying paleness, and shortness of breath. This procedure may also trigger depression, producing irritability, and an intense sadness with feelings of helplessness and suicidal thoughts. Other possible complications in the procedure are abdominal or shoulder pains, bleeding, high blood sugar, hypertension, infections, blood clots, cardiac malfunction, and death. The occurrence of extreme thirst, hunger or fatigue, or alternatively persistent nausea and vomiting, weight loss, reduced appetite, and dehydration has also been documented. On the average, out of 100,000 people who go through this procedure in the United States about 28 die.
With all these risks, would you subject yourself to this procedure? Would you want your loved ones to subject themselves to this procedure? Well, let me give you another piece of information. This “procedure” is called “pregnancy”.
Yes, that list of risks above (which is not comprehensive) is a real list of everything that can go wrong during a pregnancy. Of course, these risks are not distributed equally among all women. Obese, older, or younger women, or women who had hypertension, diabetes, and chronic heart disease when they became pregnant have higher risks. White women have a lower risk than black women or women from other races. However, despite these risks, most women choose to become pregnant. Clearly in the mind of these women and their partners the end result, having a baby, is worth these risks.
Going back to drugs and medical procedures, the idea is the same. Drugs and medical procedures are not perfect. They all have side effects and potential complications, and the frequency and severity of these complications may depend on the patient or the type of medical care provided. Prospective patients have to educate themselves and seek advice, gauge their condition, determine the risks, weigh them against the possible outcomes, and decide what to do.
The pills image is in the public domain.