In the simplest possible terms, here’s the difference among these 3 ways of describing the numbers, using a hypothetical example.
When someone says that taking a drug reduces your risk of disease by half, that’s a relative risk reduction number.
Another way to convey exactly the same information is to say that the risk of the disease is 2% for people who don’t take the drug, but your risk if you take the drug is reduced to 1%. Your risk has been reduced by half, but in absolute terms, that’s a reduction of only 1%. In other words, in this hypothetical, 98% of people won’t get cancer if they don’t take the drug; but if everyone takes the drug, that number changes to 99%.
A third way to convey exactly the same information is to say that 100 people would have to be treated with the drug for 1 person to get the benefit of the risk reduction from it. This number matters a lot if you’re concerned (or should be) about the other effects the drug might have, which are referred to medically as “side” effects.
Here's a question that lingers for me. If you have just been laid bare by a cancer diagnosis, you're vulnerable. How do you have the clarity or the confidence to ask the questions that need to be asked? How can we be our own advocates when we can't see straight?
6 comments:
From my experience, when one is faced with something like a cancer diagnosis or bad news of any sort, the initial response is actually to go into a hyper-diligence, an overly functional mode where such pragmatism is actually easier. It is after the fact we often fall apart. When my mother was diagnosed with cancer, she was able to get through everything--including a double mastectomy, chemotherapy, and radiation--with surprising strength and grace. However, within a year of her being declared cancer free, she began falling apart. The stress of facing the disease and fighting it had kept her moving but when she no longer had to hold herself together for any reason, she did what we expected she would do eventually.
I had a long answer drafted, Katie, then lost it, which is unfortunate.
The bottom line: a physician-translator you trust and/or self-advocacy is essential.
The following works wonders for me:
1) Slow down. Very few need to decide tomorrow about a treatment, even tho doctors may make it sound as tho tomorrow is better. In too many cases we don't want to take the time to sort it out but that "sorting out" time is essential.
2) Grab your smartest friend. Not kidding. Call your bookish friend who thought statistics, chemistry and physics were the greatest things in the world. You need better heads than your own in the wake of complex info.
3) Sit with your doctor until you understand it. Simply said, "Wait," goes a long way. I almost laughed out loud once, when Steve patted his hospital bed and said to the doctor, "Here, sit down." Awesome.
4) Understand that absolute risk is without context. It's a number. What I want is an understanding of what the "real and present" risk is to me, with my health picture. That is the doctor's job. I can reread statistics from an abstract myself and the information is relatively irrelevant. I work with the physician for his/her best assessment of how the information translates to my situation. Right now I am without a good primary care physician - one retired to take care of her children, the next one is on extended maternity leave...honestly.
This info I found helpful: http://stats.org/in_depth/faq/absolute_v_relative.htm and also, this one that a friend sent me:
http://bit.ly/kfGLIA
Important stuff. Thanks for posting,
Jody
Threat rigidity theory (Staw et al 1981) suggests that when facing a threat, people (whether they be alone or in groups) tend to do two things:
1) Restrict channels of information (reduces potential for seeing all the options)
2) Centralize decision making (no big groups/consensus building)
It has been suggested that when facing a familiar threat, this strategy may improve potential for survival/adaptation.
But if the threat is unfamiliar, then this approach may lead to responses that are maladaptive.
Statistics about anything can be hard to breakdown, but when your survival's on the line, it's crucial to understand them. One of the statistics that bothered me was alcohol and risk of breast cancer. I just went on a hunt for the bizantine stats, but see they're no longer available, probably because they didn't make sense to anyone else either.
My oncologist has suggests "everything in moderation, including moderation," whether it's water, vegetables or alcohol. Perhaps we should include statistics as well. Maybe I'll look at the next statistics with the thought that if I read them and take them to heart, I will have a 42% greater chance of becoming a worrywart than the person who doesn't read them, who will actually have a 17% greater chance of encountering the risk described.
Katie,
You asked a good question here. I love Jody's response, especially the part about finding your smartest friend! Sometimes after a cancer diagnosis, a person feels really rushed to "get it out" or make quick decsions. Acutally, it's crucial to do the opposite, slow down, think things through and take the time to think of those questions that need to be asked.
You pose an excellent question, Katie, one that we all ponder at some point, whether consciously or unconsciously.
After diagnosis I had to stop reading the latest breast cancer studies for a while because I panicked if something I had taken didn't work out statistically as medical professionals had originally thought.
Now that I'm several years out I can be more rational, but I never will forget that vulnerable time when we are afraid to ask questions for fear of the answers.
Jan
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