Putting Risk into Proper Perspective

A few years ago when my wife and I bought our home, we found it had high radon levels. Released as a breakdown product from uranium, it seeps from the ground into homes, is inhaled and can cause lung cancer. The whole idea of radon was terrifying, particularly the implications for our children.

We had a radon abatement expert install a radon reduction system. The average radon level dropped from 7 to 2 picocuries/liter (pCi/L). But there was still radon. While a radon level of two sounds low, zero would sound a lot better! Radon at any levels confers risk of lung cancer.

Just like radon, drugs have risks. And patients are terrified of side effects. When patients hear, “There is a risk of lymphoma with this drug,” the risk may seem totally out of proportion to reality, a mirror image that is not altogether dissimilar from the chance people think they have of winning the lottery. The human mind has trouble keeping the magnitude of rare events—good or bad—in proper perspective. Communicating safety risks is a challenge.

The Environmental Protection Agency (EPA) provides guidance that quantifies the risk of radon in comparison to the other exposures (1.usa.gov/1ijCnYB). At a radon level of 8 pCi/L, about 15 of 1,000 non-smokers would get lung cancer (the risk of radon exposure is exponentially higher in smokers), which is about four times the risk of dying in a fall. At a level of 2 pCi/L, the risk is about the same as dying from poisoning, not something I lose any sleep over. A level of 1.3 pCi/L is the level in a normal home, so it doesn’t confer any risk over the normal environment.

I know there is some risk from the radon in my home, but I also know that risk is in the same range as the risks of normal life (even normal life is not safe!). I try to give patients the same kind of understanding of the risks of taking medications I prescribe. While pharmaceutical marketers may not be able to take it as far as I do (telling patients that there is a possibility of death from the treatment, but that most of the risk comes from driving on the highway to get to my office for a follow-up office visit), they may be able to create visuals that show patients how the risk of the treatment compares to other risks in life, from shark bites and lightning strikes at one end of the spectrum to strokes, cancer and myocardial infarction at the other (and perhaps highway driving and owning a pool in the middle). Giving patients a clear mental picture of the risks helps them put into perspective that these risks are well worth taking for the potential benefit they may get from drug therapy.

  • Steven Feldman, M.D.

    Dr. Steven Feldman is Professor of Dermatology and Public Health Sciences at Wake Forest Baptist Medical Center. Steve studies patient adherence at North Carolina’s Wake Forest Baptist Medical Center. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (www.causaresearch.com), founder of www.DrScore.com, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”

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