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Medical Treatment Decisions
Balancing risks and benefits
Doctors and other primary care practitioners use their education, experience, and the results of clinical trials to provide information regarding the risks and benefits of available treatments. Riskis the likelihood that a harmful outcome will occur, such as worsening of the disease or developing a side effect from the treatment. How risks are described can make a big difference. For example, suppose that there was a clinical trial that compared a new drug to prevent stroke against an established drug. Now suppose the results of the trial showed that the new drug caused the side effect of bleeding in 2% of people but the established drug caused bleeding in 1% of people. One way to state the results would be to say that the new drug caused "twice as much bleeding" (therelative riskincrease). But it would be equally correct to say that the new drug "increased the possibility of bleeding by only 1 percentage point" (theabsolute riskincrease). In this example, the relative risk being twice as high makes the new drug sound extremely dangerous, whereas the absolute risk increase of 1 percentage point makes the danger sound minimal. And people who are for or against something typically quote only the risk description that best fits their opinion. Doctors can help people understand risk estimates and make a reasoned decision. Thebenefitof treatment could be any of the following: Cure of the disease (the greatest benefit and ultimate goal) Decreased symptoms (for example, reduced pain) Improved function (for example, being able to walk farther) Decreased likelihood of disease complications (for example, heart attack in people with diabetes) After weighing the risks and benefits of treatment and taking into account a person’s goals and preferences, the doctor might make a recommendation for a specific treatment plan. However, this process can sometimes be complicated, because There may not be one best treatment for a disease The tradeoffs between the risks and benefits may be numerous and confusing to sort through 