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Wednesday, October 11, 2006 12:00 PM

Consumer/Quality Insider: Weighing the Benefits and Risks of a Medication or Treatment

(opening music)

Debra: This is Healthcare 411 for the week of October 11, 2006. Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. I’m Debra James.

Rand: And I’m Rand Gardner.

Debra: Every day we’re bombarded with confusing and sometimes conflicting medical information. We see TV commercials that promise significant relief from seasonal allergies, but then warn us about a host of unpleasant side effects. We read about powerful, new drugs that relieve arthritis pain, and then we see them taken off the market, so we’re not sure if any drug is safe to take. And a neighbor tells you that you should have eye surgery because you’ll love not needing glasses anymore. But a friend had the procedure and now sees stars when he looks at lights. With so much differing information available, how do you weigh the benefits and risks of a medication or treatment, and make the right decision for you? To help us sort this out, Dr. Carolyn Clancy, Director of the Agency for Healthcare Research and Quality, talked with Rand Gardner.

Rand: Dr. Clancy, we hear the terms "risks" and "benefits" all the time, but what does that really mean?

Dr. Clancy: Well, benefits are pretty straight forward that’s the positive effect you expect as a result of taking medication, having a procedure done, and so forth. Risks includes a very broad category of outcomes that most of us aren’t in search of, and can range from a minor irritation, such as a rash that goes away if you stop the medication to something much more serious, like incontinence following surgery.

Rand: So, how do we weigh the risks and benefits to make a decision that works for us?

Dr. Clancy: It’s really important to understand that every treatment whether it involves medication, surgery, or some other type of intervention involves a degree of risk. So even taking an over-the-counter medication, like aspirin, can have side affects in some people. All of us need to find a balance that we’re comfortable with; for example, can you live with the side affects of a medication? For some people this ranges, actually, from the idea of taking a pill every day to a feeling that they may get as a result of taking the pill. For example, they might be taking a pill to take care of a headache, but notice that it makes them feel a little tired. It’s important for physicians to know whether you prefer if there’s an option to have an injection, to take pills, or to have something like a skin patch. These can be relatively minor risks and harms, but it’s also very important to know that for some interventions, the potential risks are much higher. So, for example, after some types of surgery, it’s possible to have problems with incontinence, either of urine or of bowels. It can be possible to have other lasting effects, as a result of the surgery, and all of which has to be balanced against your increased survival as a result of having that intervention to begin with. So, in many cases perhaps in most cases there are no perfect answers but it’s important to explore all of the options before hand.

Rand: Alright, so where can we find the information to evaluate risks and benefits of a treatment or procedure?

Dr. Clancy: You should consult with your doctor, particularly for those recommendations that he or she is prescribing for your benefit. He or she can help you evaluate the pros and cons of various options, and can also tell you having made a recommendation whether there are other options available for the problem that you have. Working as a partner with your doctor, you can decide on the best treatment option for your needs.

Rand: Dr. Clancy are there specific questions that we should be asking the doctor?

Dr. Clancy: Well, the very first question you have to ask is of yourself how involved do I want to be in making treatment decisions and people vary quite a bit. Some people want to be very active partners, and in fact, view their physician as something of a consultant. Others actually, simply, want the doctor to tell them what they would do for a close friend or family member, so it’s really important to understand for yourself how engaged you want to be. Many, many people want to hear about all of their options, but then also want a physician to make a specific recommendation, but they do want to hear about all of the options, and it’s perfectly okay to be that category as well. Once you’ve got that figured out, and if you are someone who wants more information, it’s very important to ask the doctor what are my treatment choices, how could they help me or hurt me, and what happens if I do nothing at all? Is no treatment or watchful waiting an option here as well? If you work with your doctor, using the best possible scientific information, you can find out what are all the possible options for treating, and what are the associated risk and anticipated side affects. What your doctor considers a small risk may be something that you’re going to find intolerable. So without the very clear conversation, you’re not going to know that. For example, a recent AHRQ supported study on bariatric surgery the procedure that’s done to help people who are severely obese lose weight found that the rate of complications for many patients for six months after the procedure was done was much higher than was expected or previously reported. Now this finding does not, in any way, negate the value of that procedure. For many, many patients, this is the only effective treatment available for them, and it can have a very positive affect on complications associated with obesity, such as diabetes, sleep apnea, problems with arthritis, and so forth. But it’s very important, if you’re going to have that surgery, to know about all of the expected harms, as well as benefits of the procedure. In another study, we learned that women who receive chemotherapy for breast cancer need to be aware of possibly serious adverse affects caused by the toxicity of the drugs that may actually result in hospitalization. Again, this does not say that chemotherapy is a bad idea. What we are saying is that it’s a really good idea to be informed. At the end of the day, it’s very important to know what are your options? What are the likely benefits and harms of each option? And, is it okay to not make a decision and just wait and do nothing right now?

Rand: You talked about the importance of having scientific evidence. How can we find out what the evidence is or if there’s really any at all? Do we just trust the doctor’s opinion?

Dr. Clancy: Sometimes there isn’t evidence and, in fact, one of the most challenging aspects of clinical medicine is when a decision clearly needs to be made either because it’s a fairly acute situation or because the symptoms or disease state has become intolerable for an individual and there isn’t really good information. Most of the time informed decision making is going to be more effective for those situations where you’ve got a bit more time to contemplate what are my options and which one would be best for me? Your doctor is a good source. You can also go to the Internet for more information and sometimes a medical librarian can help you as well. AHRQ’s effective health care program is also a growing source of information that doesn’t say you should do this or that. What it says is here’s what the best evidence shows us about what works, what doesn’t, for which patients, and what might be some side effects.

Rand: What else would be helpful to know when weighing risks and benefits?

Dr. Clancy: I think it’s very important to know that people who are active participants in their own care, in general, have better outcomes than those who are not active and engaged. Now, again, most people have different decision making styles, but at the end of the day, the majority of individuals actually want to know about all of the options, even if they, then, turn to a physician and say, "Doctor, what would you specifically recommend?" If you are an engaged participant in the process, the more information you can gather, the better, because, at the end of the day, you and your physician share a common goal finding the treatment that works best for you, the individual.

Rand: Dr. Carolyn Clancy, thank you very much for your time.

Dr. Clancy: Thank you for having me.


Debra: That’s it for this week. For more information on these and other health-related stories and topics go to www.ahrq.gov. Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Rand Gardner, I ’m Debra James. Please join us for the next edition of Healthcare 411.

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