Risk vs. benefits

By Mimi Johnson, Director, NCL Health Policy

In the world of health care – and more specifically treatments – there is a constant battle between risks and benefits.

This is a dilemma we’ve all faced as we’ve chosen treatments for ourselves or our loved ones. We want the best possible outcome. Policy makers, drug manufacturers, health practitioners, and every day consumers must decide what the best possible outcome is, in addition to determining how to weigh the risks and benefits in achieving the outcome.

The challenge of weighing risks versus benefits is one that sometimes divides the patient advocates from the consumer advocates. Some say that we are all “consumers” of health until we are diagnosed with or seek treatment for a problem … and then we are likely to identify as a “patient.” Traditionally, consumer advocates examine and push others to understand the risks associated with a treatment in an effort to have the safest possible treatments available. Alternatively, patient advocates tend to focus on the benefits of a treatment and the need to have greater and timelier access to treatments, sometimes overlooking risks.

Having battled against a historically bad allergy season, I faced firsthand the challenge of weighing risks and benefits. When treatments weren’t working, my doctor changed my inhaler. The new inhaler helped improve my ability to breathe, but it had a funny side effect … it altered my voice! This was not one of the top-line risks listed in the consumer medication information, and I was not warned about this side effect by my doctor. I did a little sleuthing of my own, and low-and-behold it is a very commonly reported upon side effect by users of this particular inhaler. Though I was feeling 100 percent better, everyone – particularly when talking on the phone – would ask if I was alright and often assumed I was upset by something. In this instance, I was happy to take the risk of changing my voice a bit, knowing that I would once again be able to breathe and resume my normal activities.

Many of the risk versus benefit discussions center on far more serious risks and benefits. For example, it was recently announced that a groundbreaking treatment is available for melanoma patients. The new treatment essentially melts the cancer away. While this has been deemed monumental by doctors and cancer researchers, it does not come without its pitfalls. Risk number one – there is a great chance that it won’t work on you, as it is believed to be effective in only about 20 percent of the population. Risk number two – a common side effect includes developing rheumatoid arthritis. These risks, among others, need to then be weighed against the benefit of extending one’s life.

This challenge of determining what the best outcome is and what we’re willing to face in order to achieve it is nothing new, and it will only intensify as we begin to implement health reform.

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