New graphic could clarify health reporting

Year after year, there is a pervasive use of misleading and confusing terms and numbers used to characterize health benefits and risks. This makes it virtually impossible for doctors and patients to jointly determine what constitutes appropriate medical intervention. Given its influence and authority, this is especially problematic when it comes to how the mainstream media present this information.

This year, newspapers (including The Sun) reported on studies claiming that: acid reflux drugs like Prilosec can increase the risk of heart attack by 16 percent; high dose flu shots cause 24 percent reduction of flu; and lung cancer screening can reduce lung cancer deaths by 20 percent. These are but a few of many examples.


Unfortunately, all of these numbers are contrived statistics called relative risk and do not help doctors or patients understand the real benefits and risks of these interventions. This statistical method was designed for use in epidemiological research to assess randomized controlled trials and cohort studies. It was never intended to be used for shared decision-making between doctor and patient. And, while there is general agreement on this within the medical community, little has been done to remedy the situation.

Presenting actual risk and benefit is straightforward and is the only meaningful way to show the true value of a medical intervention. For instance, with acid reflux drugs a 16 percent increase in heart attacks (relative risk) translates to mean that only one out of 4,000 people who use such drugs may be at risk for a heart attack (actual risk). High dose flu shots may prevent five cases of flu out of 1,000 people who use them, and lung cancer screening benefits three out of 1,000 people while six out of 1,000 people suffer severe complications.

In these cases, and many others, it would have been much more constructive for the media to present actual risk/benefit numbers. This would result in improved patient involvement when discussing health concerns and issues with physicians. Recently, many media outlets published the results of a blood pressure study definitively stating that aggressive treatment of blood pressure in the elderly can reduce death by 25 percent. In fact, the actual benefits and risks in this unpublished study have yet to be calculated, and its widespread media attention has caused undue consternation among many patients.

Accurate medical information needs to be presented in the media using terms, and in a setting, that is familiar to patients — the presentation needs to "feel" right. This format should show patients, as simply and effortlessly as possible, what a test, procedure or drug actually means in terms of their own health objectives and their quality of life. What is needed is a simple, straightforward graphic that presents, on one page, a clear and objective picture of actual health benefits and risks associated with various medicines, tests and procedures.

In addition to new studies, this graphic can be applied to common health endpoints including, but not limited to: the use of blood thinners in atrial fibrillation; the use of statins in people with high cholesterol; the treatment of diabetes; the use of screening tests such as mammograms, colonoscopies, stress tests, carotid ultrasounds, bone density testing and treatment of dementia; and many other issues that typically evade discussion due to a paucity of accurate information and limitations in time.

Most of us are familiar with the crowd in a typical theater as a graphic illustration of a population grouping. It occurred to us that a theater seating chart (with 1,000 seats) could be used to objectively characterize and communicate actual health benefits and risks. This decision aid is called a Benefit/Risk Characterization Theater — BRCT.

Often sensationalized and overly simplified medical language drives decision-making in the direction of over-treatment. The challenge is to develop an alternative approach that would facilitate doctor-patient communication and improve the quality and value of patient-centered care. The BRCT model can, and should, be used by media to present data in an accurate and easily understood format.

Erik Rifkin is an environmental scientist who lives in Baltimore; his email is erifkin102@aol.com. Dr. Andrew Lazris is a primary care physician who lives in Columbia; his email is alazris@ppcmd.com. They are coauthors, most recently, of the book, "Interpreting Health Benefits and Risks: A Practical Guide to Facilitate Doctor-Patient Communication" (Springer Publishing, 2015).