BMJ  2003;327 (11 October), doi:10.1136/bmj.327.7419.0-d

Preventive drug treatment decisions are individualised

Lay people expect greater benefits than clinicians when considering drug treatments to prevent heart attacks, and may decline treatment even if well informed. Lewis and colleagues (p 841) interviewed general practitioners, practice nurses, and lay people and found that all groups experienced difficulty understanding numerical risk-benefit scenarios. Lay people uniquely balanced benefits against adverse effects, cost, and quality of life, resulting in a wide range of unpredictable treatment thresholds. Some said that they preferred lifestyle change to drugs, while a few lay people wanted only treatment with 100% effectiveness and safety. Johnstone (p 844) offers a patient commentary on living with a chronic illness and making decisions about drug taking.

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