Christiaens is wrong. Treatment should not be offered when there is a
threefold increase in relative risk. Patients should choose their own
treatment threshold, but need to be sufficiently well informed to make
this decision. For this they need to know the probability of benefit, i.e
absolute risk reduction, which is often best presented as numbers needed
to treat. Sadly, this information is unavailable. The risk caculators
merely indicate the absolute risks on no treatment. Given the
cardiovascular damage already done prior to treatment, it is intuitively
unlikely that reducing cholesterol from 7 to 5 in a 60 year old, will
reduce his risk to that of a man whose cholesterol has always been 5.
Politicians tell the public that most illness is preventable. This is
nonsense, but until we have risk calculators the tell us and our patients
what we really need to know, we and they will probably continue vastly to
overestimate the benefit of preventative treatment. Bad news maybe for the
public health, but good news for drug companies, who, no doubt, will do
their best to make sure we remain ill informed.
Rapid Response:
informed consent?
Christiaens is wrong. Treatment should not be offered when there is a threefold increase in relative risk. Patients should choose their own treatment threshold, but need to be sufficiently well informed to make this decision. For this they need to know the probability of benefit, i.e absolute risk reduction, which is often best presented as numbers needed to treat. Sadly, this information is unavailable. The risk caculators merely indicate the absolute risks on no treatment. Given the cardiovascular damage already done prior to treatment, it is intuitively unlikely that reducing cholesterol from 7 to 5 in a 60 year old, will reduce his risk to that of a man whose cholesterol has always been 5.
Politicians tell the public that most illness is preventable. This is nonsense, but until we have risk calculators the tell us and our patients what we really need to know, we and they will probably continue vastly to overestimate the benefit of preventative treatment. Bad news maybe for the public health, but good news for drug companies, who, no doubt, will do their best to make sure we remain ill informed.
Patrick Bower
Competing interests: None declared
Competing interests: No competing interests