Could the simple practice of communicating health risk in real-risk terms (sometimes also referred to as absolute risk) instead of relative-risk terms be our most valuable healthcare consumer tool? Read on, and I think you’ll agree the answer is, “heck yeah!”
Here’s a brief definition of each:
- Relative Risk: Comparing a potential health outcome by percentage change. For example, a 50-percent reduction in the risk of dying prematurely. A healthcare provider may say, “Take this drug, and you’ll reduce your chances of dying of a heart attack by 50 percent.”
- Real Risk: Comparing a potential health outcome by using an absolute number. For example, three out of 100, or three out of 1,000. A pharmaceutical company may say, “Only three out of 100 people had to stop taking this drug because of side effects.”
The Weakness of Relative-Risk Information… Why Lotto Tickets Are Not Used to Secure a Mortgage Loan
If you buy three Lotto numbers instead of just two, you’ll increase your odds of winning by 50 percent. Funny, but true!
Still, your friendly, international conglomerate, credit default swap specialist, neighborhood bank will not take your three Lotto numbers as collateral for a mortgage loan (well, maybe they would have back in 2006). Why is that? Because although you’ve improved your odds of winning by 50 percent, you still only have about a three-out-of-20-million chance of winning.
You kind of knew that though, right? To win a six-digit Lotto would be like having 5,000 of your best friends all hit by lightning at the same time. Although you can improve your relative risk of winning dramatically (by buying more number picks), the reality is you’re still facing astronomical odds of actually winning the Lotto.
How Does This Work in Healthcare?
When we use percentages to compare treatment options, that’s referred to as relative risk. If your doctor were to say, “You have a 50 percent less chance of dying of a heart attack if you take this drug,” she would be making a relative-risk statement. Not so different from our little trick on how to improve your odds of winning the Lotto by 50 percent.
Here’s what the same information sounds like when expressed in real-risk terms.
If, instead, your doctor were to say, “Of 1,000 people with your health situation who do not take this drug, four will die within the next year. And of 1,000 people with your health situation who do take this drug, two will die in the next year,” she would be making a real-risk statement (also referred to as absolute risk). And this is not so different from knowing your best chance of winning the Lotto is about three out of 20 million.
Relative-Risk Statement Real-(absolute) Risk Statement
50% Less Chance of Dying two out of 1,000 instead of four out of 1,000
Relative-risk and real-risk expressions can also be used in evaluating surgical procedures:
“… media reports exclaim a study’s 50 percent (!) reduction in mortality (a reduction in relative risk), without disclosing that the actual death rate for a particular problem was only 2 per 1,000 (0.2 percent) to begin with, meaning that absolute risk of death after the intervention is now 1 per 1,000 (0.1 percent).”
The above points out the short comings of relative risk when considering the need for a colonoscopy procedure. (From the book, “Your Personal Affordable Care Act, How to Avoid Obamacare,” by Vik Khanna. For a review I did of that book see, Wellness Warrior.)
When talking about colonoscopies, Khanna concludes, “Did you know there is scant evidence that getting a colonoscopy actually reduces deaths from colon cancer?
What to Do With This Information?
Teach people to request that doctors and healthcare providers explain the risk of treatments in X out of 100 or X out of 1,000. This simple request will be new to most healthcare providers, but they should be able to explain risk in absolute terms.
Why Do Most Healthcare Organizations Communicate Using Relative-Risk Terms?
- Relative risk is where the money is.
- It’s not your best interest they have in mind (see the first reason).
Drug companies, surgical suppliers, and the healthcare system in general communicate the probability of positive outcomes of a treatment by using relative risk. The positive outcomes seem greater than they are in reality (50 percent less risk of heart attack – just like 50 percent greater chance of winning the Lotto) when you use a relative-risk paradigm.
Unfortunately for them I have an inner Sherlock Holmes. The above deception is intentional my dear, Watson. Here’s how I know that: Because healthcare providers communicate the negative risk of treatment in real-risk terms (fewer than three out of 100 people had to stop taking the drug because of side effects).
Thus, when it’s to a company’s interest to sell drugs, it uses relative risk to exaggerate the benefits of the drug. However, the company uses real risk to showcase the safety of the drug.
But if companies and healthcare providers used real risk to show the benefits of taking the drug or agree to a procedure, more people would not take the drug, or wait and monitor longer. They would do so because they would be better informed. It’s an apples and oranges use of the language, which they put in the same ads, disclosures, etc.
And that little twist on how most healthcare providers intentionally use relative risk in explaining treatment options has been the result of over treatment, over medication, over utilization, and many people agreeing to medical treatments they don’t need and should not have had.
A Few Resources on Understanding Relative Risk vs. Real Risk
As I’ve explained in previous blogs on this subject, I finally got my biofueled, C+ grade brain around this concept a few years ago after reading, “Helping Patients Understand Risks, 7 Simple Strategies for Successful Communication,” by John Paling, PhD. You can also read more on the subject by going to the Risk Communication Institute, established by Dr. Paling. His visual emphasis on communicating risk to the general public could be a precursor for developing a modern day, real-risk mobile App.
Also, here’s a great article by Sarah Williams, explaining the use of relative-risk and real-risk expression in media stories, “Absolute versus relative risk – making sense of media stories.”
Use this free, plain-language article in your workplace media to explain the issue of relative risk vs. real risk, and help your employees demand their treatment options be explained in real-risk terms. “When it comes to your health, it may not be ‘all relative.’”
Shawn is the President and Founder of Hope Health. For over 30 years, his work has focused on bringing clear, easy-to-read and watch health messages to the public via workplaces. He bills himself as the “Best C+ Student in the Wellness Biz” because, as he says, “I like to challenge the notion that there is no such thing as a stupid question.” Shawn is on a mission to tie workplaces into their surrounding communities to share resources and ideas in an effort to improve the health of all Americans.
You may reach Shawn at sconnors@HopeHealth.com or 800-334-4094.