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Talking about Treatment
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
The commentaries on our paper suggest several alternative approaches to quantitative risk communication. Drs. Saitz and Kessler all propose the use of the absolute risk reduction rather than its reciprocal, the number needed to treat, while Dr. Peirce proposes a comparison among relative odds for treated and untreated patients. Because we already know that the relative risk reduction and the number needed to treat “frame” decisions in ways that lead to different treatment choices (1, 2), we must be cautious in advocating other quantitative measures without evaluating their potential impact. A comparison between the absolute risk reduction and the number needed to treat would be particularly useful.
Several of these letters identify a larger issue. Because the way we portray risk can powerfully influence clinical decisions, we need to scrutinize carefully the values embedded in our risk communication strategies. Framing of risk in absolute terms discourages treatment acceptance, whereas framing in relative terms promotes intervention (1, 2). Our choice between these communication approaches may reveal us to be either therapeutic “evangelists” or “snails” (3). Do we choose, as Dr. Kessler suggests, to foster universal adherence in the face of selective benefit? Do we define normative guidelines for treatment based on the disease or on the quantitative relation between risk and harm, as proposed by Drs. Jain and Djulbegovic and colleagues? Do we try to develop communication strategies that emphasize the imponderable variability among individuals, as Dr. Peirce suggests? If we are aware of the values implicit in our preferred approach to risk communication, we may more easily remember to ask patients about their own values and may be less likely to impose our treatment preference on an individual whose goals differ from our own.
John F. Steiner, MD, MPH
University of Colorado Health Sciences Center; Denver, CO 80262
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
