Foundations for the Illusion of Certainty Pertaining to Health Risks and Benefits

Paper presented at the 1st International Symposium on Understanding Health Benefits and Risks: Empowering Patients and Citizens. Johns Hopkins University, Baltimore, Maryland. May 29, 2009Health benefits and risks are part of our everyday language and get extensive media coverage. Daily we are presented with information about effects from exposure to environmental contaminants and reports from public health and medical groups about the benefits and risks from medical screening tests and drugs. Are these statements accurate? If so, are they meaningful? We seek medical intervention and make dramatic lifestyle changes hoping they will provide benefits. The management of environmental contamination and exposures involves costs. The benefit and risk statements are usually presented as if they are authoritative, definitive, and based on clear and unequivocal evidence. This leads to an illusion of certainty. Risk assessment is a valid and important scientific discipline, but the uncertainty in this process tends to be forgotten. Unfortunately, ignoring uncertainty has serious results: errors of interpretation, communication of misleading information, even dissemination of deceptive statements. The chance of a health benefit or risk can be reported as a relative number or an absolute number. It can be presented as a rate, probability, or the cause of a positive or adverse effect. Since the use of risk assessment has become common-place, proper interpretation of health benefit and risk values is essential. The goal of this presentation is to provide an understanding and appreciation of the risk assessment process and to provide tools to interpret health benefit and risk values objectively. Included will be an explanation of the uncertainty inherent in the assessment of health benefits and risks, as well as an explanation of how communication and characterization can dramatically alter how these benefits and risks are perceived. An innovative and straight-forward visual aid (RCT:Risk Characterization Theater) will be used to explain the benefits of medical screening tests (e.g., mammography, prostate and colorectal cancer screening, cholesterol screening) and drugs (e.g., statins, Vioxx) and the risks associated with exposure to environmental contaminants (e.g., drinking water pathogens and radon). The intent of this presentation is to help patients and their families get more involved in making medical decisions, and citizens face critical questions about the environment. By putting the complexities of risk analysis in terms the general public can relate to, the principles presented in this talk will empower people to make well-informed decisions