Important update: it turns out the writer did get it right, and this was an editing error at the Boston Globe. See my comment August 17.
As empowered, engaged patients we have a responsibility to evaluate the articles we read. A case in point is this week’s Associated Press article Any Spread Of Breast Cancer Raises Risk Of Return. It’s about a paper in this week’s New England Journal of Medicine that found a 50% increase in the chance of cancer recurring, and quotes an expert as saying
“I think it will influence treatment. If we’re considering treating the patient, we probably should.”
Can you spot the flaw in that reasoning, if all you have is that number? That’s all the article reported, and that’s a problem.
The problem is relative risk reduction. As we discussed last November in Making sense of health statistics, relative risk is an unsound basis for policy decisions, because you can’t tell the actual size of the impact. That affects you as a patient and you as a citizen thinking about policy.
In the study, did the 50% change mean represent a change from 200 patients per thousand to 300 per thousand, or from 2 per thousand to 3 per thousand? (Specifically, if we spend a zillion dollars based on this result, will we affect 1/1oth of the US population, or 1/1,000th?
Think about it for your own body. Your health provider suggests a treatment and says it’ll reduce your chance of a problem by 35%. (That’s the number commonly cited for statins like Lipitor.) Sounds impressive, right? But that’s a relative risk number. The raw data showed that among the general population, 1.59% had a coronary event, and among Lipitor users, 1.02% had one anyway. So for the $25 billion we spend on Lipitor in the US, we affect one patient in 200.
So now imagine your provider says “There’s a one in 200 chance this prescription will make a difference for you. Want it?”
I think there are two levels of concern for us as patients engaged in the new world of healthcare:
- For you personally, ask your providers for the absolute numbers. They may need to go digging, because they themselves may not have been given the numbers. But you have every right to know, eh?
- At a national level, the same thinking must be applied to policy decisions.
I wrote a note to the author of the AP article asking if she can get the absolute numbers. (As usual, the original article in NEJM isn’t open for us to evaluate.)
- Health News Review – a superb resource for understanding how to evaluate health news. (Thanks to Ted Eytan for the tip last year.)
- Evidence-based medicine – my post last November citing the Lipitor numbers, as reported in Andy Kessler’s book The End of Medicine.