updated: 10/4/2006
Treatment options: Risks and benefits
Understanding the trade-offs will help you make the right treatment decision.
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Every treatment has risks as well as benefits. The best treatment for you may be different
from the best option for your friend or neighbor. We all have individual
needs, differing levels of comfort with various medical interventions,
and particular things that are important to each of us.
If you play an active role in making decisions about your treatment, evidence suggests that you are likely to recover quicker than if you do not.
It
is even more important to take part in making decisions when doctors do
not know which treatment is best for you. Doctors should base their treatment
decisions on what the research tells them about your condition. This is called practicing evidence-based medicine. This is a good way to practice medicine because it means your
doctor is using evidence from medical studies that have looked at what
happens to many thousands of people.
In the report Prescription for Trouble, published in the January 2006 issue, Consumer Reports identified 12 relatively common prescription-drug types linked to serious risks-including an increased likelihood of heart attack, stroke, cancer, or suicide-that were undetected or underestimated when they were approved for use.
Of course, whenever you are considering what treatment is best for you, it is important to talk to your doctor about your values and preferences, and whether the risks outweigh the benefits in your case. You can use our free guides to understand risk and to learn how to use research in your treatment decisions.
If you or someone you know is preparing to talk to a doctor about the relative safety and effectiveness of different treatment options for any medical condition, the ConsumerReportsHealth.org is a good place to start comparing the risks and benefits. The experts behind our Treatment Ratings and drug reports have reviewed the best available evidence and ranked treatments according to what is known about their safety and effectiveness. Learn how we rate treatments.
Log in here to access in-depth information on over 100 health conditions and best treatments, and the facts about medications.
Not a subscriber? Join now!
Research shows that some people want to be actively involved in making their own decisions about treatment.
Others
don't want to be involved at all. But doctors often
suggest one type of treatment when their patients would prefer another. Your
doctors may not always know what is important to you. One study looked
at what happened when men with prostate cancer who were thinking about
having their prostates taken out were shown a video about men who had already
had the operation.
In the video, the men
talked about the side effects of the operation. After watching the video, many
of the men decided not to have surgery and chose to live with their symptoms.
Many common health problems, such as colds and headaches, go away on their own. Some health problems may get worse if you don't have treatment. Diseases such as diabetes and high blood pressure fall into this group. You can ask your doctor what will happen if you don't have treatment, but sometimes your doctor won't know what will happen.
Your doctor may suggest that you make changes to your lifestyle before trying medications or other treatments. Lifestyle changes are things like exercising, eating a healthy diet, and quitting smoking. If you make changes to your lifestyle, you may be able to avoid taking medication or having other treatments. Exercising more often and cutting back on how much alcohol you drink might help lower your blood pressure. If you don't want to exercise, it's better to be honest with yourself and your doctor. You may need medication sooner, but if you know you're not likely to exercise then it's best to say so.
There may be several different medications available. If your doctor prescribes one treatment, ask if there are others. Is having an operation a possibility? Are there other treatments besides medicine or surgery? You may be able to try treatments such as physical therapy or even acupuncture. It's good to know about all the treatments that might work. This will help you choose the treatment that is best for you.
You may also want to hear about what other people with your condition have chosen to do and what their experience has been. But remember that just because something hasn't worked for a friend, it doesn't mean it won't work for you.
All treatments have both risks and benefits. Just because a drug or treatment has been approved by the Food and Drug Administration, doesn't mean that it is completely safe. Even aspirin and acetaminophen (Panadol, Tylenol) can have side effects. You always need to balance the possible benefits with the possible risks. Sometimes side effects don't show up in research studies and we only find out about them years after a medicine has become available. Even complementary or alternative treatments (whether herbal products, chiropractic care or vitamins and minerals) can be harmful. Just because something is "natural" does not necessarily mean it is safe.
How do the risks and benefits balance out for me?
If you play an active role in making decisions about your treatment, evidence suggests that you are likely to recover quicker than if you do not.
It
is even more important to take part in making decisions when doctors do
not know which treatment is best for you. Doctors should base their treatment
decisions on what the research tells them about your condition. This is called practicing evidence-based medicine. This is a good way to practice medicine because it means your
doctor is using evidence from medical studies that have looked at what
happens to many thousands of people. Treatment decision support
In the report Prescription for Trouble, published in the January 2006 issue, Consumer Reports identified 12 relatively common prescription-drug types linked to serious risks-including an increased likelihood of heart attack, stroke, cancer, or suicide-that were undetected or underestimated when they were approved for use.
Of course, whenever you are considering what treatment is best for you, it is important to talk to your doctor about your values and preferences, and whether the risks outweigh the benefits in your case. You can use our free guides to understand risk and to learn how to use research in your treatment decisions.
If you or someone you know is preparing to talk to a doctor about the relative safety and effectiveness of different treatment options for any medical condition, the ConsumerReportsHealth.org is a good place to start comparing the risks and benefits. The experts behind our Treatment Ratings and drug reports have reviewed the best available evidence and ranked treatments according to what is known about their safety and effectiveness. Learn how we rate treatments.
Log in here to access in-depth information on over 100 health conditions and best treatments, and the facts about medications.
Not a subscriber? Join now!
Key points to remember when choosing treatments
- Check out all your choices.
- Make sure you understand the risks and benefits of treatments or of doing nothing.
- Make sure you understand how the risks and benefits will affect you specifically.
- Make sure you have enough information to make a choice.
- How involved do I want to be in making decisions about treatment?
- What will happen if I do nothing?
- What are my choices for treatment?
- What are the risks and benefits of each treatment?
- How do the risks and benefits balance out for me?
- Do I know enough to make a choice?
Research shows that some people want to be actively involved in making their own decisions about treatment.
Others
don't want to be involved at all. But doctors often
suggest one type of treatment when their patients would prefer another. Your
doctors may not always know what is important to you. One study looked
at what happened when men with prostate cancer who were thinking about
having their prostates taken out were shown a video about men who had already
had the operation. In the video, the men
talked about the side effects of the operation. After watching the video, many
of the men decided not to have surgery and chose to live with their symptoms.Many common health problems, such as colds and headaches, go away on their own. Some health problems may get worse if you don't have treatment. Diseases such as diabetes and high blood pressure fall into this group. You can ask your doctor what will happen if you don't have treatment, but sometimes your doctor won't know what will happen.
Your doctor may suggest that you make changes to your lifestyle before trying medications or other treatments. Lifestyle changes are things like exercising, eating a healthy diet, and quitting smoking. If you make changes to your lifestyle, you may be able to avoid taking medication or having other treatments. Exercising more often and cutting back on how much alcohol you drink might help lower your blood pressure. If you don't want to exercise, it's better to be honest with yourself and your doctor. You may need medication sooner, but if you know you're not likely to exercise then it's best to say so.
Check out all your options
There may be several different medications available. If your doctor prescribes one treatment, ask if there are others. Is having an operation a possibility? Are there other treatments besides medicine or surgery? You may be able to try treatments such as physical therapy or even acupuncture. It's good to know about all the treatments that might work. This will help you choose the treatment that is best for you.
Listen to other people
You may also want to hear about what other people with your condition have chosen to do and what their experience has been. But remember that just because something hasn't worked for a friend, it doesn't mean it won't work for you.
All treatments have both risks and benefits. Just because a drug or treatment has been approved by the Food and Drug Administration, doesn't mean that it is completely safe. Even aspirin and acetaminophen (Panadol, Tylenol) can have side effects. You always need to balance the possible benefits with the possible risks. Sometimes side effects don't show up in research studies and we only find out about them years after a medicine has become available. Even complementary or alternative treatments (whether herbal products, chiropractic care or vitamins and minerals) can be harmful. Just because something is "natural" does not necessarily mean it is safe.
How do the risks and benefits balance out for me?
What matters is whether you think that the benefits outweigh the risk of any side effects. Each person is different. You need to decide what benefits and risks are important to you. Here are some things to consider.
- Your personal situation Does the treatment have side effects that will be tough for you to live with? For example, maybe you have small children and so you can't take medication that makes you sleepy.
- How you have to take the medication Maybe you don't like taking pills and would prefer to get your medication in the form of a skin patch.
- Your preferences for treatment and what you expect from it Would you find it difficult to live with the risk of any serious side effect even if the risk is small? Would you find it unbearable to lose your hair as a side effect of the medication you are taking? Even if the treatment increased your chances of staying alive? What's the most important thing you want the treatment to do for you? If you have heart failure, for example, what is more important to you: to breathe more easily at night or to have less swelling around your ankles?
- How you cope with side effects If you have high blood pressure, for example, you may decide that you can put up with the annoying dry cough caused by some medications. For you, the benefit of the treatment (reducing your risk of heart disease and of having a stroke) might outweigh the side effect (the cough). But many people with high blood pressure don't feel ill. It can be harder to put up with side effects from drugs when you don't feel sick. For example, if you feel well but your medication for high blood pressure makes you dizzy, you may not want to put up with that side effect. But if you are sick with a respiratory infection you may put up with the diarrhea that is caused by taking an antibiotic to treat your infection. You should talk with your doctor before stopping any medication that he or she has given you. Sometimes another medication may work just as well and have fewer side effects.
- How big the benefit may be Treatments don't always cure symptoms. You may decide that it is not worth taking a medication because the possible benefit is not big enough. You need to make sure you fully understand what the benefit of a treatment is before you stop it. If you have high blood pressure, you may think the medication you take every day is a waste of time. You feel OK. So why take the tablets? But if you stop taking them, you increase your risk of having a stroke or a heart attack.
- Your age If you are 40 and have osteoarthritis and your hip always hurts, you may want to think about having your hip replaced. If you have a hip replacement, your pain will go away and you'll be able to get around better. You won't have to take painkillers all the time. But your artificial hip may need replacing after 10 or 20 years as it may wear out. You also have to weigh the risks of the operation.
- Your sexual activity You may decide that side effects that interfere with your sex life are especially important to you. Make sure you ask your doctor about sexual side effects if they are important. If you are a man, you may find that some medications interfere with your ability to have an erection. You may run the risk of having problems getting an erection or of becoming incontinent (incontinence is the term doctors use for when a person can't always control when they urinate) after some operations, such as having your prostate removed when you have prostate cancer or other prostate problems. Your doctor should be able to talk freely about sexual issues with you. You certainly have the right to discuss them.
To make well-informed decisions about benefits and risks, you need reliable information about how likely it is that a benefit or harm will happen to you. If your doctor makes vague statements like, "The risks of this operation are small," then you need more information. What your doctor means by small may not be what you mean by small. Is there a 1 in 100 chance the surgery will cause a stroke or a 1 in a 1,000 chance? What the doctor considers a small and acceptable risk to take may be unacceptable to you. The way statistics like these are described to you can make a difference in how you feel about them. If you are told that a medication will cut your risk of having a stroke by 50 percent (what doctors refer to as a reduction in "relative risk") this may sound great. But if it actually cuts your risk of having a stroke over the next five years from 2 percent to 1 percent (a reduction in "absolute risk"), then that doesn't sound quite so great. Similarly, hearing that using a drug doubles your risk of developing leukemia in 20 years may sound scary. But if your risk of getting leukemia is small to start with (say, 2 people in 100,000 will get it), then even if the risk is doubled, it is still very small. However, if you are worried about any risk of getting leukemia, even this risk may be too high for you.
For more information about risks, see Understanding risks.
Sources for the information on this page:
Arora NK, McHorney CA. Patient preferences for medical decision
making: Who really wants to participate? Medical Care. 38(3):335-41,
2000
Deber RB, Kraetschmer N, Irvine J. What role do patients wish
to play in treatment decision making? Archives of Internal Medicine.
156(13):1414-20, 1996
Flood AB, Wennberg JE, Nease RF Jr, Fowler FJ Jr, Ding J, Hynes
LM. The importance of patient preference in the decision to screen
for prostate cancer. Prostate Patient Outcomes Research Team.
Journal of General Internal Medicine. 11(6):342-9, 1996
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