Possible vs. Probable

Many of my patients use the internet to seek information about their health, diagnoses of illnesses and treatment options.  While the internet is an excellent source of valuable information, it is also full of garbage.  The garbage comes wrapped in pseudoscience, is sold as “doctor recommended” and is capable of doing great harm.  Sorting through the heaps of material is difficult, even for a trained physician.   What is real science and what is hype?  Sometimes, I don’t know!  During the last 35 years, I have seen the best of my science proven wrong.  So how does a lay person interpret the data delivered by Google and Bing?

There is no easy answer.  While discussing how to sift through the mountains of data you need to process to be a truly informed patient is beyond the scope of this article, learning the difference between a possible problem and a probable problem may be very helpful.

In the medical world, we believe in informed consent.  Informed consent means we tell you every possible consequence of taking a medication.  Ever listen to a pharmaceutical commercial on TV?  Product XYZ is touted as good for your heart and brain but may cause explosive diarrhea, excessive bad breath, uncontrollable flatus (farting) and a myriad of other things, including death.  After listening to one of these commercials, no sane person would want to take XYZ.  You can thank the lawyers for the absurdity of the disclaimer.

If the auto industry was required to advertise under the same rules as the pharmaceutical industry, car XYZ would be sold as fast and sexy with all the bells and whistles.  The disclaimer would remind the audience of national automotive safety statistics, stating car XYZ may cause death, dismemberment and a myriad of other horrific injuries we all know exist but ignore.  If a pharmaceutical company went to the FDA with a product that cured cancer but had the risk factors of a car, I doubt the FDA would approve it.

Anything is possible.  What is important is the probability that a possible side effect is going to injure you!  If XYZ causes uncontrollable flatus in 90% of people, taking it would be absurd.  If XYZ causes uncontrollable flatus in <1% of people, it is insignificant.  So, before you decide not to take the medication your doctor prescribes because of something you read on the warnings stapled to the package at the pharmacy, ask your doctor about the probability of your getting a side effect.  In general, if there are known side effects of significance, your doctor is going to warn you before giving you the prescription.

The following is a real telephone conversation:

“Dr. Segal, this is Mr. Z.  I’m mad at you!  I want you to know I found the reason I have had so many colds this year!”

“I’m sorry you are mad at me!  What do you think is causing your colds, Mr. Z?”

“The damn medicine you are giving me for my blood pressure.  According to the PDR, 32% of people taking product X get frequent colds!!!”

“Mr. Z, could you look at what the percent of people who got frequent colds while taking a placebo is?”  Dr. Segal asked.

“What’s a placebo?” replied Mr. Z.

“A placebo is a fake pill, it contains no active ingredient.”  Dr. Segal answered.

Mr. Z went back to the PDR, and called back a second time.  “Thirty six percent of people on the “no active ingredient” pill got frequent colds.”

“Wow, Mr. Z, if 36 % of people taking a placebo got colds and only 32% of people on product X got colds, then product X decreases the chances of you getting a cold.  Maybe the reason you get frequent colds is your smoking!  It may also be the reason you have high blood pressure and are on product X.”

Remember, what is important is the probability of getting a possible side effect.  Also, remember that “placebos” have side effects and risk!

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