Thread by @dr_dmorgan

Catch yourself when you say “risks vs. benefits” because you aren’t making a fair comparison.

In @JAMA_current ja.ma/336Lj4Y
& podcast ja.ma/2FAGKI2

@eliowa @drjohnm @d_spiegel @zeynep @VPrasadMDMPH

Why we say it and what we think is better below...

This building block of clinical decisions biases by framing uncertain harm vs. certain benefits and nudges towards treatment

Written with
@DKorenstein @ldscherer
(Over 2 years, i'm embarrassed to admit)

Clearly, the words physicians use have
a critical function in this communication

Referring to harms as “risks” emphasizes that
the unfavorable outcome may or may not happen,
whereas there is no parallel language that highlights
the equally probabilistic nature of “benefits.”

The language we use changes patient decisions

#ebm and #grade emphasize harms & benefits @dnunan79

Shared decision making requires accurate information for patients
@vmontori @RichardLehman1

Why we say "Risks vs. Benefits"?

Informed consent law based on "degree of harm" vs. "potential benefit"->GOOD

Important @US_FDA Kefauver-Harris amendment requiring drug efficacy
"expected benefits outweigh its potential risks"
->BAD

R v. B proliferated since 1960s

Who gains from "risks vs. benefits"?
Huge boon for #pharma
Makes healthcare look better than it is and therefore helps the entire industry

Who looses?
Patients misinformed about treatments who have harms, excessive costs (@RosenthalHealth ), & society who funds healthcare

What is better?

Communicate probability as all medicine is understanding & optimizing chances--like poker per @mkonnikova

Compare apples to apples, not oranges

"CHANCE OF HARMS VS. CHANCE OF BENEFITS"

standard language for physicians, scientific journals, and policy makers

So, catch yourself when saying "risks vs. benefits" and replace with "Chance of harms vs. chance of benefits"

This little change over thousands of conversations can make medicine more transparent, egalitarian, scientific and ultimately is #precisionmedicine

Thanks