I hate it when oncologists talk to patients and quote relative risks regarding pros/cons of chemotherapy. When i get that patient sent back to me to put in a chemo port, and the patient extols how great the chemo treatment is, I sometimes ask them to explain to me their understanding of the pros/cons as explained to them. But when, for example, they tell me that chemo decreases their risk of cancer recurrence by 50%, but then I explain that it changes from a 94% chance of being cancer free to 97% (6% to 3% risk change certainly is a 50% relative reduction) they are flabbergasted, and often pissed off that they feel they were lied to. They werenât, but the vast majority of people DO NOT understand statistics, and I think using relative rate reductions instead of (often) much smaller absolute reductions when talking to a patient about treatment options is either in poor judgment or intentionally obfuscating them.
I still run journal clubs for residents and fellows to mentor them on how to cut through the BS of the lies,damed lies and statistics that are manipulated. I can pick up any peer reviewed journal and very few articles can withstand close scrutiny and give me any meaningful information that will alter my practice after reading that article. Everyone doesnât need a degree in statistics but should understand them enough to realize when you are being misled.
Drink wine in moderation and ignore the hysteria that the surgeon general is fanning the flames with.
In my opinion, relative risk is more useful when the absolute risk is small but the consequences are significant. There are a lot of situations where the absolute risk of something is very small, but we do it because the intervention isnât very harmful. Some obvious examples would be using SCDs and giving low dose heparin or lovenox to bed bound patients to prevent deep vein thrombosis / pulmonary embolism.
The problem with this entire discussion is most peopleâs assumptions that they are in the low/moderate group, which likely does have RELATIVELY low risk. Once youâre in the >3 drinks a day group your risk is much higher.
I get that using relative risk has become common and accepted behavior. Iâm just not happy about it because itâs more often misleading than helpful. Especially when people are in a low risk group where the differences in absolute risks are much lower than the differences in relative risks.
Iâve made my opinion clear and wonât beat the comatose horse any further. The chance that heâll survive is 50% higher if I stop now.
I think most research has to capture this anyways, because you still need to refer to number needed to treat which captures absolute risk.
Anyways when youâre dealing with relatively small risks, that have extremely serious consequences, imo RR is more useful, especially when youâre asking people to change practice, and especially when behaviors are being done for no good reason.
For example, many doctors will keep people on aspirin when theyâre been prescribed an anticoagulant like warfarin, eliquis, etc. Even 81 mg aspirin results in 2-3x RR of primary hemorrhage in trauma. While the absolute risk increase might be something like 4-6%, we might now be talking about 1 in 10 pts vs 1 in 25.
I found this New York Times Audio Opinion on the topic to be very well-stated, although one that others have also expressed in their own way. (My apologies if a NYT subscription is needed to listen to it).
This reminds of a term called âsatisficingâ coined by Herbert Simon back in the 50s. People can look it up if they like. He was a very smart guy. Basically he concluded that we only have so much time and energy and burning up too much of those resources over tiny details in an effort to optimize was not worth it. Once you find âgood enoughâ thatâs just fine.
I often apply that to many aspects of life and even work. Sometimes happiness is more important that perfect or risk-free. Sometimes done is more important than perfect. Sometimes a B+ is better than an A if it addresses the issue at hand and was achieved more efficiently in terms of cost and time. Sheez, many times I prefer a really good table wine over a very fine wine that requires some degree of intellectualization.
When I was chair of my department, I called this calculated mediocrity. What I meant by it was that any task that you could do well enough to achieve what you needed in a mediocre way, you should do in a mediocre way if it saved time. For instance, most memos I needed to write needed to be written only to state what I thought was the best thing to do about a) or b). Any effort to make them âliteraryâ or more than clear was wasted because your audience would not care and, thus, was a waste of time you would need for tasks that needed more careful thought.
That response is definitely something I think is worth considering, but it also misses the reality that we are looking at cancer warnings for alcohol and walking right past massive issues with microplastics. Theyâre everywhere whether you want it or not, and weâre all consuming them.
Iâve seen well over 10 nationally published articles on the wine/cancer connection over the past few months (and I donât go looking for wine articles to read in my spare time) and a decent amount of single use plastic commentary but no official support for making changes have come across my radar. Thereâs so much unnecessary packaging going into landfills, and the oceans, these days that itâs a little baffling that we arenât pushing more seriously to reduce extraneous plastic waste.
This is one of my biggest beliefs in making good (hopefully more than good) wine. Harvest is an intense and highly concentrated amount of work in a relatively short period of time. But for many, many in my industry, the idea of making great wine through doing everything (and I mean everything) to perfection is almost a given.
Time is the most precious thing you have during harvest. So for any task not directly related to wine quality, you should take pride in doing it as quickly as possible and moving on as long as itâs âgood enoughâ. That leaves more time, energy, and decision making capability for the smaller set of tasks that are actually directly affecting the outcome of the wine.
Iâm sure microplastics/PFAs research is coming down the line but itâs been studied for far less time than alcohol and there isnât a lot of long term data. Research takes a long time to do.
