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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 13; 335(7623): 776.
PMCID: PMC2018805
Drugs, Tales, and Other Stories

Don't mention it

Ike Iheanacho, editor, Drug and Therapeutics Bulletin

Flick through a few newspapers and you'll repeatedly come across a stark warning: “Your home may be repossessed if you do not keep up repayments on your mortgage.” This threat isn't some random frightener but a standard feature in advertisements for property loans. As such, it provides tangible balance for those contemplating the real or imagined advantages of the deals in question.

If only the possible harms of medicines were contextualised so clearly. Instead, it's often assumed that the general public just cannot understand risk when it comes to drug treatment. So, as the thinking goes, it's best not to go on about harms and side effects too much for fear of needlessly frightening patients or carers.

This well meaning attitude infects much of the communication (or lack of it) between healthcare professionals and patients about drug therapy. Although avoiding balanced discussion about risk may seem pragmatic, it can represent a false economy of effort, and the presumptions underlying the avoidance approach are ultimately rubbish.

It is patronising to suggest that people who, for instance, invest financially, take out insurance, travel to hazardous areas, or, yes, buy homes are unable or unwilling to weigh up positives and negatives when it comes to prescribed treatment. Of course, the capacity to make and act on these assessments will vary widely across the population. However, this variable capacity is also true of doctors, many of whom struggle with understanding and conveying the implications of published evidence for the care of the individual patient.

Debating treatment risks has practical limitations, even for the most committed professional. Limited consultation time is an obvious example, as is the often patchy nature of the data available on adverse consequences of treatment. But a pervasive cultural factor is also at work.

It has become too easy for patients to believe that drugs can be intrinsically “safe.” This relates, in part, to the potentially misleading ways in which treatment is sometimes portrayed. A classic example is dichotomising patients into supposedly wholly distinct groups such as “treatment successes” and “treatment failures.”

This type of binary classification can be useful shorthand in detailing clinical research findings, but it deliberately overlooks continuous variation between individuals in biological constitution, function, and response. When it is echoed in the information patients receive, it feeds the dangerous notion that drug therapy is an all or nothing experience in which the treatment either works or not, or causes adverse events or not, rather than showing a range of effects in different people. No sensible mortgage provider would be so simplistic.

Articles from The BMJ are provided here courtesy of BMJ Group