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People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. Orwell
Risk communication has long been acknowledged to be fraught with pitfalls and subject to manipulation. The magnitude of harm and the publicity given to a risk can grossly sway perception of the problem. For example, risk of death from terrorism has a low lifetime probability of occurrence (well under 0.01%) but the harm is sufficiently clustered in time and space that it becomes newsworthy and therefore noted; in contrast, cardiovascular deaths have a high lifetime probability of occurrence (∼20–25%) but the harm is spread very thinly because each victim dies alone and out of the public eye.
Measures which are seen to be reasonable in preventing these varying classes of event have differing levels of acceptability. While it is widely considered acceptable to curtail personal freedoms to reduce the threat of rare but aggregated attack, restriction of personal choice of food in order to prevent the 2000 times more likely occurrence of cardiovascular disease (CVD) is almost universally considered unacceptable. The problem becomes amplified in primary prevention, where returns from intervention are low and accumulate over the long term, whereas the disutility incurred by forced lifestyle change or the side effects from drug treatment are immediate.
Choice of framing
Doctors and patients tend to view risks differently.1 Even the ‘15% 10-year risk of CVD’ benchmark used in many guidelines for starting preventive treatment, intrinsically means that only 15 out 100 people with similar risk profiles would develop a coronary event if left untreated. However, a patient may interpret this to mean that s/he has a low (or high) risk of CVD, depending on her/his prior internal perception of her/his …
Funding DF is funded by a BHF Senior Clinical Fellowship FS/10/038/28268 and acknowledges support from the NIHR biomedical research centre scheme. PA is funded by a Wellcome Trust Clinical PhD Fellowship.
Competing interests None.
Provenance and peer review Commissioned; not externally peer reviewed.