Communicating risk key step to good care

Misunderstanding risk can lead patients to make decisions that may not be in their best interests.

By Victoria Stagg Elliott, AMNews staff. Oct. 20, 2003.

It's an interesting case study in risk communication.

Britain has experienced an increase in the rate of measles and a decline in use of the measles-mumps-rubella vaccine. Parents have been avoiding the MMR because of fears of a link to autism. These fears found traction after a 1998 study in The Lancet. Since then, celebrities have publicly refused shots for their kids, and even Prime Minister Tony Blair won't say if his youngest received it.

This situation, say experts, is what can happen when risk communication goes awry. The Lancet report was refuted by subsequent studies. Still, the vaccine is being shunned, triggering not only public health problems, but physician frustration. The continuing difficulties even led the British Medical Journal to devote its Sept. 27 issue to the overall topic of risk.

"For various reasons, we do not think rationally about risk, and this has reached a level where perverse judgments are damaging to society," wrote Andy Alaszewski, PhD, professor of health studies at the University of Kent in Canterbury and Tom Horlick-Jones, senior research fellow at Cardiff University in Wales.

In the United States, vaccination rates remain high. Physicians here do say, however, that the British episode offers an object lesson.

"I hope we don't see rates as low as Great Britain, and I'm disturbed by trends that are allowing parents to opt out of immunizing their children so easily," said Sanford Kimmel, MD, professor of clinical family medicine at the Medical College of Ohio in Toledo.