Introduction

Reviews

Weighing the Risks and Benefits of Drug Therapy

Timothy B. McCall, M.D.

Before taking a drug, carefully consider what the potential benefits are, how likely they are, what side effects are likely and whether the likelihood of benefit justifies the risk. Ask your doctor about side effects but don't stop there. Consider consulting one of the prescription drug references aimed at consumers.

When weighing the risks and benefits of a drug, consider the following:

• The most effective drug is not always the best drug. The best drug is the one that balances likely effectiveness against the risk of serious side effects. A small risk of a very serious complication should be given a lot of weight.
• The less severe your symptoms, the less risk you should be willing to accept. Say a new pain reliever is extremely effective but one out of every 10,000 people who use it die from a side effect. Most people wouldn't want to take that chance when there are other pain relievers out there, even if they aren't quite as effective. A cancer patient, racked with pain that hadn't responded fully to other drugs, might decide the risk was worth it.
  The more life-threatening a disease is, the greater the risk that can be justified. Chemotherapy itself may be deadly but if that's your only chance of beating cancer, that risk may be worth taking. In fact, even when there is only a small chance for cure, most people opt for chemotherapy.
• Doctors tend to underestimate the risks of drugs. If your doctor tells you a medicine doesn't have any side effects, be skeptical. It may just mean the drug is too new for side effects to have been recognized yet. It's only as time goes on and the reports trickle in, that many side effects come to light.
  If you look in the PDR (the drug guide many doctors use), you will see that most drugs have dozens if not hundreds of potential side effects. Many of these side effects are fairly rare but when you add them all up, overall total may be larger than you’d expect. Many less common side effects may not be recognized by either doctors or their patients as side effects, especially if they occurs weeks or months after the start of therapy.
• Consider the alternatives. You can’t fully evaluate the risks and benefits of a drug, unless you understand the risks and benefits of the alternatives. Ask the doctor What are the risks of not taking the drug? Are there non-drug therapies that could work? Could my condition improve without treatment? Are there other drugs that could be tried? What are their risks and benefits?
• Your values count the most. Different people will examine the same information and come to different conclusions. Many rational people with cancer believe that the prospect of living a few extra months or even a few extra years is not worth spending several months in the hospital tethered to IVs, getting poked and prodded and feeling sick from chemotherapy most of the time. Others feel that the chance at longer life makes almost anything worth enduring. Your physician's advice can help you make the decision about whether to take a drug but since ultimately it's a matter of values, you want your values to be considered. The question should not be How much risk and discomfort is your doctor willing to accept? but rather How much are you willing to accept?

Next: Choosing the Safest Drug

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