​How to Assess Your Risks vs. Benefits

Everything we do in life has risks and benefits. This includes medical care as well as just life itself. You make decisions every day about your life. This can include eating out, how much sleep you get, with whom you associate, etc. For example, you might not think about what you are eating. However, if you are deciding between a salad for lunch or cupcakes, you are making a decision about risks, the salad dressing may be loaded with calories, and the cupcakes will add pounds. The benefit is that salad is a healthy food that your body can use, the cupcakes will be tasty, but that is all. The risks to your health from eating a salad are low, the cupcake risk is high.

Risks are challenges to your health and well-being. Benefits are things that will improve your situation. All treatments, medications, and surgeries have risks and benefits in healthcare. Every individual should make an assessment of how any aspect of healthcare will affect their body and mental health.

Understanding the risks and benefits of medications can be found by reading the prescription insert that comes with all medications. This is that almost tissue paper document that contains a seemingly infinite amount of information. Some of the information is very scientific, which most people gloss over. However, there is very important information, such as what conditions the medication is used to treat, side effects, contraindications, how to take the medication, a description of the medication, and how to store it. This is the information that you should really know for your risks and benefits.

Know what the prescribed medication is used to treat. For instance, if you have nerve pain, you will want to know that the prescribed medication is actually designed to affect nerve pain. Other medications can be used to treat nerve pain but were not specifically designed to do so. For instance, low-dose antiepileptics and antidepressants are used to treat nerve pain, even if the medication was developed for the treatment of seizures and depression. This information should be contained in the product information. Some medications are prescribed ‘off label.’ This means the medication was developed for another effect, but a side effect could be the treatment of nerve pain. Off-label drugs may not have the purpose you are taking the drug listed in the specification of diagnoses. Your healthcare provider will alert you to the alternative purpose of the drug.

Side effects can be critical to your analysis of risks and benefits. If a side effect of a medication is decreased bowel function, your bowel program can be affected if you already have a slow bowel. Diarrhea is a common side effect of many medications. It may be a side effect that you would choose not to deal with if you have a neurogenic bowel. On the other hand, taking a medication that leads to a quickly moving bowel (diarrhea) may enhance your bowel program. In this case, the side effect of a speedy bowel might be both a risk and a benefit. Only trying the drug will help you make that decision, but at least you will be prepared for negative or positive consequences.

Contraindications provide information about what not to do so that the medication in your body will not be affected. Some heart medications require you not to drink or eat grapefruit as it impacts the effectiveness of the drug. This creates a risk if you drink or eat grapefruit. Giving up grapefruit gives you the benefit of the full effect of a needed medication to assist with cardiac function. The same is true for some blood thinners and eating leafy greens. The greens affect the functioning of the medication leading to consequences of taking a reduced dose even though you are taking the prescribed amount. There will also be information about medications that should be taken separately.

A description of the medication is very important to notice. This will tell you what the medication looks like. It may be a round white pill, a diamond-shaped blue pill, or any other option. There may be a code number stamped on or in the pill. Each pill is unique. If the pharmacy changes the manufacturer of your drug, the pill can look different. Knowing what your medication looks like assures you are taking the correct pills. If the medication is an injection, the description will provide information about what the solution should look like. Some injectable medications may be described as clear. If it is cloudy or has a change in color, the medication is no longer safe for use.

Storage information about your medication is essential in maintaining effectiveness. Medications should not be kept in the bathroom due to exposure to dampness. Some medications will need refrigeration; others should not be kept in the cold. Medications should be stored in their original containers where they are correctly labeled and stored in air-tight and childproof containers. If you have hand or finger functional issues and can safely keep your medication stored away from children, you can request non-child-proof containers at your pharmacy.

The risks and benefits of surgery are a bit more difficult to assess as these are so unique to each individual. If surgery is recommended to save your life, the risks may be great, but the benefit of continuing to live can overrule the risks. Some individuals will elect not to have surgery if they feel the outcome would impair their life. This is a deeply personal decision that should be made by you with input from your family and healthcare professional. These can be emotional and heartbreaking situations.

However, some surgeries may improve your life situation. One that I often am asked about is having surgery for a colostomy. Many individuals have this surgery, are completely satisfied with the outcome, and are delighted that they had it done. Others have complications that make life more difficult. Ask your surgeon and primary healthcare professional about how easy it will be for you to come off mechanical ventilation, the risks of bleeding and blood clots postoperatively, and your ability to deal with the colostomy. Some individuals with neurological issues have difficulty weaning from mechanical ventilation, and develop pressure injuries, blood clots, and a host of post-surgical issues. The same is true for individuals with rotator cuff repair, surgical pressure injury closure, and every other surgery which can be serious. That does not mean you should not have it, just consider the risks and benefits for your individual health concerns.

Treatments and therapies are issues that people do not often consider the risks and benefits of. So many new treatments and therapies are being studied or recently released to the public. One way to assess the risks and benefits is to look at where something is in the research process. Earlier phases of research may have higher risks than later phases. However, remember there is always risk and benefits in each phase as well as when the treatment is available to the public. Research is performed in phases:

Phase I is the first study in humans after a discovery in the lab or science. These are performed for safety in humans only, usually not for treatment effect. Individuals in these studies may not have any change in function as these are performed to assess if the treatment or therapy is safe in humans. This level is small in numbers, typically under 10.

Phase II research is a review of dosing. Is a small dose effective, a medium dose better, or a large dose too much? You may get a placebo (sham treatment) to see if there is really an effect. This can be in hours of therapy, medications, surgery, implants, or procedure. This level has a wide range of subjects, perhaps from 50-100 subjects.

Phase III solidifies the dosing and makes any tweaks in the research that was gained in phases I and II. The number of subjects may be in the hundreds or thousands.

Phase IV is the treatment before it goes public for finalizing the process. Again, these are large numbers of studies.

The number of individuals in each study phase varies by treatment or therapy. The numbers provided here are only averages. There is great variability.

When research has ended, the treatment or therapy will eventually be offered to the public with approval from governing bodies like the FDA. Even though something has been approved, there will still be risks and benefits to each unique individual.

There are also risks and benefits in the community. This has been learned clearly in the COVID epidemic and with other health issues currently at high rates, such as Flu and RSV. Knowing the levels in your community is critical to keeping yourself safe. A high rate of these viruses in your community will help you decide whether to keep wearing a mask or stay home. Always wash your hands and remain socially distant. We know all these techniques work to keep you safe. Nurse Linda

Pediatric Consideration:

As parents or guardians, you must make decisions for your child. Children should be included in the decision-making process as their developmental level allows. It can be a huge challenge to decide what to do for someone else that could affect their life. As parents, we want to do what is best. One good way to help with the decision process is to study the risks and benefits concerning the health and issues of your child. Your child’s healthcare professional can assist with providing direction. Ask for a second opinion to get additional information and input if needed.

Research in pediatrics is as carefully controlled as with adults. Due to age and development, some research is only done with children once it is successful with adults. Still, you can review the adult therapies and see if some adaptations would be safe for your child. It is critical not to become blindsided by possibility rather than reality. As we want everything for our child, sometimes it is better to be cautious as we only sometimes know what will happen in the next few years. Nurse Linda