Accepting Risks

Accepting Risks

March 2, 2025

Joy Stepinski, MSN, RN-BC

An important piece of making health decisions is avoiding too much medical care. In the book Less Medicine More Health: 7 Assumptions that Drive Too Much Health Care [1], Dr. Gilbert Welch presents seven assumptions that drive not only healthcare, but also public policy. We will consider these assumptions and how this knowledge can avert overdiagnosis and provide meaningful care.

The first assumption is that all risks can be lowered. Welch explains that “we are subjected to a confusing barrage of information about dangers to our health” [p.1]. For example, there is much publicity that exposure to wine, chocolate, and cell phones is harmful. Yet too much noise and meaningless worries about insignificant health issues can prompt people to seek medical care or worry fruitlessly.

One example of too much noise is that cancer risk increases with height. When using a search engine, this topic appears with an article from the World Cancer Research Fund [2]. The content states that for every 5 cm in height, there is an increased risk of six cancers (kidney, breast, ovarian, pancreatic, colorectal, and prostate). Welch states that the actual risk would be exceedingly miniscule.  Furthermore, what purpose would this knowledge achieve? People cannot shrink.

There are important points to consider about the risk effects on health. First, the benefit of treatment depends upon the relationship of how high a risk is from its baseline measurement. If blood pressure is very elevated from the normal range, a treatment benefits more against cardiovascular disease than someone who has mildly elevated blood pressure. Secondly, is there certainty of a treatment benefit? Sometimes a treatment, such as a cholesterol-lowering statin, is widely promoted without much advantage. Finally, is there any certainty of harm? For instance, one in ten people experience muscle damage when taking a statin [3]. Reducing medical risks has the unfortunate potential to create new harms.

As Welch states, [1] “it is prudent to accept low-level risks. We do it every day.” [p.27].

References:

1.      Welch, H. G. (2015). Less medicine, more health: 7 assumptions that drive too much medical care. Beacon Press.

2.      Brown, S. (2015). Why taller people are at greater risk of cancer. World Cancer Research Fund. https://www.wcrf.org/about-us/news-and-blogs/why-taller-people-are-at-greater-risk-of-cancer

3.      Newman, D. (2013). Statins given for 5 years for heart disease prevention (with known heart disease). The NNT. https://thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/