Medical risk assessment and you

Every time you encounter a medical or psychological problem, some risk assessment is involved. Regardless of whether or not you’re aware of it, you have to assess the risk involved in any action you take.

For any treatment you may seek, you have to accept possible benefits and risks caused by that treatment. Even ignoring a problem and doing nothing implies an acceptance of risk.

Unfortunately, in my experience most people are ill equipped to make these judgments because of a lack of sufficient knowledge and an unawareness of existing biases. For example, most people who visit my office seem to be much more attuned to the possible side effects of drug therapy than they are to the ill effects of doing nothing in the face of their mental illness.

This is true in spite of the reality that with most psychiatric problems the negative consequences of doing nothing are generally far worse than any potential side effects of medication.

Risk of death from untreated depression is far worse than the risk of death as a consequence of treatment. This has been shown in many studies and is highlighted in the nearly 4,000 suicides completed in Canada each year – mostly due to untreated mental illness.

Even the risk of organ damage from untreated depression is far worse than the risk of organ damage from taking an antidepressant – yet most people ask about the latter and not the former.

In the presence of constant depression and/or anxiety, the brain is known to atrophy. Taking antidepressants is neuroprotective.

Most people are also more aware of side effects of drug therapy than they are to the possible harmful effects of psychotherapy. Because it involves ‘simply talk’ people believe this must not have the same kind of powerful effects as medication.

But studies show suicidal ideation increases with psychotherapy just as it does with drug therapy – even though this is seldom discussed.

Also, there are more than 400 different kinds of ‘talk’ therapy and they are not all helpful. Some can be downright harmful. Contrary to popular belief, it is not always better to discuss traumatic experiences and sometimes talking makes people worse.

Aside from bias regarding the use of psychiatric medications, many people I see believe their use of cannabis is harmless and perhaps even helpful to their psychiatric conditions. Unfortunately, this is simply not true. Cannabis has been shown to make most psychiatric conditions worse rather than better and has not actually been found helpful for any mental health condition.

In my clinical experience, I have seen cannabis trigger psychotic episodes or panic attacks in some patients and it is a major obstacle in successful treatment of mood disorders.

Finally, with the abundance of so called natural products in the marketplace and the unlimited information – both useful and not – available on the internet, many people turn to ‘alternative’ methods for treating their mental illness.

Unfortunately, many are unaware of the risks associated with taking natural products or therapies and see no need for these treatments to be subject to regulation or testing. For some reason, many people don’t think over the counter vitamins and other natural products require such limits as testing or regulation.

Many studies have shown natural health products often don’t contain the ingredients they advertise.

When it comes to the question of testing, I can’t understand why anyone would support a company making a claim about a product, which cannot be supported by evidence.

History is filled with stories of snake oil salesmen and charlatans of all kinds making false claims for personal profit. Not only does this harm people by giving false hope and delaying more effective treatment, but many so called treatments may also have harmful effects, which have not been documented in studies.

A great book highlighting the history of such practices is Charlatan: America’s Most Dangerous Huckster, the Man who Pursued Him and the Age of Flimflam, by Pope Brock.

It seems like common sense to me to have some regulations in place to ensure people get what they pay for and can be assured of the effects a product will have.

Finally, we recently asked health food stores in Kelowna to provide information to individuals buying gluten free products about an ongoing study testing a potential treatment for celiac disease. Most refused to help since clinical research is not consistent with their ‘philosophy’ (or financial best interest I suppose) – even though there are currently no treatments for Celiac disease aside from a gluten free diet.

I question what philosophy chooses untested products over effective treatment as proven in clinical trials?


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