Releases Saturday 27 September 2003
No 7417 Volume 327

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(1) HAVE PARENTS BEHAVED IRRATIONALLY
TOWARDS MMR?

(2) CHRONIC DISEASES LINKED TO FALLS IN
ELDERLY WOMEN

(3) HOW CAN DOCTORS BEST COMMUNICATE
HEALTH RISKS?



(1) HAVE PARENTS BEHAVED IRRATIONALLY
TOWARDS MMR?

(Communication and miscommunication of risk:
understanding UK parents' attitudes to combined MMR
vaccination)
http://bmj.com/cgi/content/full/327/7417/725

Parents seem to neglect a real risk to their children
(injuries from road crashes) but amplify an insignificant
risk (autism caused by MMR vaccine), argues a senior
researcher in this week's BMJ. But does this suggest that
parents are irrational?

Paul Bellaby of Salford University considers the public
perception of three risks to children: an insignificant risk
(autism from vaccination), a real but probably small risk
(vCJD from BSE), and a real and demonstrably larger
risk (injuries from road crashes).

Although injuries from road crashes carry by far the
largest risk of the three, they have raised little
controversy, says the author. In contrast, the alleged link
between MMR vaccination and autism, and the small
risk of vCJD both met with widespread concern from
parents.

He suggests that parents seem to neglect the easily
perceptible risk, to reject the expert assessment, and to
amplify the virtual risk.

However, in spite of appearances to the contrary, one
can argue that parents have behaved rationally, says the
author. They act in what they perceive to be the interests
of their children. Thus they avoid beef products and
question the safety of MMR. Even though taking children
to school and elsewhere by car is a risk, it is seen as a
way of protecting them from greater dangers on the
streets, such as abduction by strangers.

Communicating risk effectively is about much more than
providing even the best of information: it is a matter of
two-way communication and obtaining agreement, he
concludes.

Contact:

Paul Bellaby, Director, Institute for Public Health
Research and Policy, University of Salford, Greater
Manchester, UK
Email: p.bellaby@salford.ac.uk

(2) CHRONIC DISEASES LINKED TO FALLS IN
ELDERLY WOMEN

(Association between falls in elderly women and chronic
diseases and drug use: cross sectional study)
http://bmj.com/cgi/content/full/327/7417/712

Elderly women with chronic diseases, such as arthritis
and depression, are at higher risk of falling, finds a study
in this week's BMJ.

In fact, chronic diseases may account for 30% of falls in
this group.

Researchers at the University of Bristol surveyed 4,050
women aged 60-79 years about whether they had had a
fall in the previous 12 months, how many times they had
fallen, and whether they had received medical attention
for any falls.

Nearly three quarters (2,961) of the women had at least
one chronic disease. The risk of falling associated with
having any chronic disease was 32%. Circulatory
disease, chronic obstructive pulmonary disease,
depression, and arthritis were each associated with
higher odds of falling, even after adjusting for other
factors.

However, no such relation with falling was found for the
number of drugs used. After adjusting for chronic
diseases, only sedatives and anti-depressants were
associated with an increased risk of falling of between
2% and 5%.

These findings suggest that, in public health terms,
targeting prevention and control of chronic diseases
rather than the number of drugs taken may be a more
useful strategy for preventing falls in elderly people,
conclude the authors.

Contact:

Debbie Lawlor, Senior Lecturer in Epidemiology,
Department of Social Medicine, University of Bristol,
UK
Email: d.a.lawlor@bristol.ac.uk

(3) HOW CAN DOCTORS BEST COMMUNICATE
HEALTH RISKS?

(Education and Debate:)
http://bmj.com/cgi/content/full/327/7417/728

Doctors can improve the ways in which they
communicate risk information, according to several
articles in this week's Education and Debate section of
the BMJ.

Most approaches to communication of risk are based on
the assumption that patients rationally review evidence,
but for various reasons, we do not think rationally about
risk, write Andy Alaszewski and Tom Horlick-Jones.
Instead, individuals evaluate the trustworthiness of
sources and the relevance of information for their
everyday lives.

They suggest that if doctors want to communicate risk
effectively to their patients and the public, they need to
be aware that they are just one source of information and
may no longer be the most trusted.

In another article, researchers from Canada describe
how decision aids may help by structuring the way risk
information is presented, displaying options, and helping
patients to clarify their values in healthcare decisions.

Bad presentation of medical statistics can lead to patients
being misled or making uninformed decisions about
treatment, warn Gerd Gigerenzer and Adrian Edwards in
a third article. They demonstrate that simple mind tools
can reduce confusion and suggest that efficient
communication of statistical information should be part of
medical curriculums.

Finally, John Paling, a consultant in risk communication,
offers some simple rules that can help doctors
communicate risks clearly.

Contacts:

Andy Alaszewski, Professor of Health Studies, Centre
for Health Studies, University of Kent, Canterbury,
Kent, UK
Email: a.m.alaszewski@kent.ac.uk

Annette O'Connor, Professor, Ottawa Health Research
Institute, Ottawa Hospital, Ottawa, Canada
Email: aoconnor@ohri.ca

Gerd Gigerenzer, Director, Centre for Adaptive
Behaviour and Cognition, Max Planck Institute for
Human Development, Berlin, Germany
Email: gigerenzer@mpib-berlin.mpg.de

John Paling, Research Director, Risk Communication
Institute, Florida, USA
Email: drp@trci.info


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