Patients' understanding of risk associated with medication use: impact of European Commission guidelines and other risk scales

Patients want and need comprehensive and accurate information about their medicines so that they can participate in decisions about their healthcare: In particular, they require information about the likely risks and benefits that are associated with the different treatment options. However, to provide this information in a form that people can readily understand and use is a considerable challenge to healthcare professionals. One recent attempt to standardise the Language of risk has been to produce sets of verbal descriptors that correspond to specific probability ranges, such as those outlined in the European Commission (EC) Pharmaceutical Committee guidelines in 1998 for describing the incidence of adverse effects. This paper provides an overview of a number of studies involving members of the general public, patients, and hospital doctors, that evaluated the utility of the EC guideline descriptors (very common, common, uncommon, rare, very rare). In all studies it was found that people significantly over-estimated the likelihood of adverse effects occurring, given specific verbal descriptors. This in turn resulted in significantly higher ratings of their perceived risks to health and significantly lower ratings of their likelihood of taking the medicine. Such problems of interpretation are not restricted to the EC guideline descriptors. Similar levels of misinterpretation have also been demonstrated with two other recently advocated risk scales (Caiman's verbal descriptor scale and Barclay, Costigan and Davies' lottery scale). In conclusion, the challenge for risk communicators and for future research will be to produce a language of risk that is sufficiently flexible to take into account different perspectives, as well as changing circumstances and contexts of illness and its treatments. In the meantime, we urge the EC and other legislative bodies to stop recommending the use of specific verbal labels or phrases until there is a stronger evidence base to support their use.

Perceptions of the risks and benefits of medicines in patients with rheumatoid arthritis and other painful musculoskeletal conditions

Objectives. To examine beliefs about medication risks and benefits in patients attending a specialist rheumatology clinic for pain-related conditions. Methods. Eighty-one patients (37 first attendees and 44 existing clinic patients) completed a written questionnaire which asked about current treatments, perceived effectiveness, main risks and benefits, and compliance. Results. Existing clinic patients perceived medications to be more effective and more risky than did the new patients, although both groups rated risks to be moderately low. The main perceived risks were adverse side-effects, although patients reported only moderately low levels of experiencing such effects. Conclusions. In contrast to some other studies, many of our patients were aware of medication risks and were prepared to accept them provided benefits were seen to be high. Existing clinic patients were more aware of risks and benefits, and reported higher compliance levels than new patients, possibly as a result of the hospital education programme. Future studies should evaluate the effects of the programme more systematically.

Counting Her Dresses and other plays

Counting Her Dresses and other plays, devised by Lib Taylor, is a short, mixed-media, promenade performance based on theatre writings by Gertrude Stein. Gertrude Stein was an American writer who lived in Paris for most of her adult life and was a significant figure in the development of early twentieth century modernism. She was an artists’ patron and one of the first collectors of paintings by Picasso, Matisse, Cezanne and others. She wrote novels, short stories, poetry and criticism, as well as a number of very short ‘plays’ and opera libretti. Even though her plays are very rarely performed they have been very influential in the development of avant-garde theatre. The performance juxtaposes a soundcape of voices, live performance, an ‘exhibition’ of paintings and mediated images projected onto and across the space to evoke Stein’s sense of theatre as a place of experience and emotion, not as a place of story and action. The performance comprises five theatre fragments which have been combined in a collage that alludes to the experimental art that Stein promoted.

Eyes, amygdala, and other models of face processing: Questions for the SIMS model

This commentary raises general questions about the parsimony and generalizability of the SIMS model, before interrogating the specific roles that the amygdala and eye contact play in it. Additionally, this situates the SIMS model alongside another model of facial expression processing, with a view to incorporating individual differences in emotion perception.

Far infrared filters for the GALILEO-Jupiter and other missions

Extrapolation of PbTe/II-VI multilayer interference-filter technique from 20 to beyond 40µm is described and PbTe transparency reviewed; improvements below 20µm are reported. A composite filter cutting on steeply at 40µm is described that uses absorptive films of ZnS and As2S3, thin Quartz, and supplementary multilayer interference. Absorptive filters are described containing the II-VI compounds since these are found transparent at wavelengths shorter and longer than their reststrahl.

English nettles and other poems

A collection of poems, illustrated by Sally Castle.

Out of the ivory tower: the impact of wider social contact on the values, religious beliefs and identities of Chinese postgraduate students in the UK

This article explores the impact of wider social contact on the experience of Chinese postgraduate students of adaptation to life in the UK. Focus group and individual interviews were conducted with a group of 11 Chinese students on an MA programme at a university in southern England and individual interviews with three representatives of a local volunteer group (LVG) offering support to the Chinese students. Although it was perceived that the students’ support needs were not adequately met by the University, the additional support offered outside the University was unanimously valued and considered as enriching their cultural and linguistic experiences and meeting their expectations. However, frequent social contact with the LVG, whose members were mostly Christians, also had an impact on their values, religious beliefs and identities. In a discussion framed within the sociological perspective of proselytization or religious conversion and the broad framework of international education and globalization, the different responses to this contact are described in terms of believers, doubters, empathisers and commentators. Implications are considered for universities, people involved in providing social support for international students, and sponsors of international students.