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.

'Roman' or 'native' bodies in Britain: the evidence of late Roman nail-cleaner strap-ends

This paper reviews late Roman `nail-cleaner strap-ends', a group of objects first discussed by Hawkes and Dunning (1961). The precise function of these objects is unclear as their shape suggests use as toilet instruments but the split socket suggests that they were part of belt-fittings. We suggest a detailed typology and discuss the dating evidence and the spatial distribution of the type. Regardless of their precise function, it is argued in this paper that nail-cleaner strap-ends of this type are unique to late Roman Britain and thus represent a distinct regional type. The use of nail-cleaner strap-ends can be viewed in the context of gender associations, military status and religious beliefs.

History in tatters: bodies and things in Samuel Beckett’s theatre

The article takes a phenomenological approach to the relationship between stage properties and the performing body in Beckett's theatre.

Mutated bodies: stage performances of Beckett's late prose texts by Mabou Mines (1984) and Gare St. Lazare Players, Ireland (2005)

An exploration of the stage adaptations of Beckett's fictional texts by the New York based Mabou Mines theatre company.