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.

Pathogenicity and other genomic islands in plant pathogenic bacteria

Pathogenicity islands (PAIs) were first described in uropathogenic E. coli. They are now defined as regions of DNA that contain virulence genes and are present in the genome of pathogenic strains, but absent from or only rarely present in non-pathogenic variants of the same or related strains. Other features include a variable G+C content, distinct boundaries from the rest of the genome and the presence of genes related to mobile elements such as insertion sequences, integrases and transposases. Although PAIs have now been described in a wide range of both plant and animal pathogens it has become evident that the general features of PAIs are displayed by a number of regions of DNA with functions other than pathogenicity, such as symbiosis and antibiotic resistance, and the general term genomic islands has been adopted. This review will describe a range of genomic islands in plant pathogenic bacteria including those that carry effector genes, phytotoxins and the type III protein secretion cluster. The review will also consider some medically important bacteria in order to discuss the range, acquisition and stabilization of genomic islands.