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What to ask your doctor (About the RCT)

Most of us are familiar with the crowd in a typical theater as a graphic illustration of a population grouping.  It occurred to us that a theater seating chart would be useful for illustrating health benefit and risk information.  With a seating capacity of 1,000, our Risk Characterization Theater (RCT) makes it easy to illustrate a number of important values:  the number of individuals who would benefit from screening tests, the number of individuals contracting a disease due to a specific cause (e.g., HIV and AIDS), and the merits of published risk factors (e.g., elevated cholesterol, exposure to low levels of environmental contaminants).

We use our RCT to illustrate the specific case studies in this book, but we believe it is applicable to a larger set of situations involving health benefit and risk analyses.  We use it to represent benefits and risks in a way that avoids bias and facilitates understanding.  Our primary motivation is to present health benefit and risk information to the public in an objective and useful format.  Two case studies in the book of interest are cholesterol and Vioxx™.

Cholesterol and Vioxx™ Risk Characterization Theaters

The cholesterol RCT below shows that out of 2,000 people with an elevated cholesterol level between 210 and 250 mg, there will be one additional death each year from coronary heart disease (represented by a single darkened seat) as compared to 2,000 people with normal cholesterol lower than 210 mg.

RCT of Cholesterol

This means that 99.95% of the population would not benefit from efforts (diet and/or drugs) to reduce blood serum cholesterol levels. To put it another way, for 1,999 out of 2,000 of these individuals each year, it makes no difference whether they have elevated cholesterol or normal cholesterol, in terms of whether or not they develop coronary heart disease. While counterintuitive, this striking conclusion is accurate.

The sixteen darkened seats in the Vioxx™ RCT below represent the number of additional people experiencing cardiovascular events when taking Vioxx™ as compared to 1,000 individuals not taking this pain reliever over a 9-month period.

RCT of Vioxx (Trademarked) patient statistics

This means that approximately 98.5% of individuals taking Vioxx ™ will not experience increased heart attacks as a result of taking this drug. In other words, 984 people out of 1,000 will be able to reduce their pain with relative safety. The final decision must be based on a value judgment and each individual’s level of acceptable risk. (While Vioxx TM has been taken off the market, the risks and benefits from a similar drug Celebrex TM could be displayed using our RCT).