Selfies and Other High-Risk Activities (March 8, 2016)
Our lesson today was prompted by what appears to be an entirely serious article about people who managed to get themselves killed while taking selfies. It’s on priceonomics.com and is entitled (I kid you not) “The Tragic Data Behind Selfie Fatalities”. Said article is also notable for its completely incorrect usage of the word “visage”, which only goes to demonstrate yet again why spellchecking will never be a substitute for proofreading.
Tragic, maybe. Any time anyone dies prematurely, you are entitled to call it a tragedy. Even if they were, say, a Republican presidential candidate. It happens that my own immediate impulse on reading of a selfie death is simply to nominate the deceased individual for a Darwin Award, but I know that this is unkind. Such deaths are technically tragedies because they are, to a man (and they are indeed mostly men) so unnecessary.
If you research this subject a bit (particular the parts about people posing in front of oncoming trains) you tend to find yourself thinking "If only someone had taken the time to really appreciate the risk versus benefit issues here." For example, Benefit: impressing a cute girl you just met. Risk: that the circuit you just threw the breaker for is NOT the one that feeds the industrial mixer you just climbed into.
And that brings me to the point that I wish to make today. Because I want to do something a bit more useful than simply make fun of people whose desperate need for attention has caused them to kill themselves without even getting a good photo out of the deal. The point is the subject of relative risk, which in the case of medicine and health care generally is a very, very big and important subject.
Simply taking a lot of selfies won’t get you in trouble. But taking them in inappropriate circumstances (like in the company of a live grenade with the pin removed) will. That is also one of the keys to medical risk. Most medical procedures carry with them some possibility of causing real harm, and unless they also have a much stronger possibility of achieving a positive result you are risking your health without a chance of genuine reward. Similar to posing for a photo with a loaded gun pointed to your head.
Now, if you have been reading your newsletters (or maybe even if you haven't) you know that despite the best efforts of pharmaceutical companies to prove otherwise, statins improve life expectancy only for people who already have heart disease. So if you are healthy and living well but happen to have a highish Bad Cholesterol number, by taking a statin you are exposing yourself to the considerable downsides of those medications without any expected benefit. This is the medical equivalent of taking a picture of yourself dangling by one foot off El Capitan.
The subject of medical risk can get dizzyingly mathematical. One concept that can be useful, however, is something known to those of us in the biz as “NNT” or “Number Needed to Treat”. In other words, how many people have to be given a particular treatment in order to achieve one desired result.
For somebody who has heart disease, the NNT for a statin drug might be something like 100 -- meaning for every 100 heart disease sufferers who take a statin, one heart attack will be prevented. That's not too bad. However, if someone doesn’t have heart disease, his or her NNT is much larger. You may have to treat many thousands of those people with a statin in order to prevent one heart attack. At THAT point the side effects associated with statins are statistically going to be a much bigger problem than any benefits and taking a statin becomes a Bad Idea.
So you can see that the circumstances of the individual you are treating has everything to do with an NNT, since the risk/benefit ratio for a treatment will be very dependent on the person who is being treated. Let’s compare this to an analogous statistic for taking selfies.
With selfies, the “NND” or “Number Needed to Die” would be the average number of selfies taken per resulting selfie death. Across all continents, ages and sexes let’s say that the overall NND is one million. Does that mean that once you’ve taken a million selfies (as a couple of my Facebook acquaintances probably have) you are Doomed? Not if you’re taking them at your kitchen table -- then the specific NND is probably something like 10 trillion. But if you’ve been taking them in the turning lane in front of the Wendy’s on Thompson and Bransford, even Nick the Greek wouldn't touch you.
Therefore, as in the case of the NND, the NNT alone doesn’t tell you a whole lot. But used properly it’s another piece of information that can help decide on what might be the best course of action. Education is very helpful for medical issues here, unlike with selfies where I am sure that this Russian website admonishing against dangerous selfie-taking is going to do for selfie deaths what chumming usually does for the local shark population.
Ya gotta love it.
If I may end with a quote from the original article: “You have to be careful about taking shortcuts when trying to determine what is and isn’t threatening.” That applies to medication, invasive testing and surgical procedures the same way it does to selfies. Just doing what your friends find impressive, or what one doctor recommends, may not be the smartest thing to do.
So don’t forget to ask yourself if a few extra Likes is worth the risk of being squashed by an oncoming train. Or to ask your doctor if "some people find it helpful" is really the best reason to add another pill to your morning complement of same. And stay safe.
--dr. diane holmes
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