[refurb]

Sorry, I should have been clearer.

My argument is this: If you can't count on people to take a drug that will drastically reduce their likelihood of dying, how can you trust them to accurately determine the trade-off between efficacy and safety?

Most patients don't display the ability to figure out risks and trade-offs now (and relatively simple trade-offs at that). Do you think they'll be able to figure out what "45% increase in the risk of heart-attacks (41.2 - 48.8%, 95% confidence interval) in populations who have had a transient ischemic attack in the last 180 days, excluding those who have diagnosed atherosclerosis" means to them?

[yew]

I think the real problem is that many doctors also lack the capacity to translate statistical data into a rational evaluation of risk.

Consider the infamous 'mammogram statistics problem' as an example. So what do you do then, when nobody in the decision-making chain can be trusted to understand the data?

[liber8]

Yes, yes I do.

Especially if the alternative is denying other people loads of relief (not only in the form of proven effective drugs that are taken off market, like Vioxx, but all the drugs that aren't even investigated because they fit in a class of drugs with known negative side effects).

Edit: misread your post. Yes, I do trust people to make decisions on efficacy v. risk. This would be even easier if we had a system that promoted the discussion of this information rather than one that effectively prohibited it. Merck should be able to openly say, "Hey guys, we have this great drug that is really effective at managing pain, plus it's non-narcotic. The only downside is, it increases your risk of heart attack by 50%. Talk to your doctor about it."

[jeremyarussell]

"Do you think they'll be able to figure out what "45% increase in the risk of heart-attacks (41.2 - 48.8%, 95% confidence interval) in populations who have had a transient ischemic attack in the last 180 days, excluding those who have diagnosed atherosclerosis" means to them?"

That's why I stated earlier that your doctor is and should explain to you what those words and statistics mean in laymen. Your example is full of the exact opposite of what I was saying.