The Preventive-Pill Paradox
How Shared Decision Making Could Increase Cardiovascular Morbidity and Mortality
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As we progress toward ethical prescribing through better informing patients of the absolute risks and benefits of medications, fewer individuals may choose to take preventive medications, leading to increased population-level cardiovascular morbidity and mortality. We term this theoretical phenomenon the preventive-pill paradox, where reducing the perception-reality gap of preventive medications at the patient level paradoxically produces more harm at the population level.
Current Status of Shared Decision Making
Physicians have a duty to inform their patients about the risks and benefits of the interventions available to them. However, physicians rarely communicate with methods that convey absolute risk, such as numbers needed to treat, numbers needed to harm, or prolongation of life, despite patients wanting this information.1 Furthermore, instead of considering the risks and benefits alongside their personal values, patients often succumb to their physicians’ recommendations.2 It is clear that this type of decision making conflicts with the principles of informed consent and autonomy, and has subsequently seen patient-centered care and shared decision making …