Sunday, February 11, 2007

Relative risk vs absolute

Yesterday evening I met up with Melanie and Einar in Luxembourg-City. We all stutter and spend 4 hours discussing many things with varying degrees of fluency.

Medication to treat stuttering came up, and they were concerned about side-effects especially for the long-term. I realised that it is important to look at the relative rather than absolute risk. The right question to ask is "How much riskier is taking the medication over 20 years as opposed to stuttering more severely for 20 years?" (assuming the medication does alleviate stuttering), and NOT "How risky is taking the medication over 20 years?". Stuttering can add a lot of emotional stress and handicap to a person's life, especially to those that never went to a self-help group or therapy. For many, quality of life is lower and for some possibly even life duration!

Another illustration of this concept is having a LASIK operation to correct long-distance vision. You shouldnt ask how risky is the procedure but how risky is it compared to wearing contact lenses as an alternative. And then LASIK is actually less risky than contact lenses due to risk of infection, discomfort, and so on. Of course, wearing glasses is the safest option, even though I could argue that in accident glasses break and cause facial or eye injuries, and you have a reduced vision field...

12 comments:

Einar said...

Yeah was nice chat we had, expecially enjoyable as fluency was no issue...

Wearing Glasses also has other advantages:
It protects the eyes from possible damage from spills or flying debris (dust, acid, flies...)
when the glasses are made from synthetic material then breaking the glass is not that dangerous and most important wearing glasses makes a person look more intelligent.. ;-)
I agree the LASIK operation is getting more popular and more trendy, but nobody can tell what the longterm effects are (10, 20 years...) as the operation is quite new... So for myself I prefer to continue to look geeky and wear my glasses as a fahion accessory... ;-)

Law Student said...

To me there is no contest...I'd rather stutter than pummel my liver with medications every day. I even hate to take Tylenol for a headache. I can't say that I wouldn't be tempted to take a pill if it would totally eliminate my stutter...but it's not so debilitating that I can't have a normal life, so the health risks of side effects outweigh the downside of stuttering. At least for me.

Adrian said...

Interesting (and logical) way of looking at this. I know several who refuse to entertain the idea of taking drugs for stuttering. But you make a good point, I wonder just how hazardous stuttering and the related anxiety that often goes with it are to our health. Yes prescription drugs can tax the liver, but is this unknown risk any worse then the unknown risk of stuttering? Perhaps taking a drug and being more fluent is healthier then continuing to stutter.

Einar said...

I think "law student" has mentionned a valid point. The health risks for such a drug cannot be completely predicted (as long term results can only be available in the future). And the drug Pagoglone would only reduce stuttering temporarily, not eliminate it.

It seems to me that there is a new "fashion" in medicine, which consists of increasingly relying on new drugs to alleviate illnesses, such as anxiety, phobias, neuroses, depression, OCD etc...
There are millions of people out there who take these drugs and for many of them they are useless and those people would probably be better helped with a good psychotherapy... I think the same applies to stuttering, a drug will never be able to achieve what a good stuttering therapist can achieve... Taking a good drug for the wrong illness is useless and a waste of money...

Adrian said...

I disagree with Einer when he says, "a drug will never be able to achieve what a good stuttering therapist can." For one, even the good stuttering therapists have dismal records in treating stuttering. Furthermore, I believe stuttering is a brain based disorder and some sort of medication will be the first truly effective stuttering treatment. When this will happen is anybody's guess, but I believe it will happen.

Einer does make a very valid point that health risks for new medications cannot always be predicted. But hey, one could get hit by a truck walking to the SLPs office. Risks are an inherent part of life. I personally would take a drug if it were considered safe, had little to no side effects, and significantly reduced stuttering. I know others don't agree and I completely respect that.

Einar said...

Ok, stuttering is brainbased, I think that is commonly accepted nowadays. However the effects of stuttering are mostly behavioural, ie fear, shame, avoidance, resignation... I agree, if one could eliminate the cause for stuttering (inside the brain) all those effects would disappear, but science is still a very long way away from this...

Law Student said...

Interesting discussion, guys! I agree with a lot of what both are saying. I don't know if we can know the long-term risks of such a drug, though, so that doesn't give me much confidence. So much of what I read from the experts rings true in some ways...but false in others. For example, Dr. Schwartz personally told me that our stress zone is in our throat (as opposed to others who mainly have it in their shoulders) and this causes the stutter. However, I often will stutter in the middle of a sentence when I am completely un-stressed. There seems to be no reason for that...thus, I'm not certain he's 100% correct in his conclusions.

Adrian said...

Yes this is an interesting discussion. As for Schwartz and his laryngeal tension theory, it has been around for decades but other professionals have never taken it seriously. Here is a group of discussions between Schwartz and several respected CCC-SLPs as well as former clients taken from Stutt-L (a stuttering discussion group). They are fairly lenghty but interesting exchanges.

http://www.mnsu.edu/comdis/kuster/Internet/1997.html

http://www.mnsu.edu/comdis/kuster/Internet/1996.html

http://www.mnsu.edu/comdis/kuster/Internet/1995.html

Adrian said...

The last portion of my links was cut off. It is .html

Law Student said...

Wow, thank you for those links. Very, VERY good reading.

holger stenzel said...

I am at present in Hong Kong. Best greetings to the blog community. The current discussion is interesting.I could profit from nothing speech therapy in nearly 40 years "very professional" stuttering. I have doubts that normal speech therapy has still large development-potential.

Anonymous said...

I'm not sure you can really compare lasik eye surgery, which is purely cosmetic, with medications which can be life-saving. I wear glasses and have no desire for surgical "correction". But I take an antidepressant and expect to have to continue taking it indefinitely because without it I would probably end up dead from 'unnatural' causes.