A new drug reduces the risk of heart attacks by will suffer a fatal shark bite each year.
ar. Imagine that out of a group of 1,000 people
40%.
Shark attacks are up by a factor of two.
Drinking a liter of soda per day doubles your
chance of developing cancer.
These are all examples of relative risk,
a common way risk is presented in news
articles.
Risk evaluation is a complicated tangle of
statistical thinking
and personal preference.
One common stumbling block is the difference
between
relative risks like these and what are called
absolute risks.
Risk is the likelihood that an event will occur.
It can be expressed as either a percentage—
for example, that heart attacks occur in 11% of
men
between the ages of 60 and 79—
or as a rate— that one in two million divers
along Australia’s western coast
These numbers express the absolute risk of
heart attacks
and shark attacks in these groups.
Changes in risk can be expressed in relative or
absolute terms.
For example, a review in 2009 found that
mammography screenings
reduced the number of breast cancer deaths
from five women in one thousand to four.
The absolute risk reduction was about .1%.
But the relative risk reduction from 5 cases of
cancer mortality to four
is 20%.
Based on reports of this higher number,
people overestimated the impact of screening.
To see why the difference between the two
ways of expressing risk matters,
let’s consider the hypothetical example of a
drug
that reduces heart attack risk by 40%.
who didn’t take the new drug, 10 would have
heart attacks.
The absolute risk is 10 out of 1,000, or 1%.
If a similar group of 1,000 people did take the
drug,
the number of heart attacks would be six.
In other words, the drug could prevent four
out of ten heart attacks—
a relative risk reduction of 40%.
Meanwhile, the absolute risk only dropped
from 1% to 0.6%—
but the 40% relative risk decrease sounds a lot
more significant.
Surely preventing even a handful of heart
attacks,
or any other negative outcome, is worthwhile
— isn’t it?
Not necessarily.
The problem is that choices that reduce some
risks
can put you in the path of others.
Suppose the heart-attack drug caused cancer Sometimes, we have to decide between especially when it shares some numbers in
in one half of 1% of patients. exposing ourselves to risks absolute terms

In our group of 1,000 people, that aren’t directly comparable. and others in relative terms.

four heart attacks would be prevented by If, for example, the heart attack drug carried a Understanding how these measures work
taking the drug, higher risk
will help you cut through some of the
but there would be five new cases of cancer. of a debilitating, but not life-threatening, confusion

The relative reduction in heart attack risk side effect like migraines rather than cancer, and better evaluate risk.
sounds substantial
our evaluation of whether that risk is worth
and the absolute risk of cancer sounds small, taking might change.

but they work out to about the same number And sometimes there isn’t necessarily a
of cases. correct choice:

In real life, some might say even a minuscule risk of shark

attack is worth avoiding,
everyone’s individual evaluation of risk will
vary because all you’d miss out on is an ocean
swim,
depending on their personal circumstances.
while others wouldn’t even consider skipping
If you know you have a family history of heart
a swim
disease
to avoid an objectively tiny risk of shark attack.
you might be more strongly motivated to take
a medication For all these reasons, risk evaluation is tricky
at baseline,
that would lower your heart-attack risk,
and reporting on risk can be misleading,
even knowing it provided only a small
reduction in absolute risk.