(Published June 2006)

Risk, Health Decisions, and the Media

An important tenet of risk communication is that health decisions are not based strictly on a technical understanding of risk. Instead, such decisions reflect a person’s values, needs, and preferences. For this reason, effective risk communication involves more than simply providing additional or more accurate risk calculations in an attempt to correct an erroneous perception of risk.

A number of causes underlie the risk misperception that exists among both patients and providers about hormonal contraceptives, including lack of understanding of statistics, psychological factors, media influences, and factors that affect risk perception and interpretation.

Lack of Understanding of Statistics

Statistics is a complicated field, requiring sophisticated numerical training and comprehension that many people do not have. For this reason, it may be difficult for patients (and providers) to fully comprehend the mathematical basis of risk calculations about the effectiveness of hormonal contraceptives or the risk of associated adverse events.

Psychological Factors

Psychological factors also may influence a woman’s perception of risk. For example, ambivalent feelings about women’s sexuality—due to cultural or other factors—may lead women to avoid methods that require advanced planning, even if those methods are more effective at preventing pregnancy. In addition, the negative views of some people about “putting hormones in my body” or toward large pharmaceutical manufacturers may lead them to see effective hormonal contraceptive methods in a jaundiced light and thus may fuel misperceptions of risk.

Media Influences

The media—whether television, the Internet, magazine articles, or other forms—provide a means for widespread dispersion of reproductive health information. However, the media also serve as a source of risk misperception for several reasons:¹

They often provide incomplete information and are designed to deliver news in small portions, or “sound bites.”
Media outlets remain viable by “selling” the news, frequently following the philosophy, “if it bleeds, it leads,” and they often stimulate controversy or seek out divergent opinions rather than trying to educate.
When the media report on risks associated with a treatment or intervention, they often neglect to provide perspective for the risks or place them in context.
Specifically pertinent for hormonal contraceptives, television ads for prescription products are required to include an overwhelming list of the adverse events reported in clinical trials.

Research has documented that the media can have a profound effect on contraceptive use. Discontinuation of OCs has followed specific media events highlighting cases of adverse events. One study looked at the monthly discontinuation rate of OCs from 1970 to 1975.^1,2 As shown in Figure 5, the percentage of women discontinuing OC use increased after an adverse media report, peaking at 16 percent discontinuation five months after the report aired.

Research also has uncovered a phenomenon called the Weber effect, which may explain the spike in reporting of adverse events picked up by the media. The number of adverse events reported for a drug peak at the second year of the drug’s marketing and then decline, despite an increase in prescribing over time.³ Researchers speculate that the effect is caused by prescriber familiarity with the drug, with prescribers more likely to report adverse events for newly available and less familiar drugs. Prescribers are exposed to many new drugs each year; two years may be the maximum time they sustain interest in reporting adverse events for any particular drug.⁴ Figure 6 shows the Weber effect for diflunisal (Dolobid^®). Media reports are triggered in part by adverse event reporting by prescribers. A wave of negative media events that is perceived to indicate an increase in risk or a newly discovered danger may not reflect an actual increase in risk associated with a product; it may simply be a reflection of the Weber effect.

The last cause of risk misperception regarding hormonal contraceptives—factors affecting risk perception and interpretation—is addressed in detail in the next chapter.

References

Grimes DA. Breast cancer, the pill and the press. In: Mann RD, editor. Oral Contraceptives and Breast Cancer. Park Ridge, NJ; The Parthenon Publishing Group; 1989. p. 309-22.
Jones EF, Beniger JR, Westoff CF. Pill and IUD discontinuations in the United States, 1970-1975: the influence of the media. Fam Plann Perspect. 1980;12:293-300.
Hartnell NR, Wilson JP. Replication of the Weber effect using postmarketing adverse event reports voluntarily submitted to the United States Food and Drug Administration. Pharmacotherapy. 2004;24:743-9.
Weber JCP. Mathematical models in adverse drug reaction assessment. In: D’Arcy FF, Griffin JP, editors. Iatrogenic Diseases. Oxford, England: Oxford University Press; 1986. p. 102-7.