Reading this I could not help but think of compliance and treatment safety for self-managed dosing.
It's evident, for example, that drugs such as Paracetamol (Tylenol for you Americans) should be dosed by body weight in children. To make life simpler for parents, they are given age and/or weight brackets, sometimes along with upper thresholds (e.g. mg/day).
This of course means that lighter children are comparatively over-dosed and heavier children under-dosed compared to a median.
The problem is - I think this works pretty well as a safeguard against dangerous over-dosing (i.e. liver toxicity etc.).
Now how would we turn that advice into a gradual dosing recommendation? We can use mg/kg body weight as is done e.g. in antibiotics. But that carries the potentially fatal risk of miscalculation, and some parents might intentionally overdose over a wrong risk perception.
What we would need is something like an exponential risk curve, indicating a "safe zone" and a "danger zone" while highlighting some critical threshold. This again would need to be age/weight-specific.
Do we think parents would be deterred from giving a kid too high of a paracetamol dose? I'm not so sure, especially over time.
So in the end, I think that in some cases (especially with self-administered dosing) round numbers and sharp thresholds may work well to mitigate fatal risks, even while increasing nonfatal risks.
Sure, most of us stay in system 1 (heuristic) most of the time.
But I think it's wrong to assume most people are incapable of serious, thorough thinking. Parents around the world correctly dose medication for their kids all the time, and they mostly do this completely fine.
The key is that people are clever when they both can and want to, and some communication regarding drugs is not well-designed to alert them to want at the right time.
https://www.awrestaurants.com/press/press-release/101921-aw-... ("In the 1980s, A&W tried to compete with the immensely popular McDonald’s Quarter Pounder by offering a bigger, juicier ⅓ Pound Burger at the same price. Unfortunately, Americans aren’t so great at math. Confused consumers wrongly assumed that ¼ was bigger than ⅓ (You know, because 4 is bigger than 3) and the whole experiment went down in history as a huge marketing fail.").
First, many people are ... let's politely call it arithmetically challenged. They won't understand how to compute the amount and then obtain the correct dose. A chart or a table might have more success than a formula, no matter how simple the formula.
Then again, the dangers of paracetamol overdose aren't high (and I would think it's less for children than for adults). It's typically only needed for a few days. Perhaps that's where the stress should go: stop as soon as you can.
Depending on location doctors will frequently come into contact with people who are illiterate, as in unable to write down their own names on a piece of paper. They still need care and it cannot wait until society has been fixed.
What you are implying would work great in a world that had prioritized education. We don’t live in that world in America for sure unfortunately.
> The statement is a popular anecdote from the 1980s, illustrating a widespread misunderstanding where many consumers thought that a 1/4 pound burger was larger than a 1/3 pound burger because the number "4" is larger than "3". This led to the failure of a new third-pound burger campaign by the fast-food chain A&W.
Acetaminophen/Tylenol/Paracetamol and many similar drugs are indeed dosed by weight in the hospital but as sibling comments say, this is likely too complex for parents.
In the hospital, a formulary likely carries pills of different medication amounts, so a nurse can readily administer the correct dose - which a parent would struggle with.
This is an amazing paper (but I’m not a statistician, apologies if I am overstating its value).
Note that the GitHub repository associated with the paper is 2 years old and that this journal is not very popular - it likely was sent to Nature or NEJM and not accepted, though I wonder why it wasn’t sent to Health Services Research.
> paradoxical risk, where successful treatments unexpectedly lower the risk of higher-risk patients to below that of untreated lower-risk patients.
This seems perhaps tautological whenever the treatment intensity is binary, and it's an effective treatment. Someone at the threshold that receives treatment would necessarily do better than someone at the threshold not receiving the treatment.
It's a pretty good argument against any binary treatments, or at least to set the threshold low enough that improvement with treatment at the threshold is minimal.
It's evident, for example, that drugs such as Paracetamol (Tylenol for you Americans) should be dosed by body weight in children. To make life simpler for parents, they are given age and/or weight brackets, sometimes along with upper thresholds (e.g. mg/day).
This of course means that lighter children are comparatively over-dosed and heavier children under-dosed compared to a median.
The problem is - I think this works pretty well as a safeguard against dangerous over-dosing (i.e. liver toxicity etc.).
Now how would we turn that advice into a gradual dosing recommendation? We can use mg/kg body weight as is done e.g. in antibiotics. But that carries the potentially fatal risk of miscalculation, and some parents might intentionally overdose over a wrong risk perception.
What we would need is something like an exponential risk curve, indicating a "safe zone" and a "danger zone" while highlighting some critical threshold. This again would need to be age/weight-specific.
Do we think parents would be deterred from giving a kid too high of a paracetamol dose? I'm not so sure, especially over time.
So in the end, I think that in some cases (especially with self-administered dosing) round numbers and sharp thresholds may work well to mitigate fatal risks, even while increasing nonfatal risks.
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