Letters - to Payal, Newsletter Winter 2018



I enjoyed reading your piece in the Kinexum newsletter, and noted in particular the fourth and fifth points which I believe are topics needing more exploration.  In some ways they are related. 


The fourth opens with a comment on perceptions of risk.  I do agree entirely that people need to integrate it into their decision making, but in clinical practice did not find this easy.  There are barriers here – quite large ones.  Most of us find it very difficult to formulate risk in any meaningful way, and rather tend to react emotionally when they cannot cope.  Classical examples relate to risks from terrorist incidents, plane crashes etc, and (sad example) the recent train accident in Oregon will kill more people on the roads (because they avoid trains) than died in the accident.  We are of course familiar with this from medicines and side effects.  I have seen people take decisions based on risks down in the 100 000 area when they will not take avoidance measures at the 1% level.  Some careful exploration of risks, numeracy and emotions as we apply these ideas clinically is I think warranted.  Lack of data and poor professional knowledge of it are also a problem – may HCPs are surprisingly ill-numerate. 


Your fifth point (taking personal responsibility) is also well taken, and worth further exploration.  Observation of society here in the UK is that it has moved in the opposite direction in terms of health care behaviours – become more hedonistic.  Why is this so as education has improved?  As you know I believe the essence of the whole problem lies in childhood (as the tobacco manufacturers knew well) so concepts of health responsibility and how they are adopted need addressing from that angle. 


Again, thank you, and best wishes to everyone for the festive season and 2018. 




Professor Philip Home

Professor of Diabetes Medicine, Newcastle University