October 17, 1990

Benefits and Harms: The Balance Sheet-Reply

Author Affiliations

Durham, NC

Durham, NC

JAMA. 1990;264(15):1945. doi:10.1001/jama.1990.03450150043015

In Reply.—  Dr Haas makes a very important point: decisions about interventions can be strongly influenced by the measure used to describe the effect of the intervention. In particular, describing the effect of an intervention as a relative change instead of an absolute change can lead to very different decisions. Dr Haas' disagreement with me, however, is not about an "arithmetical error" but about an important concept. This issue was discussed in the article on page 2501, but it is sufficiently important to justify another example.To avoid confusing the concepts with any personal beliefs about the desirability of colorectal cancer screening, I will use a nonmedical example. Imagine that there are reports of a new species of termite that, if it should infest your house, will virtually destroy it, causing damage in the range of, say, $100 000. Suppose there is a treatment that can be sprayed on your