Multiple sclerosis and risk behavior

Abstract

There are several aspects to the concept of risk behavior in MS patients. Thus, a recent publication (Heesen et al., 2010) assessed patients. Foremost is their attitude to novel immunotherapies with the attendant short and long term hazards. Related to this, is their concern about everyday risks to health before disease onset. Finally, there is the behavior pattern of patients once they have the disease and its impact on lifestyle. These aspects of riskrelated behavior have been studied relatively little. An initial study by Prosser et al. (2002) addressed the attitude to medication risk in MS and explored why many patients who were eligible for beta-interferon or glatiramer acetate chose to forgo or discontinue treatment. Sixty-two patients with MS completed a survey on risk preference, and risk attitude was measured using an in-house standard gamble question on shortterm health outcomes. It was found that risk-taking patients were less likely to choose standard treatment compared to risk-averse patients. In other words the more risk-seeking an individual is, the more likely they would choose no treatment—a somewhat unexpected finding. Risk attitude did not appear to have an important effect on the decision to discontinue treatment. In their subsequent survey (Prosser and Wittenberg, 2007) 56 MS patients and 57 community members were assessed for risk attitude based again on standard gamble questions relating to money or health outcomes. Patients and community members were predominantly risk neutral with respect to health outcomes and risk averse with respect to money. In a further study (Johnson et al., 2009) evaluated by questionnaire the willingness of 651 MS patients to accept lifethreatening adverse event risks in exchange for improvements in their health outcome. Patients chose imaginary therapies from pairs of treatment alternatives that had varying levels of clinical efficacy and associated drawbacks. It was found that delay in years to disability progression was the most important factor in treatment preferences. In return for decreases in relapse rates from 4 to 1 and increases in delay in progression from 3 to 5 years, patients were willing to accept a 0.38 percent annual risk of death or disability from progressive multifocal leukoencephalopathy (PML) a 0.39 percent annual risk of death from liver failure or a 0.48 percent annual risk of death from leukemia. There are few publications that assess directly the willingness of the treating physician to offer newer immunotherapies but one would expect most doctors would be more cautious than their