Risky business - or is it? : risk perception and integrative medicine

We are living with risks all the time; it's just a fact of life. There are some risks we happily accept, others we fear so much that they over-ride our rational decision making and some very large risks that are so mundane that we often ignore them. Identifying, minimising and communicating risk is necessary for improving public safety and a frequent concern for many working in healthcare. However, there is relatively little discussion about risk perception, which ultimately influences how people respond and can explain why some make seemingly irrational decisions, regardless of the evidence. This has obvious implications for clinicians and patients, but also committees and policy makers who consist of individuals with varying levels of experience, knowledge and risk perception. Deciding to restrict or promote a particular behaviour, access to a medicine, practice of a profession or integration of a therapy will be influenced by these factors. This article reviews some of the social science and psychology literature which has identified the key factors which attenuate or amplify risk perception. In particular, Ropeik's perception gap is discussed together with Slovic's work identifying factors which affect risk perception and heuristics. Several examples are given which are relevant to integrative medicine as it relates to safety. Drug-herb interactions and the perceived danger of herbal and nutritional medicines in surgery are key examples. The 'risk as feelings' hypothesis is also discussed as a means of better understanding barriers to the adoption of evidence based integrative medicine, and how it may affect practitioner-patient interactions.