Communicating risk: Does scientific debate compromise safety?

摘要

A recent publication in the influential British Medical Journal (BMJ) using the Danish National Registry databases reported an increased risk of venous thrombosis (VT) in women using the combination contraceptive ring and patch, and suggested that the risk may also be increased among users of the etonogestrel implant [1]. While an increased risk of VT is well established for women using combined hormonal methods, in this database study, users of the ring and patch were noted to have double the risk of VT compared to users of a low-dose levonorgestrel (LNG) pill. In 2009, the same research group using similar methodology reported a twofold increase in VT risk among users of drospirenone-containing combined oral contraceptives (OCs) relative to LNG pills [2]. This created a ripple effect that bounced off our shores and led to FDA hearings that resulted in media attention and a change in labeling for these products. How should we communicate this new information about the ring and patch to patients and other health care providers?