The High Stakes of Medicine

Medical care can be a gamble--and patients often don't understand the odds. University of California researchers aim to change that, with an interactive Web-based tool that they are calling the roulette wheel. This color-coded visual model uses a computer algorithm to help patients and their doctors assess the possible outcomes of different treatments. Take the prostate-specific-antigen (PSA) test for prostate cancer, for example. The wheel for PSA screening shows a typical patient the potential harm (incontinence, impotence, death) or benefit (no symptoms) that could result from treatment following a PSA test in which high levels of the antigen are found. Another wheel shows probable outcomes if he opts against the test. "Screening isn't all apple pie and motherhood," says project leader Dr. Jerome Hoffman of UCLA, who expects the tool to launch in seven California hospital networks this summer and more widely in the spring of 2008.

The team considered other models--a dartboard with a perfect outcome as the bull's-eye, or a minefield, in which a mine represents death and a rock might be, say, nausea. That analogy failed. ("People thought they could step over the side effects," he says.) The roulette wheel best illustrated the range of outcomes. With medical care, as with that little white ball, says Hoffman, "you know that it could land anywhere."