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Risk and genomics – misunderstanding risk

misunderstanding risk - second part of interviewee's with Jon Roberts
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So are there simple ways that you could explain or demonstrate risk for students? So yeah, there’s lots of different ways you can help people try and understand risk. So for example there’s pictorial representation. So for example, a 1 in 100, you can have a kind of picture where there’s going to 100 little people. And one of them is painted red just to give people a kind of visual representation of something. There are other things we know from psychological research. For example, if you’re trying to help people compare different rates risks and are using fractions, you have to keep the denominator the same. So for example, you might compare one in eight versus six in eight.
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That’s a lot easier to compare in your head than one in eight versus two and three. They’re the same, but actually how is one in eight compared to two in three? That’s harder to picture than one in eight versus six in eight. So there are little things that you can do, like that. It’s important to make sure you frame things in both ways. So for example, you say there’s a one in eight chance of something happening, that’s also a seven in eight chance it won’t happen. So how people look at it from different perspectives. The other key thing from a counselling point of view is to think about the emotions.
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You’re giving someone a ways or tools to understand that kind of objective number, but at the same time, people are going to be making subjective appraisals of how they feel about this. Is it a big risk or a small risk or even a risk at all? And this is really important when you’re trying to understand people’s values and feelings, because that’s also going to help you understand what this risk means for an individual. So we come back to what we talked about before, this kind of duality of risk. It’s a figure, an empiric figure, but it’s also an appraisal of what this threat is. How serious it is. And to explain risk, you need to understand both those things.
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What should we be mindful of when we’re discussing things like risk with students? So for example, if you say you’ve got a risk of a disease, are you definitely going to get that disease? So I think one of the things you could think about with risk is categorising different types of uncertainty. So with a risk, obviously that there’s an element of uncertainty, but uncertainty kind of comes in different types, if you like. So one uncertainty we’ve talked about so far is probability, which is with the information we’ve got, what’s the kind of chance that you might have something?
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And there’s different ways you can talk about that, because we are familiar with probability and things like a coin toss or the world of a dice for example. It’s also useful to think about ambiguity. So this is kind of what you call uncertainty about uncertainty. But an example from genetics is where you’ve got a lot of variation of uncertain significance. So for example, you might do a genetic test in someone who’s had breast cancer from the genes BRCA1 and BRCA2. Which are genes if you have– a gene fault in that gene, it can lead to an increased risk of breast and ovarian cancer. Now sometimes, you find a genetic change with those genes.
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And you’re not sure whether it would actually disrupt the function of that gene or not. You just can’t say with the evidence that we’ve got. And that can be a different type of uncertainty. Because it’s not– we’re not saying you’ve got this gene change, we don’t know whether you may or may not get cancer. We say, you’ve got this gene change, we don’t know what it means. And that’s difficult, because then you’ve got a potential risk and uncertainty about uncertainty and emotion that’s really quite uncomfortable for people. And then the final type of uncertainty is kind of complexity, which is where you’ve got lots of different factors.
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You’re not quite sure how they all kind of marry together, which is why we’re talking about polygenic risks. So one of the things that you can kind of think about when talking about risks, is there is an inherent uncertainty in risk. But also then, you can sort of subcategorize. Okay, what uncertainty we’re dealing with it, and then how is that playing into what this person is feeling? Once you kind of start to kind of put all that together, you start to get a sense of, well, what does this mean for an individual? Thank you so much for that John. That was so interesting.
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And hopefully that is now given you a really good introduction to what risk is and how to explain some of these concepts to your students. If you’ve got any feedback or comments, please remember to put them in our comments box.

In this second video with Jon Roberts we discuss some methods to help students understand and discuss risk.

As we have discussed It is quite easy to misinterpret risk if you are not familiar with the concepts. Read this article about Matt Hancock former UK health secretary interpretation of his Genetic test results. https://www.bbc.co.uk/news/health-47652060

Could you explain to students how this misinterpretation occurred? How easy is it to misinterpret risk? Write your thoughts in the comments section.

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