Balancing benefits and harms in public health prevention programmes mandated by governments

doi:10.1136/bmj.329.7456.41

BMJ 2004;329:41-43 (3 July), doi:10.1136/bmj.329.7456.41

Education and debate

Balancing benefits and harms in public health prevention programmes mandated by governments

Godfrey P Oakley, Jr, visiting professor of epidemiology¹, Richard B Johnston, Jr, professor of paediatrics²

¹ Rollins School of Public Health, Emory University, Atlanta GA 30345, USA, ² University of Colorado School of Medicine, Denver CO 80262, USA

Correspondence to: Godfrey P Oakley Jr gpoakley@mindspring.com

Even when scientific evidence for a preventive health interventionis strong, many barriers exist to population-wide implementation

The first 150 words of the full text of this article appear below.

Introduction

The principal rationale for medical research is to improve health.In clinical medicine, the goal is to get the results of medicalresearch to individual patients as soon as possible. In preventivemedicine, however, the challenge is to apply clinical and epidemiologicalevidence to whole populations. The most effective way to dothis is through government legislation. However, once a governmentrequires an intervention, individuals may have little chanceto influence whether they are exposed to it. This means thatgovernment decisions to require prevention measures are political.Unless the decision is anchored securely in science, even weakpolitical arguments can over-rule the science and the needsof public health. We consider the challenges that face the introductionand maintenance of evidence based public health interventionsusing the current debates over preventing birth defects by fortificationof flour with folic acid and the safety of the MMR (measles,mumps, and . . . [Full text of this article]

Fortification of cereal grains with folic acid

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