BMJ  2004;329:458 (21 August), doi:10.1136/bmj.329.7463.458

Letter

Balancing benefits and harms in health care

Ethical dimension was not discussed in theme issue

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

EDITOR—The interesting selection of papers in the BMJ on balancing harms and benefits in clinical medicine and public health all seem to make a questionable assumption. While all speak of "balancing" harms and benefits, in the arguments presented the authors assume that a purely rational judgment can be made about whether or not the true harms outweigh the true benefits.

For instance, Dieppe et al point to a dearth of evidence which causes us to mis-estimate the true magnitudes.¹ Greenhalgh et al point to the variety of cognitive biases which "prevent" people from making rational judgments.² Oakley and Johnston, with Wald, can barely conceal their annoyance at the irrational public and the devious industrial interests that try to delude them.³

Yet in at least some cases differences in "balancing" come about because of differences between people about what is important to them, rather than differences in estimation of . . . [Full text of this article]

Imperial College London, Medical Ethics Unit, London W6 8RP r.ashcroft@imperial.ac.uk

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