Subject: | | MMR |
From: | | "Montori, Victor M., M.D." <[log in to unmask]> |
Reply-To: | | Montori, Victor M., M.D. |
Date: | | Fri, 26 Jan 2001 08:51:09 -0600 |
Content-Type: | | text/plain |
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It is clear that people would prefer to act if there is evidence for
efficacy and harm and the balance favors acting.
This discussion about the MMR (leaving other patient and provider factors
and reality constraints aside) seems to illustrate decision making (or
policy-making) in the context of uncertainty.
(notice the difference in these questions between lack of evidence of
efficacy or harm with evidence of lack of efficacy or harm)
1. Should you act when there is evidence of efficacy but not enough evidence
of the likelihood of harm?
2. Should you wait until high-quality evidence of efficacy AND evidence of
harm become available?
3. Should you act if there is no high-quality evidence of efficacy but there
is evidence of no harm?
And, how do the answers to these questions change with the frequency of the
outcome you want to prevent and the harm you want to avoid (particularly
rare or very rare adverse effects)?
Victor
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