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The following is a thought exercise to illustrate where in current medicine the utilitarian way of thinking shows to be inconsistent. Looking at statin use in primary prevention where the absolute benefit could be 1%, this benefit can be seen as compelling evidence for making the case to add statins to the tap water. And not only statins because the polypill results are said to be encouraging too. It is best to start these health promoting substances at an early age to harvest the health benefits that accumulate over longer periods of time (a life time). Similarly, bottled water for women over 50 years old could, as standard, contain HRT supplements because from an utilitarian perspective the health benefits of preventing vaginal atrophy-related symptoms and osteoporosis probably outweigh the risk. When a statistician from a utilitarian perspective compares the benefits from promoting these health generating substances for daily consumption, this will show far greater benefits than those from vaccines. Tap water additions, from a primary prevention public health intervention point of view, would result in much larger gains in morbidity prevention and mortality benefits compared to vaccines in populations with good hygiene, sanitation and nutrition. Wouter Dr W Havinga, locum GP, England. ######################################################################## To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following link: https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1