Risk within reason

Article Abstract:

The position is taken that our society's ability to evaluate health risks is impaired, with resulting misdirection of social goals and priorities. A discussion of risk and the development of reasonable approaches to the issue is provided, from the standpoint of needing to make the best environmental decisions possible. The focus is health and health policy; expected utility is the result against which risk management policies should be evaluated. This approach assigns each potential outcome a value, weights the values by their probability of occurrence, then adds them to produce an expected utility. As such, the measure reflects the attractiveness of the alternative. A risk policy needs to be formulated considering the consequences if people acted to maximize their own expected utility. Human fallibility is a major distorter of risk estimation, and an important example of this is the difficulty people have comprehending very low-probability events. Mistakes in estimation, distortions in economic valuations, problems within health agencies, and aspects of the use of information are discussed. Information can be gathered from a variety of sources, and the source must be considered before rational use can be made of the information. Risk policies should be guided by the relative gains or losses of a particular policy as compared with the policy's alternatives. Improved mortality historically occurs as a result of technological progress and a higher standard of living, rather than as a result of government regulation or better personal habits. Risks are inherent in life, and we now need profound changes in our methods of decision-making. A stance is taken that is strongly critical of our society's approach to risk management. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Statistics (Data), Health risk assessment

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Impact of mass treatment of onchocerciasis with ivermectin on the transmission of infection

Article Abstract:

Onchocerciasis (river blindness) is a condition that can cause blindness or visual impairment; approximately 18 million people are infected with Onchocerca volvulus (the parasite that causes it), of whom between one and two million have serious eye disease. Simulium flies transmit the parasite to humans; then, adult worms lodged in nodules in human tissue release offspring (microfilariae) that migrate through the body and become particularly concentrated in the skin and eye. Previously untreatable, onchocerciasis can now be safely and effectively treated with ivermectin. The effectiveness of this drug among a large population (14,000 people) living on a rubber plantation in Liberia was evaluated. The study took place between September 1987 and November 1989. A description is provided of the study's methodology. Results showed a reduction in the prevalence of infection in five-year-old children from 23.9 percent to 19 percent (a reduction of more than one fifth). New cases among uninfected children decreased by 35 percent, with a reduction in incidence for children aged 7 to 12 of 45 percent. The microfilarial load (estimate of the quantity of microfilariae in the skin) for all patients fell by 65 percent. The results show that a community-based treatment program can be effective, even in areas such as the rubber plantation, where transmission rates are high and the parasite is endemic. In reducing the incidence of onchocerciasis in this population, ivermectin also reduced the rate of disease transmission. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Liberia, Onchocerciasis, Ivermectin

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AIDS: a global response

Article Abstract:

The new joint United Nations Program on HIV/AIDS (UNAIDS) should assure that plans for global AIDS/HIV research are designed to meet the needs of developing countries not just those of the richer nations. Ninety percent of people with AIDS or HIV live in developing nations.

Editorial, Research, International aspects, Medical research, AIDS (Disease), AIDS research

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