Faculty of 1000

Post-publication peer review


Posted by rpg on 21 January, 2010

The distribution and uptake of antivirals and vaccination was in the news quite a bit before Christmas. H1N1 swine flu didn’t turn out to be the Armageddon some commentators were forecasting, but I don’t think it’s overstating the case to say that we dodged a bullet there. In cases like this we might expect the government to give a clear message, based on the best possible epidemiology. No, please, stop laughing. After all, the UKian government was right about the MMR combined vaccine, even if they did handle the situation incredibly poorly.

And that’s a problem, isn’t it? In our culture we don’t trust what the government tell us anymore. That may or may not be a good thing, but it certainly creates problems for public health policy, especially in a potential epidemic situation. Sometimes it’s quite clear what the right thing to do is, but how do we get them to do it?

A paper just published in PNAS and reviewed on f1000 (link free for three months) sets out an economic framework for controlling transmissible and evolving diseases. Now, I’m not an epidemiologist (you should possibly go and talk to my mate Bill if you’re that interested), and the argument therein apply more to a healthcare system that is not free at point of care (Obama’s reforms notwithstanding), but it’s an interesting paper nonetheless.

Antibiotic treatment for otitis media

“public policies such as taxing and subsidizing goods are frequently used to correct (for public benefit) the private actions of individuals when externalities, or side effects, of these actions exist.”

By comparing four different scenarios and addressing negative externalities, the authors predict where financial dis/incentives should be applied for maximum public health benefit. The scenarios discussed here are

  1. Tetanus: infectious but not transmissible between humans, and no herd immunity
  2. Measles: infectious, effective vaccination that generates a herd effective by reducing transmission
  3. Otitis media: non-transmissible, but unnecessary antibiotic treatment can lead to the negative externality of antibiotic resistance
  4. Pandemic influenza: antiviral treatment generates negative (resistance) and positive (reduced transmission) externalities.

Antiviral treatment for pandemic flu

There’s a whole heap of math in this paper, and although (or perhaps because) I’m supposed to be coming up with robust formulae for our rankings on the main site, it makes my brain hurt.

I find the thesis that economic impact can be leveraged to get maximum public health benefits an interesting one. I’m not sure how that would apply to the UK, for example, where the cost of healthcare is more-or-less invisible.

Infectious diseases tend to evolve quite rapidly when we attempt to control them, whether we use antibiotics, other drugs or prophylactic vaccinations. The framework expounded in this paper should prove to be readily applicable to a wide range of such diseases. Assuming, of course, that the authorities responsible for public health have the appropriate fiscal executive power, and access to current and accurate scientific information…

Althouse, B., Bergstrom, T., & Bergstrom, C. (2009). Evolution in Health and Medicine Sackler Colloquium: A public choice framework for controlling transmissible and evolving diseases Proceedings of the National Academy of Sciences DOI: 10.1073/pnas.0906078107


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