Public Policy as Human Experimentation?
I found this article in today’s NY Times to be fascinating. Although it is about salt restriction, it could easily be applied to legislative and other public policy approaches to infection control interventions.
An obvious example? Legislative mandates for active MRSA screening, and the Veterans Affairs system-wide directive to screen all admissions for MRSA. Given the lack of scientific consensus on the effectiveness of active MRSA screening approaches, these mandates amount to a huge natural experiment, with every patient admitted to the involved hospitals becoming a study subject. Worse yet, the conclusion is foregone—as invasive MRSA infection rates fall for other reasons, those states or healthcare systems that enforced screening mandates will claim that this intervention was key to their success.
This would all be fine if active screening for MDROs such as MRSA, combined with increased use of isolation precautions for asymptomatic carriers, had no associated risks. Alas, this is certainly not the case. It’s not just bad public policy, it’s harmful and wrong.
An obvious example? Legislative mandates for active MRSA screening, and the Veterans Affairs system-wide directive to screen all admissions for MRSA. Given the lack of scientific consensus on the effectiveness of active MRSA screening approaches, these mandates amount to a huge natural experiment, with every patient admitted to the involved hospitals becoming a study subject. Worse yet, the conclusion is foregone—as invasive MRSA infection rates fall for other reasons, those states or healthcare systems that enforced screening mandates will claim that this intervention was key to their success.
This would all be fine if active screening for MDROs such as MRSA, combined with increased use of isolation precautions for asymptomatic carriers, had no associated risks. Alas, this is certainly not the case. It’s not just bad public policy, it’s harmful and wrong.
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