The Precautionary Principle

["Jim Nelson" <nelsonjima@HOTMAIL.COM>]

Any thoughts on this principle?



J Chir (Paris) 2001 Apr;138(2):68-80



The Precautionary Principle: advantages and risks



Tubiana M.



Centre Antoine Beclere, Faculte de Medecine, Paris.



The extension of the precautionary principle to the field of healthcare is 

the social response to two demands of the population: improved health safety 

and the inclusion of an informed public in the decision-making process. The 

necessary balance between cost (treatment-induced risk) and benefit 

(therapeutic effect) underlies all healthcare decisions. An underestimation 

or an overestimation of cost, i.e. risk, is equally harmful in public 

healthcare. A vaccination should be prescribed when its beneficial effect 

outweighs its inevitable risk. Mandatory vaccination, such as in the case of 

the Hepatitis B virus, is a health policy requiring some courage because 

those who benefit will never be aware of its positive effect while those who 

are victims of the risk could resort to litigation. Defense against such 

accusations requires an accurate assessment of risk and benefit, which 

underlines the importance of expertise. Even within the framework of the 

precautionary principle, it is impossible to act without knowledge, or at 

least a plausible estimation, of expected effects. Recent affairs (blood 

contamination, transmissible spongiform encephalitis by growth hormone, and 

new variant of Creutzfeldt-Jacob disease) illustrate that in such cases the 

precautionary principle would have had limited impact and it is only when 

enough knowledge was available that effective action could be taken. 

Likewise, in current debates concerning the possible risks of 

electromagnetic fields, cellular phones and radon, research efforts must be 

given priority. The general public understands intuitively the concept of 

cost and benefit. For example, the possible health risks of oral 

contraceptives and hormone replacement therapy were not ignored, but the 

public has judged that their advantages justify the risk. Estimating risk 

and benefit and finding a balance between risk and preventive measures could 

help avoid the main drawbacks of the precautionary principle, i.e. inaction 

and refusal of innovation, highly restrictive administrative procedures, and 

a waste of funds on the search for the utopian goal of zero risk. Other 

drawbacks are more insidious. The precautionary principle could contribute 

to a general feeling of anxiety and unease in the population. It could be 

used by campaigns to manipulate public opinion in favor of a particular 

commercial interest or ideology. Furthermore, practitioners and public 

policy makers could be led to make choices not dictated by a search for the 

optimal solution but rather a solution that would protect them from future 

accusations (the so-called umbrella phenomenon). On the international level, 

the precautionary principle must not be used to mask protectionism. 

Nevertheless, a clear advantage of the precautionary principle is that it 

requires decision-makers to explain the rationale behind their decisions, to 

quantify the risks, and to provide objective information. However, the 

physician must not be tempted to make patients sign documents certifying 

that they have been given all relevant information on his or her diagnosis 

and treatment. This example underlines the role of legal texts and 

jurisprudence in the application of the precautionary principle. Finally, 

the precautionary principle implies new obligations for the State. In the 

field of health and healthcare, the State must undertake actions based on 

fully open and undisguised decision-making and provide complete information 

to the public. A pplication of the precautionary principle requires much 

discernment because the final outcome can be beneficial or harmful, 

depending on the way it is implemented. The precautionary principle, and its 

applications, must be precise and detailed within a well-defined framework.



Jim Nelson

Nelsonjima@hotmail.com

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