The Precautionary Principle in Healthcare

In our daily lives, we take precautions routinely: we look both ways before we cross a road, and if we drive a car, we are constantly alert to avoid danger. This process does not require scientific ‘proof’. It is a natural process.  This so-called “precautionary principle” (PP) has until now not found a place in health economics. A paper recently published by OHE’s Alastair Fischer argues that the PP can easily be applied to standard decision theory.

The PP applies mainly to big future threats such as antimicrobial resistance (AMR) and climate change, those instances where we cannot use randomised controlled trials to generate evidence. The approach works by reversing the onus of proof when we look at harm reduction. So instead of trying to prove with 95% confidence that AMR will be a problem in future, we’d ask “Prove with 95% confidence that AMR is not going to occur”. Similarly, for climate change.

The paper also posits that as a nation we should be prepared to spend more than the cost effectiveness threshold (£20,000 to £30,000 per quality-adjusted life year) to reduce the possibility of catastrophic future events or to mitigate their effects.

The criterion for spending more than the usual threshold to avoid catastrophic events is a circumstance where decision theory cannot be used. In situations where nations can no longer act as if they are risk neutral, because they cannot insure against a potential catastrophe, then this risk aversion increases the spending threshold.

Applying the PP would make it easier to justify a decision to stockpile a drug like Tamiflu to take the edge off a possible flu pandemic. It would have also allowed a more rapid response to combat the Zika virus, well before it was known with greater scientific certainty that it causes birth defects.

Access the full paper here.

For more information please contact Alastair Fischer at OHE.