Balancing benefits and harms in public health prevention programmes mandated by governments

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Abstract
Introduction The principal rationale for medical research is to improve health. In clinical medicine, the goal is to get the results of medical research to individual patients as soon as possible. In preventive medicine, however, the challenge is to apply clinical and epidemiological evidence to whole populations. The most effective way to do this is through government legislation. However, once a government requires an intervention, individuals may have little chance to influence whether they are exposed to it. This means that government decisions to require prevention measures are political. Unless the decision is anchored securely in science, even weak political arguments can over-rule the science and the needs of public health. We consider the challenges that face the introduction and maintenance of evidence based public health interventions using the current debates over preventing birth defects by fortification of flour with folic acid and the safety of the MMR (measles, mumps, and rubella) vaccine.1 2