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Discounting, Isoniazid, and Tuberculosis

David N. Rose, MD; Clyde B. Schechter, MD, MA; Alan L. Silver, MD, MPH
JAMA. 1987;258(7):910. doi:10.1001/jama.1987.03400070048022.
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To the Editor.—  The letters of Taylor et al1 and Dr Cobb2 regarding our study of the age threshold for isoniazid chemoprophylaxis for low-risk tuberculin reactors3 raise important issues of tuberculosis prevention policy. Their comments, however, do not affect our conclusion that isoniazid's benefits outweigh its risks for all affected persons between ages 10 and 80 years, by the measures of life expectancy and expected mortality.One comment made was that isoniazid's benefit in life expectancy gain— one to 16 days, depending on one's age at the time of the decision—seems "trivial." Such magnitude in benefits, however, must be appreciated in context. The prevention of any one disease, even a common one, may add little to average life expectancy. Tuberculosis has a relatively small effect on a tuberculin reactor's life expectancy because activation is uncommon (about a 5% chance over a lifetime) and the case fatality rate


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