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Costs and Benefits of Hepatitis Prophylaxis

David Egilman, MD, MPH; Peter Lichty, MD, MOH
JAMA. 1984;251(21):2794. doi:10.1001/jama.1984.03340450022015.
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To the Editor.—  Dr Hamiltons1 article evaluating criteria for the use of hepatitis prophylaxis in medical personnel is misleading in several respects. Dr Hamilton states that prior to the initiation of a prevention strategy, it is necessary to "assess the costs and expected benefits of these strategies." This is contrary to the Occupational Health and Safety Administration (OHSA) Act of 1970, and the interpretation of that law as expressed by the Supreme Court in the case of American Textile Manufacturers Institute, Inc, et al v Donovan et al. The OHSA Act states that preventive measures must be implemented when they are feasible (Public Law 91-596). While economics is a part of feasibility, the Supreme Court has ruled that unless the control measure would put an entire industry out of business, an economic argument cannot prevent the implementation of a control measure.Furthermore, Dr Hamilton's argument is troubling from an


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