The precautionary principle: a double edged sword?

There is no doubt that the introduction of quality system principles and regulation to blood and tissue services in the 1990’s has brought about significant improvements in the control of processes and the quality of products being released for patient care. But, as regulation extends into new areas of cellular and tissue therapy, it is perhaps time to review the regulatory paradigm within which we work, and the principles that underpin it. At what point do the costs of regulation exceed the benefits to be gained? At what point to regulations cease to yield measurable benefits to patient care and safety at all, but instead become simply a burden on service providers and businesses, and ultimately the community as a whole? And is there a point at which regulation actually compromises patient care and safety, or the development of new technologies? In the early stages of regulation, there is demonstrable cost-benefit as assessed by product quality and patient outcomes. However, there is inevitably a “law of diminishing returns”, whereby the degree of improvement that can be achieved decreases and the cost of achieving that benefit increases. What has not yet been determined is whether, as regulations and regulators become more precise and more demanding, there remains a measurable net cost benefit over time, or whether there is a point at which the cost of further improvement matches, or even exceeds, the benefits to be gained. A key underpinning of the regulatory philosophy is the “Precautionary Principle”. This paper will focus on the application of the Precautionary Principle in the area of blood and tissues, which encompasses the burgeoning field of cellular therapies.     

Integrating economic costs into conservation planning

Recent studies that incorporate the spatial distributions of biological benefits and economic costs in conservation planning have shown that limited budgets can achieve substantially larger biological gains than when planning ignores costs. Despite concern from donors about the effectiveness of conservation interventions, these increases in efficiency from incorporating costs into planning have not yet been widely recognized. Here, we focus on what these costs are, why they are important to consider, how they can be quantified and the benefits of their inclusion in priority setting. The most recent work in the field has examined the degree to which dynamics and threat affect the outcomes of conservation planning. We assess how costs fit into this new framework and consider prospects for integrating them into conservation planning.     

Guest Lecture 9.45–10.30 Wednesday 17 September 2003

The success of the Cervical Screening Programme (CSP) is due in part to its management being underpinned by Quality Assurance. These measures ensure uniform standards across the country. Since 1992 Colposcopy Guidelines have been in place; these were updated in 1997 and have just been redefined. It is entirely consistent with the National CSP that colposcopy is governed by Guidelines.
The aim of clinical practice guidelines is to raise the standard of care and improve outcomes. The objectives are, therefore:

The credibility of guidelines is crucial to their adoption and this depends far more on the demonstration of an evidence base than that the authors are 'experts'. Development by a professional group or body who are seen as having a legitimate role is very important as is involvement of all 'stakeholders' in ensuring acceptability.
In terms of their nature, guidelines should be valid i.e. they will achieve what they are intended to achieve, and they should be robust i.e. they will work when implemented by different individuals in different settings. Colposcopy lends itself well to guidelines because it is largely a routine practice, but substandard care can have serious consequences.
In previous years there has been a set of Guidelines for Practice ^{1, 2} and a set of Quality Standards ³ . On this occasion these two components have been put together in a simple publication.
It needs to be borne in mine that the new guidelines were being developed in the context of a number of potential changes which could interact with each other and impact on the Guidelines. These include:
 

     

Economics of invasive species policy and management

This article examines the use of economic analysis to inform bioinvasion management, with particular focus on forest resources. Economics is key for understanding invasion processes, impacts, and decision-making. Biological invasions are driven by and affect economic activities at multiple scales and stages of an invasion. Bioeconomic modeling seeks to inform how resources can be optimally allocated across invasion management activities—including prevention, surveillance programs for early detection and management, and controlling invasion populations and spread—to minimize the long-term costs and damages. Economic analysis facilitates understanding of decisions by public and private decision-makers, gaps between these, and the design of policies to achieve socially desirable outcomes. Private decision-makers may undercontrol invasions relative to socially optimal levels, because they generally account for their own costs and benefits of control but less often for broader ecosystem impacts or future spread across the landscape. Economic analysis considers approaches for increasing private invasion management and evaluates feedbacks between ecological and economic systems that can affect policy outcomes. Future research should continue evaluation and design of control strategies across the biosecurity continuum and across species to enhance cost-effectiveness, better incorporate uncertainty into policy design, increase focus on incentives and behavioral tools to influence private behaviors that affect invasion spread, and incorporate invasive species consideration within broader systems-focused science. In addition, challenges in valuing biodiversity and ecosystem service impacts and the costs and effectiveness of control measures are key data gaps. Greater collaboration between decision-makers and researchers will facilitate development and communication of usable economic research.     

Evidence-based care: 2. Setting guidelines: how should we manage this problem?

There are four steps in determining how to manage a clinical problem. The first is to formulate questions that are answerable; the second is to locate and synthesize the evidence needed to answer the questions; the third is to estimate the expected benefits, harms and costs of each option based on the evidence; and the fourth is to judge the relative value of the expected outcomes to conclude whether the benefits are worth the harms and costs. It is impractical to repeat these steps for every clinical decision. Therefore, implicitly or explicitly, physicians rely on guidelines, "rules" that simplify decision making about complex problems. If the methods used to develop a guideline are not explicit it is difficult or impossible to know how much confidence to place in it. Therefore, for common and important clinical problems, physicians should rely on guidelines that are systematically developed using explicit methods.     

Benefits and costs of mutualism: demographic consequences in a pollinating seed-consumer interaction

Interspecific interactions can affect population dynamics and the evolution of species traits by altering demographic rates such as reproduction and survival. The influence of mutualism on population processes is thought to depend on both the benefits and costs of the interaction. However, few studies have explicitly quantified both benefits and costs in terms of demographic rates; furthermore there has been little consideration as to how benefits and costs depend on the demographic effects of factors extrinsic to the interaction. I studied how benefits (pollination) and costs (larval fruit consumption) of pollinating seed-consumers (senita moths) affect the reproduction of senita cacti and how these effects may rely on extrinsic water limitation for reproduction. Fruit initiation was not limited by moth pollination, but survival of initiated fruit increased when moth eggs were removed from flowers. Watered cacti produced more flowers and initiated more fruit from hand-pollinated flowers than did unwatered cacti, but fruit initiation remained low despite excess pollen. Even though water, pollination and larvae each affected a component of cactus reproduction, when all of these factors were included in a factorial experiment, pollination and water determined rates of reproduction. Counter-intuitively, larval fruit consumption had a negligible effect on cactus reproduction. By quantifying both benefits and costs of mutualism in terms of demographic rates, this study demonstrates that benefits and costs can be differentially influential to population processes and that interpretation of their influences can depend on demographic effects of factors extrinsic to the interaction.     

The influence of trade-off shape on evolutionary behaviour in classical ecological scenarios

Trade-off shapes are crucial to evolutionary outcomes. However, due to different ecological feedbacks their implications may depend not only on the trade-off being considered but also the ecological scenario. Here, we apply a novel geometric technique, trade-off and invasion plots (TIPs), to examine in detail how the shape of trade-off relationships affect evolutionary outcomes under a range of classic ecological scenarios including Lotka-Volterra type and host-parasite interactions. We choose models of increasing complexity in order to gain an insight into the features of ecological systems that determine the evolutionary outcomes. In particular we focus on when evolutionary attractors, repellors and branching points occur and how this depends on whether the costs are accelerating (benefits become ‘increasingly’ costly), decelerating (benefits become ‘decreasingly’ costly) or constant. In all cases strongly accelerating costs lead to attractors while strongly decelerating ones lead to repellors, but with weaker relationships, this no longer holds. For some systems weakly accelerating costs may lead to repellors and decelerating costs may lead to attractors. In many scenarios it is weakly decelerating costs that lead to branching points, but weakly accelerating and linear costs may also lead to disruptive selection in particular ecological scenarios. Using our models we suggest a classification of ecological interactions, based on three distinct criteria, that can produce one of four fundamental TIPs which allow for different evolutionary behaviour. This provides a baseline theory which may inform the prediction of evolutionary outcomes in similar yet unexplored ecological scenarios. In addition we discuss the implications of our results to a number of specific life-history trade-offs in the classic ecological scenarios represented by our models.     

Mapping the economic costs and benefits of conservation

Resources for biodiversity conservation are severely limited, requiring strategic investment. Understanding both the economic benefits and costs of conserving ecosystems will help to allocate scarce dollars most efficiently. However, although cost-benefit analyses are common in many areas of policy, they are not typically used in conservation planning. We conducted a spatial evaluation of the costs and benefits of conservation for a landscape in the Atlantic forests of Paraguay. We considered five ecosystem services (i.e., sustainable bushmeat harvest, sustainable timber harvest, bioprospecting for pharmaceutical products, existence value, and carbon storage in aboveground biomass) and compared them to estimates of the opportunity costs of conservation. We found a high degree of spatial variability in both costs and benefits over this relatively small (~3,000 km²) landscape. Benefits exceeded costs in some areas, with carbon storage dominating the ecosystem service values and swamping opportunity costs. Other benefits associated with conservation were more modest and exceeded costs only in protected areas and indigenous reserves. We used this cost-benefit information to show that one potential corridor between two large forest patches had net benefits that were three times greater than two otherwise similar alternatives. Spatial cost-benefit analysis can powerfully inform conservation planning, even though the availability of relevant data may be limited, as was the case in our study area. It can help us understand the synergies between biodiversity conservation and economic development when the two are indeed aligned and to clearly understand the trade-offs when they are not.     

Deer,wolves, and people: costs,benefits and challenges of living together

Human‐driven species annihilations loom as a major crisis. However the recovery of deer and wolf populations in many parts of the northern hemisphere has resulted in conflicts and controversies rather than in relief. Both species interact in complex ways with their environment, each other, and humans. We review these interactions in the context of the ecological and human costs and benefits associated with these species. We integrate scattered information to widen our perspective on the nature and perception of these costs and benefits and how they link to each other and ongoing controversies regarding how we manage deer and wolf populations. After revisiting the ecological roles deer and wolves play in contemporary ecosystems, we explore how they interact, directly and indirectly, with human groups including farmers, foresters, shepherds, and hunters. Interactions with deer and wolves generate various axes of tension, posing both ecological and sociological challenges. Resolving these tensions and conflicts requires that we address key questions using integrative approaches: what are the ecological consequences of deer and wolf recovery? How do they influence each other? What are the social and socio‐ecological consequences of large deer populations and wolf presence? Finally, what key obstacles must be overcome to allow deer, wolves and people to coexist? Reviewing contemporary ecological and sociological results suggests insights and ways to improve our understanding and resolve long‐standing challenges to coexistence. We should begin by agreeing to enhance aggregate benefits while minimizing the collective costs we incur by interacting with deer and wolves. We should also view these species, and ourselves, as parts of integrated ecosystems subject to long‐term dynamics. If co‐existence is our goal, we need deer and wolves to persevere in ways that are compatible with human interests. Our human interests, however, should be inclusive and fairly value all the costs and benefits deer and wolves entail including their intrinsic value. Shifts in human attitudes and cultural learning that are already occurring will reshape our ecological interactions with deer and wolves.     

Costs, benefits and the evolution of inducible defences: a case study with Daphnia pulex

Phenotypic plasticity is one major source of variation in natural populations. Inducible defences, which can be considered threshold traits, are a form of plasticity that generates ecological and evolutionary consequences. A simple cost-benefit model underpins the maintenance and evolution of these threshold, inducible traits. In this model, a rank-order switch in expected fitness, defined by costs and benefits of induction between defended and undefended morphs, predicts the risk level at which individuals should induce defences. Here, taking predator-induced morphological defences in Daphnia pulex as a threshold trait, we provide the first comprehensive investigation into the costs and benefits of a threshold trait, and how they combine to reflect fitness and predict the switchpoint at which induction should occur. We develop reaction norms that show genetic variation in switchpoints. Further experiments show that induction can confer a survival benefit and a cost in terms of lifetime reproductive success. Together, these two traits combine to estimate expected fitness and can predict the switchpoint between an undefended and a defended strategy. The predictions match the reaction norm data for clones that experience these costs and benefits, and correspond well to independent field data on induction. However, predictions do not, and cannot, match for clones that do not gain a benefit from induction. This study confirms that a simple theory, based on life history costs and benefits, is a sufficient framework for understanding the ecology and evolution of inducible, threshold traits.     

Catchment management in England and Wales: the role of arguments for ecosystems and their services

This study uses document analysis and interviews to explore how the use of arguments for biodiversity and ecosystem services has evolved in recent years in the water industry in England and Wales, with a focus on investments in catchment management programmes. Changes to land management practices within catchment areas can lead to improved water quality and lower treatment costs, and also ancillary benefits to the natural environment and various stakeholders. Our analysis reveals the increasing effectiveness of arguments associated with ecosystem service values in enabling the industry regulator (Ofwat) to support water industry investments in catchment-level conservation projects. Ofwat has adopted a much more flexible approach to regulation, moving from initial resistance to ecosystem service framings and a dominant focus on financial benefits to customers, to acceptance that customers have a legitimate interest in environmental quality and a willingness to accept some ‘beneficiary pays’ solutions. Companies are now required by Ofwat to include environmental impacts in cost-benefit analysis of investments, alongside assessment of customer preferences and support. This has facilitated investments in catchment management with positive results for water companies, customers, farmers and the natural environment. The shift in arguments in this industry matches a broader shift at European and UK levels towards greater use of economic evidence and payment instruments. The challenge now is to stabilise a secure regulatory environment in which companies are encouraged to pursue innovative methods to benefit the wider interest of customers and the natural environment, today and in the future. Arguments based on the value of water quality improvements and of the wider associated ecosystem services benefits have been, and remain, a key tool for achieving the environmental improvements and economic efficiency gains associated with successful catchment management initiatives.     

Evolution of cooperation with shared costs and benefits

The quest to determine how cooperation evolves can be based on evolutionary game theory, in spite of the fact that evolutionarily stable strategies (ESS) for most non-zero-sum games are not cooperative. We analyse the evolution of cooperation for a family of evolutionary games involving shared costs and benefits with a continuum of strategies from non-cooperation to total cooperation. This cost-benefit game allows the cooperator to share in the benefit of a cooperative act, and the recipient to be burdened with a share of the cooperator's cost. The cost-benefit game encompasses the Prisoner's Dilemma, Snowdrift game and Partial Altruism. The models produce ESS solutions of total cooperation, partial cooperation, non-cooperation and coexistence between cooperation and non-cooperation. Cooperation emerges from an interplay between the nonlinearities in the cost and benefit functions. If benefits increase at a decelerating rate and costs increase at an accelerating rate with the degree of cooperation, then the ESS has an intermediate level of cooperation. The game also exhibits non-ESS points such as unstable minima, convergent-stable minima and unstable maxima. The emergence of cooperative behaviour in this game represents enlightened self-interest, whereas non-cooperative solutions illustrate the Tragedy of the Commons. Games having either a stable maximum or a stable minimum have the property that small changes in the incentive structure (model parameter values) or culture (starting frequencies of strategies) result in correspondingly small changes in the degree of cooperation. Conversely, with unstable maxima or unstable minima, small changes in the incentive structure or culture can result in a switch from non-cooperation to total cooperation (and vice versa). These solutions identify when human or animal societies have the potential for cooperation and whether cooperation is robust or fragile.     

WHO ARE THE BENEFICIARIES?

Is it defensible that society spends money on medical or research projects intended to help people solve their fertility problems? Suppose that we want to answer this question from the point of view of a utilitarian cost-benefit analysis. The answer to the question then depends, of course, on how expensive these projects turn out to be, relative to the costs of other possible projects. But it depends also on how we assess the benefits of these projects. To whom do they accrue? Who are the beneficiaries of these projects?     

Guest Lecture 9.45–10.30 Wednesday 17 September 2003. Csp Colposcopy Guidelines

The success of the Cervical Screening Programme (CSP) is due in part to its management being underpinned by Quality Assurance. These measures ensure uniform standards across the country. Since 1992 Colposcopy Guidelines have been in place; these were updated in 1997 and have just been redefined. It is entirely consistent with the National CSP that colposcopy is governed by Guidelines. The aim of clinical practice guidelines is to raise the standard of care and improve outcomes. The objectives are, therefore:

• a) to develop evidence based guidelines;
• b) to ensure the guidelines are widely adopted.

The credibility of guidelines is crucial to their adoption and this depends far more on the demonstration of an evidence base than that the authors are ‘experts’. Development by a professional group or body who are seen as having a legitimate role is very important as is involvement of all ‘stakeholders’ in ensuring acceptability. In terms of their nature, guidelines should be valid i.e. they will achieve what they are intended to achieve, and they should be robust i.e. they will work when implemented by different individuals in different settings. Colposcopy lends itself well to guidelines because it is largely a routine practice, but substandard care can have serious consequences. In previous years there has been a set of Guidelines for Practice ^1, 1Duncan 1992 ² 2Duncan 1995 and a set of Quality Standards ³ 3Luesley 1996 . On this occasion these two components have been put together in a simple publication. It needs to be borne in mine that the new guidelines were being developed in the context of a number of potential changes which could interact with each other and impact on the Guidelines. These include: The process for the development of the Guidelines included an Editor, an editorial group, and a group of contributors to produce a draft set of evidence based guidelines across 18 areas. New areas covered included HIV +ve women, immuno suppressed women, and working practice. The draft has been available for comment for several months and amendments have been made. Clearly there are areas where evidence is lacking and where different views are expressed. The most contentious area not surprisingly is in the topic of managing mild dyskaryosis; controversy in this has persisted for many years. The quality standards are either attainable or within attainment and are a driver for rising standards. These programme practice guidelines and standards have earned UK colposcopy international respect. They provide a benchmark for QA assessment and will continue to require amendment as new developments come into being.     

Incorporating Science,Technology, Fairness,and Accountability in Environmental,Health, and Safety Decisions

The Precautionary Principle is in sharp political focus today because (1) the nature of scientific uncertainty is changing and (2) there is increasing pressure to base governmental action on more “rational” schemes, such as cost-benefit analysis and quantitative risk assessment, the former being an embodiment of ‘rational choice theory’ promoted by the Chicago school of law and economics. The Precautionary Principle has been criticized as being both too vague and too arbitrary to form a basis for rational decision making. The assumption underlying this criticism is that any scheme not based on cost-benefit analysis and risk assessment is both irrational and without secure foundation in either science or economics. This paper contests that view and makes explicit the rational tenets of the Precautionary Principle within an analytical framework as rigorous as uncertainties permit, and one that mirrors democratic values embodied in regulatory, compensatory, and common law. Unlike other formulations that reject risk assessment, this paper argues that risk assessment can be used within the formalism of tradeoff analysis—a more appropriate alternative to traditional cost-benefit analysis and one that satisfies the need for well-grounded public policy decision making. This paper will argue that the precautionary approach is the most appropriate basis for policy, even when large uncertainties do not exist, especially where the fairness of the distributions of costs and benefits of hazardous activities and products are a concern. Furthermore, it will offer an approach to making decisions within an analytic framework, based on equity and justice, to replace the economic paradigm of utilitarian cost-benefit analysis.     

Modeling the Impact and Costs of Semiannual Mass Drug Administration for Accelerated Elimination of Lymphatic Filariasis

The Global Program to Eliminate Lymphatic Filariasis (LF) has a target date of 2020. This program is progressing well in many countries. However, progress has been slow in some countries, and others have not yet started their mass drug administration (MDA) programs. Acceleration is needed. We studied how increasing MDA frequency from once to twice per year would affect program duration and costs by using computer simulation modeling and cost projections. We used the LYMFASIM simulation model to estimate how many annual or semiannual MDA rounds would be required to eliminate LF for Indian and West African scenarios with varied pre-control endemicity and coverage levels. Results were used to estimate total program costs assuming a target population of 100,000 eligibles, a 3% discount rate, and not counting the costs of donated drugs. A sensitivity analysis was done to investigate the robustness of these results with varied assumptions for key parameters. Model predictions suggested that semiannual MDA will require the same number of MDA rounds to achieve LF elimination as annual MDA in most scenarios. Thus semiannual MDA programs should achieve this goal in half of the time required for annual programs. Due to efficiency gains, total program costs for semiannual MDA programs are projected to be lower than those for annual MDA programs in most scenarios. A sensitivity analysis showed that this conclusion is robust. Semiannual MDA is likely to shorten the time and lower the cost required for LF elimination in countries where it can be implemented. This strategy may improve prospects for global elimination of LF by the target year 2020.     

Natural selection on extrafloral nectar production in Chamaecrista fasciculata: the costs and benefits of a mutualism trait

Cost-benefit models of the evolution of mutualism predict that the current state of mutualism results from trade-offs between fitness costs of mutualist traits and the fitness benefits of association. We test the assumptions of such models by measuring patterns of natural selection on a mutualist trait, extrafloral nectar production in Chamaecrista fasciculata. Selection was measured on plants from which ants had been excluded (removing the mutualist benefit of the trait), from which all insects had been excluded (removing costs of herbivory in addition to mutualist benefits), and unmanipulated plants (where both costs and benefits were present). Selection analysis based on half-sibling-mean regressions of fitness on the trait revealed no evidence of costs of extrafloral nectar production in the absence of all insects or in the absence of ants. However, examination of the selective surfaces for these treatments suggest that costs of nectar production may exist and are exacerbated by the presence of herbivory. In the presence of ants, natural selection favors high extrafloral nectar production, consistent with a fitness benefit to this mutualist trait in the presence of the mutualist partner. In this study, the interaction of costs and benefits did not produce an evolutionary optimum for the trait within the range of variation observed, suggesting that application of a cost-benefit framework to this trait will benefit from considering the influence of temporal and spatial variation on the quality of costs and benefits.     

Assessing the impact of the remedial actions taken at a contaminated Italian site: an ex-post valuation analysis

The remediation and reuse of industrial brownfields sites offers important opportunities for the improvement of urban quality of life. The aim of this paper is to estimate the primary costs and benefits of different cleanup projects implemented in Venice Porto Marghera, Italy. The industrial area of Porto Marghera is one of the most notorious contaminated sites of national interest in Italy; at this site, vacant and polluted areas coexist, posing several problems for the local government and community. However, this site also represents one of the primary strategic areas for the future development and the economic renaissance of the entire Veneto Region. In fact, the area is located in the heart of the northeast, close to the main transport networks, and it is provided with a full range of urban services and infrastructure. The area for the national priority list site of Porto Marghera extends over 3,500 ha, and in the last 10 years, different cleanup interventions have been implemented to rehabilitate the area under various regulatory systems. However, only a small number of these interventions can be considered to be completed or have been certified by law. This paper performs a retrospective cost–benefit analysis of these case studies to provide information for potential regulatory modifications, insights and knowledge for methodological improvements in prospective economic assessments and information for local and central governments to use in implementing the remaining remediation activities.     

Dealing with different conceptions of pollution in the Gene Regulation Knowledge Commons

Current research of gene regulatory mechanisms is increasingly dependent on the availability of high-quality information from manually curated databases. Biocurators undertake the task of extracting knowledge claims from scholarly publications, organizing these claims in a meaningful format and making them computable. In doing so, they enhance the value of existing scientific knowledge by making it accessible to the users of their databases.In this capacity, biocurators are well positioned to identify and weed out information that is of insufficient quality. The criteria that define information quality are typically outlined in curation guidelines developed by biocurators. These guidelines have been prudently developed to reflect the needs of the user community the database caters to. The guidelines depict the standard evidence that this community recognizes as sufficient justification for trustworthy data. Additionally, these guidelines determine the process by which data should be organized and maintained to be valuable to users. Following these guidelines, biocurators assess the quality, reliability, and validity of the information they encounter.In this article we explore to what extent different use cases agree with the inclusion criteria that define positive and negative data, implemented by the database. What are the drawbacks to users who have queries that would be well served by results that fall just short of the criteria used by a database? Finally, how can databases (and biocurators) accommodate the needs of such more explorative use cases?     

Constrained Optimization of Average Arrival Time via a Probabilistic Approach to Transport Reliability

To achieve greater transit-time reduction and improvement in reliability of transport services, there is an increasing need to assist transport planners in understanding the value of punctuality; i.e. the potential improvements, not only to service quality and the consumer but also to the actual profitability of the service. In order for this to be achieved, it is important to understand the network-specific aspects that affect both the ability to decrease transit-time, and the associated cost-benefit of doing so. In this paper, we outline a framework for evaluating the effectiveness of proposed changes to average transit-time, so as to determine the optimal choice of average arrival time subject to desired punctuality levels whilst simultaneously minimizing operational costs. We model the service transit-time variability using a truncated probability density function, and simultaneously compare the trade-off between potential gains and increased service costs, for several commonly employed cost-benefit functions of general form. We formulate this problem as a constrained optimization problem to determine the optimal choice of average transit time, so as to increase the level of service punctuality, whilst simultaneously ensuring a minimum level of cost-benefit to the service operator.