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A Quantitative Methodology for Determining the Need for Exposure-Prompted Medical Monitoring

44 Pages Posted: 7 Oct 2003  

Christopher P. Guzelian

Thomas Jefferson School of Law

Bruce E. Hillner

Virginia Commonwealth University (VCU) - School of Medicine

Philip S. Guzelian

University of Colorado at Denver - Health Sciences Center

Abstract

Some toxic exposures to drugs or other environmental chemicals may create an increased risk of future disease for which periodic preventive medical screening might be desirable. However, many of these risks, even if unacceptable as a matter of public health policy, might still not be significant enough for medical monitoring (periodic diagnostic screening for latent illnesses or medical conditions) to be an appropriate medical intervention. This somewhat unintuitive, but statistically certain conclusion can be demonstrated in relatively simple mathematical terms. Accordingly, we introduce Bayes's Rule and decision analysis, a quantitative methodology commonly employed by medical practitioners. A review of current medical practices indicates that physicians decide whether to recommend monitoring for a particular exposed population by knowing the natural history of the disease and by first calculating the predictive value of a positive test (PPV), which will be one to five percent or greater for an endorsable monitoring exercise, absent exceptional circumstances. Rather than simply relying on the opinions of retained medical experts, this accessible quantitative method permits judges, jurists, and policymakers to more confidently and objectively decide whether medical monitoring is appropriate and necessary as a result of a specific chemical exposure.

Keywords: medical monitoring, Bayes's Rule, decision analysis, positive predictive value, medical screening, toxic torts,

JEL Classification: C0, I1, K0, K3

Suggested Citation

Guzelian, Christopher P. and Hillner, Bruce E. and Guzelian, Philip S., A Quantitative Methodology for Determining the Need for Exposure-Prompted Medical Monitoring. Indiana Law Journal, Vol. 79, No. 57, December 2003. Available at SSRN: https://ssrn.com/abstract=439220 or http://dx.doi.org/10.2139/ssrn.439220

Christopher P. Guzelian (Contact Author)

Thomas Jefferson School of Law ( email )

1155 Island Ave
San Diego, CA 92101
United States
619-961-4248 (Phone)

Bruce E. Hillner

Virginia Commonwealth University (VCU) - School of Medicine ( email )

1101 E. Marshall Street
Richmond, VA 23298-0565
United States
804-828-5129 (Phone)
804-828-3741 (Fax)

Philip S. Guzelian

University of Colorado at Denver - Health Sciences Center ( email )

4200 E. Ninth Avenue
Denver, CO 80262
United States
(303) 315-3501 (Phone)
(303) 315-7180 (Fax)

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