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Matthew M. Davis, MD; John D. Lantos, MD

JAMA. 2000;284:85-87.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Standards for evaluating clinical innovations are very different from standards for evaluating policy innovations. In the case of the former, the research community appropriately insists on exquisite attention to fair participant selection, a favorable risk-benefit ratio of the intervention, informed consent, and respect for enrolled subjects.¹ Conversely, innovations in public policy are initiated by legislative action or agency dictate; evaluation (if it occurs) is often retrospective and conducted without the oversight of an institutional review board (IRB) or without informed consent. In this issue of THE JOURNAL, Kerpelman et al² describe an admittedly controversial program that used the threat of sanctions of welfare benefits to encourage compliance with early childhood immunizations. Their evaluation highlights some of the ethical problems involved in policy evaluations.

In 1993, the state of Georgia began to require that all families receiving Aid to Families with Dependent Children . . . [Full Text of this Article]

Author Affiliations: Departments of Pediatrics (Drs Davis and Lantos) and Medicine (Drs Lantos and Davis), Robert Wood Johnson Clinical Scholars Program (Drs Davis and Lantos) and McLean Center for Clinical Medical Ethics (Dr Lantos), University of Chicago, Chicago, Ill. Dr Davis is now with the Division of Pediatrics at the University of Michigan Medical Center, Ann Arbor.

RELATED LETTER

Effects and Ethics of Sanctions on Childhood Immunization Rates
Cynthia S. Minkovitz, Bernard Guyer, Malcolm Maclure, Bruce Carleton, Sebastian Schneeweiss, Larry C. Kerpelman, David B. Connell, and Matthew M. Davis
JAMA. 2000;284(16):2056-2057.
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Effect of a Monetary Sanction on Immunization Rates of Recipients of Aid to Families With Dependent Children
Larry C. Kerpelman, David B. Connell, and Walter J. Gunn
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Ethics and Immunization Policy: Promoting Dialogue to Sustain Consensus
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Pediatrics 2001;107:1158-1164.
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JAMA 2000;284:2056-2057.
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