MASS MEDICATION

The term "mass medication" describes procedures used to deliver a preventive or therapeutic regimen to a population, rather than to individual members of that population. The implication is that the regimen is delivered unobtrusively. The members of the target population may not be aware that they are receiving the medication, and they have not given individual consent. Examples include the addition of vitamin and mineral supplements to infant formula, iodine to table salt, and fluoride to drinking water. When vitamin and mineral supplements are added to infant formula, the facts are provided on the label, although not everyone reads this; salt that has been enriched with iodine chloride is identified as "iodized salt"; and in most communities where sodium fluoride is added to reservoir water, information about this is kept in the public consciousness by antiflouridationists who make this a political issue. In theory, and usually in practice, individuals can exercise the option to avoid mass medication—they can use infant formula without vitamin and mineral supplements, table salt without added iodine, and drink unfluoridated water. The last of these may require some effort and expense for the individual, but it is feasible.

These situations differ from mass vaccination campaigns against a communicable disease, such as poliomyelitis, when the vaccine is offered to all members of a target population. The distinction is that members of the population usually volunteer to be vaccinated. Thus there are both ethical and political implications of mass medication. In a time when autonomy is the dominant political philosophy, the paternalist philosophy underlying mass medication is less acceptable than it was throughout the twentieth century. Public health authorities who seek to implement a mass medication program, therefore, are wise to do so only after adequate and careful consultation with representatives of the target population.

John M. Last

(see also: Community Water Fluoridation; Director of Health; Ethics of Public Health )