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September 1991

Isoniazid Prophylaxis for Young Adults

Author Affiliations

New York, NY

Arch Intern Med. 1991;151(9):1884. doi:10.1001/archinte.1991.00400090150033

To the Editor. —  We applaud Colice's1 thoughtful analysis of whether or not young adults should take isoniazid chemoprophylaxis. An empirical study would require large subject groups and a long observation period, unlikely to be funded in today's economy, leaving decision analysis as the only tool for resolving the issue. Shortly after the decision tree analysis of Taylor et al,2 Beck and Pauker3 explicated the use of the Markov process for medical prognosis. We saw in it a perfect model for tuberculosis studies. It captured the essence of our clinical impression that the risk of isoniazid lasted but 1 year, but the benefit remained for one's lifetime.4 Tsevat et al,5 by using essentially the same Markov model, showed, however, that the major difference in these studies was the choice in probabilities of the occurrence of pertinent events.We believe that the benefit-risk ratio is even

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