- The Washington Times - Saturday, April 21, 2001

What price safety? John Graham knows. At least, he has devoted a good deal of his professional life as founder and director of the Harvard Center for Risk Analysis to devising a measure of the costs and benefits of social choices.
His measure is the QALY, an acronym (say "kwally") for "quality-adjusted life year."
The idea is first to add up all the additional years of life that result from adopting a policy annual mammograms, say, or drivers-side air bags.
But longer life expectancy, though important, is not the whole story.
Surgery that frees you from chronic pain, or allows you to walk again, is valuable to you even if it does nothing directly to prolong your life.
Patients, or community members, are asked to rate their quality of life on a scale from 0 (dead, or close to it) to 1 (perfect health). The average rating times the number of extra years is the number of QALYs.
Mr. Grahams hypothetical example, from the centers newsletter "Risk in Perspective," is a hypothetical patient with coronary disease, who without surgery would live for 10 years at an average quality weight of 0.6. If surgery raises life expectancy to 15 years, and the average quality of life to 0.8, then the surgery contributes 6 QALYs (0.8 x 15-0.6 x 10).
Whatever the limitations of this measure, it does allow comparisons of very dissimilar policies. The centers research focuses on medical technology, motor vehicles, environmental science and food safety.
On airbags, where Mr. Grahams work has been very influential, his chart of "cost-effectiveness for selected life-saving measures" (expressed in 1995 dollars) shows that drivers-side airbags, compared with manual seat belts, cost $24,000 per QALY. Passenger-side airbags, compared with drivers side only, cost $61,000 per QALY.
Thats not per life, remember; its per year of extra life.
Medical comparisons are even more striking.
The cost per QALY for a pap smear every four years for women 20-75, compared with no screening at all, is $16,000. But the cost per QALY to go to annual pap smears from every other year is $1,600,000.
For breast cancer, the cost per QALY for annual mammography for women 55-65 is $150,000; for women 40-50, its $240,000.
Again, thats per year of extra life.
I had breast cancer, found on an annual mammogram; obviously, I think it was worth doing. And even if I had to pay for the exams myself, I wouldnt mind at all if they came up negative every time.
But the choices that individuals would make for themselves are not necessarily the best choices for the society as a whole at least, not as long as the resources available are finite, which is going to be forever.
"When lives are at stake," Mr. Graham wrote, "we believe it is particularly important to expend resources wisely. To do otherwise is to engage in what we call 'statistical murder a phrase meant (with provocative intent) to protect the interests of anonymous people whose lives are lost when cost-effectiveness is ignored."
Why look at Mr. Grahams work now? Because President Bush has nominated him to head the Office of Information and Regulatory Affairs, in the Office of Management and Budget, possibly the best spot in the whole of the federal government for injecting some sanity in rule-writing run amok.
He wont be able to do everything; the Environmental Protection Agency, for example, takes no account of costs and benefits when it makes its rules, a practice upheld by the Supreme Court. But a full and fair disclosure of what the true costs and benefits are something the EPA has not been known for in recent years would at least ensure an informed public debate. If the debate got noisy enough, perhaps even Congress would be moved to require regulatory agencies to take cost-benefit analysis into account before imposing new rules.
Some people find the vary idea of putting a dollar value on life, or rating its quality, distasteful. Theyre the ones who intone piously "If it saves just one life its worth it," about whatever their issue of the day may be. But piety is not argument.
We will experience the consequences of our policy choices whether or not we try to determine ahead of time what the consequences are. Passenger-side airbags do kill children and small adults, contrary to expectations, and making them mandatory before the risks were fully known caused many unnecessary deaths.
Washington should know the price of safety before demanding Americans pay it.


Linda Seebach is a nationally syndicated columnist.

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