A pound of prevention barely worth an ounce of cure

Michael F. Cannon has a blog post at Cato.org about preventive medicine.

While I've always thought that prevention of disease would be less costly than treatment, that is only true, when we stop to ponder it, when the total cost per person treated with some preventive measure is less than the savings in cure costs. That means that the total cost per person treated or per preventive measure would have to be lower than the difference between the cure expenditure with and without prevention. Furthermore, those costs have three categories: direct costs, indirect costs, and abstract costs.

You there at the back! Please don't yawn unless you've got enough for the rest of us.

Where was I? Oh, yes. The direct costs are the costs of shots, educational materials, and so on.

The indirect costs include the time off work going to get some preventive treatment, the loss of efficiency when some supposed safety control is implemented, and the added bureaucratic sludge that happens whenever we try to prevent something bad by changing the behavior of everyone.

Abstract costs include the loss of freedom for the individuals who are given the prevention.

Nestled invisibly between the indirect and abstract costs of preventative medicine is what it does to people's opinion. Much of preventative medicine consists of "raising awareness" of the problem, so that people can avoid stepping into open pits and so forth.

But if told too many times about an open pit, or a hot stove, or dangerous intersection, people will be filled with thoughts only of safety and precaution, aftraid to risk opening their eyes lest ultraviolet radiation damage their unprotected corneas. They exist only to be safe.

Alternatively, the more preventive measures we implement, the more jaded the people become and the more difficult it becomes to raise their awareness to a preventive level.

But the key problem is that for prevention to work, the pool of those treated with the preventive measure must be larger than the number cured, in many cases far larger. Taken together, and since prevention must be applied to the wider pool while remediation only to those affected, the cost of the prevention must be very low, and its effectiveness very high, for prevention to make sense.

Depending on the depth of the pit and the type of snakes at the bottom, it may be more cost-effective and indeed more humane to wait for someone to step into the pit and throw them a rope. Put a sign on the pit perhaps, but don't develop a slick ad campaign to tell people to avoid the pit, which will likely draw more people to it anyway.

This all yields the best quote ever on socialized medicine:

The point of the medical-care system is to serve people. It is not the point of people to serve the medical-care system.
-- Louise B. Russell

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War and Peace

The history of mankind is the history of war and waiting for war. Peacetime is a kind of stalemate, in which the cost of war is judged by all sides to be greater than the fruits of victory, or at least, greater than the cost of peace.

The search for new weapons and destructive power in warfare is the search for leverage. Leverage is the ability to exert a small amount of effort to command a large amount of force. The history of war is the history of learning to use leverage.

In The Balance Sheet, we saw a hierarchy of values, ranging from our ideals at the top, then our civilian lives and on down to enemy military lives and enemy ideals at the bottom. Depending on the situation, we might spend or compromise massive amounts of items lower on the list to preserve or obtain things at the top.

In case it isn't clear, the notion that we can't put a value on human life holds true only because we value the things ranked below it so much less than we value it. We can, however, engage in cold calculation when we weigh the cost in lives of our decisions against the return in lives saved, or ideals defended, or the return of something of greater value to us than the lives we anticipate losing.

The calculus of war is a kind of vector equation, in which that range of values interacts with a set of risks. In a given situation, we calculate the risk that we will be forced to lose too much of a higher-value item than we will likely gain in other items. More generally, we have

War =

(Risk to ideals)*(Value of ideals)*(Quantity of ideals) +
(Risk of civilian loss)*(Value of a civilian loss)*(Quantity of civilian losses) +
Risk*Value*Quantity{Our Territory
Ally Ideals
Ally Civilian Lives
Ally Territory
Neutral Civilian Lives
Enemy Territory
Ally Military Lives
Enemy Civilian Lives
Our Military Lives
Neutral Territory
Our Money
Our Resources
Ally Money
Ally Resources
Neutral Ideals
Neutral Military Lives
Neutral Money
Neutral Resources
Enemy Resources
Enemy Money} +
(Risk of killing enemy)*(Value of enemy soldier)*(Quantity of enemy losses) +
(Risk of civilian loss)*(Value of enemy ideal losses)*(Quantity of enemy ideals)

While many military thinkers have considered the goal of war to be ending the enemy's ability to enforce his will, that maxim has shown weakness as the cost to acquire leverage has fallen. In particular, the cost of leverage has gotten so low that we now face an enemy whose values place all of the terms in the above equation except his own values at zero. When we can't convince the enemy that his cost for imposing his will is too high, our end goal must be to utterly discredit the enemy's ideals that conflict with our own.

When a new technology comes on the scene, people are quick to exploit it for military advantage. A tiny change in weaponry, or a change in the availability of weaponry or training in the use of weaponry, can have a large impact on the conduct of war.

The tactics and armor needed to fight an enemy armed only with swords, spears, and bows are dramatically different than those needed against one armed with crossbows. The canon reduced mighty castles and fortresses to so much rubble. The musket altered tactics again, as did in turn the rifle, the repeating rifle, and barbed wire. But each of these technologies depended on advances in manufacturing technique and technology for non-military purposes.

Technology changes the calculus of war by changing the relative risks. When access to information is as easy as it is today, coordination of resistance and the ability to impose some amount of will is in reach of very small operators. Leverage is higher than ever before, and increasing with no end in sight.

History happens

Technology is not the only reason war becomes an option. Governments grow and change, tyrants come and go, reformers reform and burn out, and the people endure it all. Sometimes the government of some state or another will decide it needs to grow more than its territory will allow. When the desire for territory exceeds the value of the costs associated with taking it, we have war.

Sometimes a government will become so corrupt or incompetent that it fails. The resultant 'power vacuum' makes the decision to attack that territory easier, because it lowers the risk involved.

History waits for a technology, people, resources and tactics to come together. When the dreaded combination presents a lower risk to achieve a goal by military force, peace is soon only a sweet memory.

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Embryonic Stem Cell Research

Embryonic stem cell research presents an easy expected value problem. An expected value problem is one for which two or more values or outcomes are weighed, when each has a likelihood of occurring. Expected value problems are solved by converting all variables to the same unit of measurement and multiplying each outcome by its likelihood.

Comparing only like terms, we have:

Decision = Prob(life-threatening diseases cured)(number of cured people) - (1)(number of embryo lives destroyed in research)

... where Prob(X) represents the likelihood of X occurring, on a scale from 0 to 1.

So we're being asked to balance the hypothetical cure against the definite death. Roll the dice that some person could be cured by taking the life of another, without that other's consent.

The doctor is correct. When the probability of a cure for some life-threatening disease gets high enough, the number of lives saved will outweigh, in a grisly fashion, the number of lives destroyed to save them.

I ignore the easy straw man argument, that embryonic stem cells have the "potential" to keep aging actresses on screen longer and prolong the careers of aging athletes. But what of old age generally? What if embryonic stem cells hold the fountain of youth?

It's the same expected value. To do the research to find out whether such is possible, human beings have to die.

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