ARV Treatment: Special Focus
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As an economist, I agree absolutely that the ethics should push the numbers. The fundamental objective of the branch of economics known as "public economics" is to "maximize social welfare". Surely that is an ethically admirable objective. The problems arise because in a world of limited resources, trade-offs inevitably arise. As an economist, when I look at a problem of allocating scarce resources I always hope I can find a way to show that there are no trade-offs. If I can find a so-called "win-win" solution, then everybody is better off and the problem of scarce resources does not bind so tightly. There are some areas of AIDS policy where such win-win solutions seem possible. For example, there is some suggestive work that seems to show that an affordable program of community-based home care for AIDS patients actually enhances prevention efforts in the village in which it is launched. So in this case instead of there being a trade-off between AIDS prevention and AIDS treatment, there is actually a synergy between them. Also, within prevention programs, there is some work that shows that efforts to change the behavior of high-risk groups benefit from more broadly aimed communication efforts. These win-win examples need to be documented, for they are exciting and promising areas where government expenditure may be particularly justified. However, the laws of physics and human behavior being what they are, the win-win examples are rare and we must typically work in the more mundane and frustrating world in which doing more of one thing means doing less of another. We economists believe that we are serving the common good in elucidating these trade-offs so that policy-makers understand the costs they incur when they choose one policy rather than another. We really don't enjoy "counting beans" for its own sake! We share with professionals in the health sciences the hope that we will be understood as serving ethical objectives. You perhaps know the story about the woman who is diagnosed with a fatal disease and told that she has only six months left to live. She says: "Oh, Doctor, that's terrible. Please give me some advice on what to do next." He responds: "I suggest that you move to North Dakota and marry an economist." "But doctor, how will that help my disease?" "Oh it won't help your disease, but it will make six months seem like an eternity." For the non-economists in this discussion group, the last few weeks may have seemed like an eternity. But thanks for participating and sharing your experiences and your views. Mead Over |
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