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Letter from Joshua Lederberg to Emilio Daddario

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  • Biology
  • Economics
  • Medicine

Abstract

February 27, 1913 (773 5 . cj c j\ Mr. Emilio Daddario 2524 Q Street, N.W. Washington, D.C. 20007 i* \ 07b Dear Hr. Daddario, I have in mind a more detailed discussion that I will send you in some few weeks about the problematics of a technology assessment of prenatal screening. Meantime, however, I thought I should send you some calculations tUt John O'Brien has made for the specific case of Tay-Sachs disease. You will see that he reaches a conclusion that population screening and selective abortion would be quite cost effective for the Jewish population, with a benefit cost ratio of 2.6 whereas it would not be for the population at large with a corresponding ratio of only .03. I should point out that this is a rather special case in which a deleterious gene is concentrated within a particular group and where a serum assay enables one to find the. rather infrequent carriers. You will see that a very large part of the total cost would be extended in the serum assays and that these are relatively unproductive except for the concentrated population group in this case the Ashkenaei Jews. One must also point out that the costs and benefits are calculated in strictly medical terms and that such intangibles as a) the non-monetary impact of the damaged child on the parents and the family aud b) the overall cultural consequences of medically encouraged abortion and the fntangible costs of that procedure are neither of them gone into. This, of course,, epitomiees the dilemma you will face many times in technology assessments, the extra-economic values. I have gone Into this rather superficially in another paper that I am enclosing on "Radiobiology and the Cost of Life". A recent paper by MB=han develops a basically similar line of argument rather further. I was very warm to the idea of an Intensive but low profile study of these questions. Conversely I was rather less enthusiastic when Larry Horowitz from Senator Kennedy's staff called me yes

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