The hard truth which Dr. Sanghavi's argument fails to confront is that, egregious as it may sound, we must place a dollar value on life if we are to have any hope of functioning rationally. As people we make economic trade-offs every day, all of them involving our well-being. Consider driving time work: our speed is a fairly good measure of our risk of bodily harm, and theoretically, if we drove 25 the entire way, we'd be a lot safer. Instead, we weigh the options and determine that getting to the office in 15, rather than 50, minutes is worth the added danger. Clearly, we don't think our lives have infinite value or we'd be inclined to take no risks at all. And it appears the government (the same one paying out $50,000 per QALY for dialysis) agrees -- they're well aware of the hazards of speed, and yet Interstate Highways, some allowing travel at up to 80mph continue, continue to expand. Perhaps Dr. Sanghavi would argue this is simply irresponsible on the part our leaders, though with the absence of public outcry, one assumes he would be in rare company. In a perfect world, we could spend an infinite sum of money to prolong and enrich every life, but sadly, no such world exists.

I am new here and fear I have little to offer as I deal with HIV/AIDS in the US.

Public Health is about PREVENTION. However we can get the message out in a culturally appropriate way must be done,using the people and cultural resources of the country we hope to reach. Hopefully the monies given by a 'high income country'' will not be hindered by the ideology and prejudices of that country.

If pigs had wings...

clwood, ph/anthropology