In Paul's class, we had learned how failures of imagination undermined global efforts to respond to AIDS, tuberculosis, cancer, and other modern plagues.
When dealing with the health problems of the poor, public health policymakers often adhere so strictly to the doctrine of "cost - effectiveness" - a valuable tool for setting priorities, but just one tool among many - that responses to the big challenges in global health are anemic.
Only inexpensive medical care is deemed appropriate for settings of poverty. Paul has a pithy expression for this perverse outcome: "cheap shit for the poor." (He left that one out during class.)
When used in a vacuum, cost - effectiveness analysis at times produces incorrect and unethical claims. To cite just one example, a 2002 study concluded that in Africa it is 28 times more cost - effective to prevent new HIV infections than to treat people who already have AIDS.
The authors thus effectively recommended letting 25 million people - all those living with AIDS in Africa at the time - die because they thought it would be too expensive to save them. How could well - meaning people make such a monstrous (and ill-founded) suggestion?
Is anyone authorized to wield instruments like cost - effectiveness analysis with such certainty when so many human lives are at stake?- Jonathan Weigel