Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
To the Editor: Mr
Lamm's1 excellent essay should be required reading for all
physicians, politicians, and especially citizens of any society in
which competition exists for monetary resources.
Society makes value judgments on a daily basis, weighing the cost to
the entire society vs the possible benefit to the individual for each
decision he or she makes. For example, lighting a mile of highway costs
money, both for the installation as well as the ongoing cost of
maintenance and electricity. Were the cost involved $1 per mile, it is
safe to assume that all roads would be lit. The actual cost is well in
excess of $1 million per mile so society has chosen to light some roads
but not others. An unlit roadway can produce serious health
consequences, yet we do not hear that all roads should have equal
access to highway lights.
Spitzer D. Marginal Medicine. JAMA. 1999;281(12):1082-1083. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-12-jbk0324