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August 1, 1986

STD Clinics and the Prevention of Sexually Transmitted Diseases

Author Affiliations

Sayville, NY

JAMA. 1986;256(5):592. doi:10.1001/jama.1986.03380050060013

To the Editor.—  I am grateful to Dr Cates1 for calling attention to my ideas.2,3Dr Cates says, "No data support the assertion that relatively small financial incentives may influence the vicissitudes of sexual decision making and/ or behavior." But he presents no data that refute what is, if nothing else, a sound economic presumption.Patients with venereal disease are not stupid. They know that condoms cost them money but treatment is free so therefore it's economically irrational to buy condoms, and they don't. If we establish economically irrational policies then we're irrational, too. No one should be surprised if they fail.Dr Cates says it's cheaper for the public to treat sexually transmitted diseases earlier than later. I'm sure he's right.But his argument can be made for every treatable illness or injury: breast cancer, for example, or diabetic retinopathy. People with serious conditions may eventually become