A risk that kills thousands of Americans every year surely seems like something the government should regulate. But what if that risk also comes with a benefit, providing people with a service that improves their lives?
Take the case of cellphones and driving. Drivers using cellphones cause 2,600 deaths and 330,000 injuries in the United States a year, according to our estimates. But Americans are deeply attached to their cellphones and are willing to spend billions of dollars for the convenience and business and social contact that cellphones provide when they are driving. A ban would save lives but deprive people of a benefit they badly want.
The decision is not as obvious as it seems. If you were in charge, what would you do?
In recent years, the Clinton and Bush administrations have put more of these decisions to the test of risk analysis, a decades-old process that attempts to consider comprehensively the complexities inherent in risk. This means studying the nature of the hazard, where we're exposed to it, how much of it we're exposed to and the severity of the consequences (death or something less) -- as well as the benefits and costs of various risk-reduction strategies. Risk analysts try to weigh all these factors, determining how many lives would be saved and how much health would be protected, at what cost, for each given strategy.
After all, money and time are limited, even when it comes to saving lives. And a million dollars spent protecting against one risk might save more lives if spent protecting against another.
Here's a simple example of how risk analysis can work. Some women who get Pap smears are told that their results are uncertain and that they should get follow-up tests every year. Totaled across all the women tested, annual follow-ups cost about $800,000 per year of life saved, according to our analysis. On the other hand, if those women got follow-up tests every two years, the reduction in cervical cancer rates would be almost the same -- while the cost per year of life saved would decline to about $200,000. That means that the healthcare system would save tens of millions of dollars per year that could be used to screen more women or to provide other health benefits.
The implications of risk analysis to policymakers are obvious. Yet to its critics, it is profanity. They say quantifying the value of human lives in dollar terms is an unacceptably cold and mechanistic metric for decision making, that it forces us to decide whether some lives are worth more or less and whether there is, in fact, a limit to what society should spend to reduce fatality risks.
