Short abstract
Frank Ackerman, Lisa Heinzerling
Priceless poses an important question—how should we value the things that we cherish, such as the environment and human life, and assess risks to them? The authors reject the proposition that cost-benefit analysis can be used to assign monetary value to the environment and health because the outcomes are often antithetical to human decency. Such analysis, for example, leads to the conclusion that toxic waste should preferably be dumped on to the developing world. After all, life is already short in the developing world, and the presence of low wages and poor productivity means that the dumping will be inexpensive in both action and consequence.
Figure 1.
The New Press, £17.95/$25.95/$C39.95, pp 277 ISBN 1 56584 850 0 http://www.thenewpress.com/books/priceless.htm
Rating: ★★
Another example of cost-benefit analysis gone awry is the use of Quality Adjusted Life Years (QALYs) to rank health care. QALYs provide a numerical measure of health over time and, as more good health is desirable, the effort to provide the most QALYs at the least cost appears sensible. When the state of Oregon, however, tried to rationalise its healthcare system using QALYs they ranked treatment for thumb sucking and dental problems ahead of that for ectopic pregnancy, cystic fibrosis, and AIDS. Using QALYs also devalued the lives of elderly people (who have fewer QALYs to live) and disabled people (who have reduced QALYs). Furthermore, there is the problem of assigning comparative numerical values to different diseases. Rank values have been assigned to diseases by asking people bizarre questions such as how much they would be willing to pay to avoid a year of bladder cancer versus a year of bronchitis. It is easy to agree with the authors that these are not the sorts of questions likely to provide for good health care.
Although Priceless poses an important question, there are serious problems with the proposed solution. Certainly it is ridiculous to ask people what they might pay to avoid a cancer bearing toxin, for example, and then assume that a company can “pay” an amount to disperse that toxin. At the same time, however, it is equally ridiculous to believe that society can function with only positive consequences. People want to be able to travel, communicate, use consumer goods, and have the comfort of running water, electricity, and gas appliances, to name just a few elements of modern existence. A grown up society accepts that these things will inevitably go wrong sometimes and that injuries, even severely destructive and fatal ones, are bound to happen. Equally it is understood that all risks, including life threatening ones, cannot be avoided. This is not to accept passivity in the face of danger but to demand realism as to what steps can and should be taken.
It is here that Priceless badly fails the reader. In Priceless the “company” is always the bad guy. I liked this theme in the Alien movies but in an academic work it is problematic. The belief, favoured by Priceless, that the company will always take the cheap and dirty option is just as biased as the belief, favoured by right wing economic groups, that the company can do no wrong. Sometimes a company will ignore a risk it really ought to tackle but sometimes the risk is really much too small and indeterminate to be worth the cost of pursuing. When it comes to carcinogens and toxins, for example, Priceless assumes that there is no safe threshold. This is, of course, untrue as many things that can be toxic in large doses (salt, sugar, and even water) are harmless or beneficial in low doses.
Priceless urges “precaution in the face of scientific uncertainty,” but the authors needed to attack this idea with the same zeal as they attacked cost-benefit analysis. If they had done so they would have noticed that everything new carries uncertainty and that abiding by the precautionary principle can have negative consequences. For example, Priceless argues that the decision to ban the pesticide DDT because of the uncertain effects of DDT accumulation in fat tissue was a good one, but the book fails to acknowledge even that DDT had helped to successfully control malaria in large parts of the world. The uncertain threat of DDT trumped the certain threat of malaria with fatal consequences for vast numbers of people.
The banning of DDT is considered a good idea by the authors, not just because of the uncertain health effects of DDT, but also because the perception of risk itself is bad for people's health. The authors state, “Certain kinds of risk not only frighten people, they also make people severely anxious, depressed, distrustful, and angry.” The authors fail, however, to consider people getting so angry and depressed about risks because their fears are inflated by books like Priceless that have a jaded view of modern society. Instead of being reassuring, approaches based on precaution, which assume everything to be dangerous unless proven otherwise, encourage needless anxiety and introspection and promote unnecessary, unfounded and unshakable bitterness and cynicism. Rather than taking society forward, such bitterness and cynicism throws society into reverse gear, where, ironically, we are likely to miss real dangers and forgo real opportunities to tackle them.