Priceless: On Knowing the Price of Everything and the Value of NothingBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7499.1091 (Published 05 May 2005) Cite this as: BMJ 2005;330:1091
- Stuart W G Derbyshire (DerbyshireSW@anes.upmc.edu), assistant professor
- University of Pittsburgh Medical Center, USA
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.
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 …