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222  Cost-Analysis of Genetic Disease from Radiation:

                $100 per man-rad

           (present value of its future costs)

    For purposes of discussion the radiation background is taken to be
0.1 rad per year.  This is consensually estimated to account for 10%
of our load of mutational damage.  Since there is general agreement
that the genetic effects of radiation outweigh all the others, this
may give a convenient if somewhat oversimplified yard-stick for a cost
benefit analysis.

     We will say then that doubling the background  would increase the
rate of mutation by about 10%.  There are only minor quarrels about
the extent to which mutational damage might be increased at very low
dose rates and there are radiation with other pollutants.

     To estimate the health cost of that increase in mutation rate 
requires a judgement of.

     1. the economic cost of imperfect health.
     2. the fraction of this attributable to genetic defect.
     3. the relationship of increased mutation rate to prevalance of
genetic impairment.

     1. Assume that the total burden of ill health costs (the U.S.)
about $200 billion today.  Direct health care alone approaches $80
billion.  The extrapolation from 80 to 200 is a crude intuition based
on the following consideration:

     a) Hardly anyone, even if he invests five times the mean value,
believes he is getting a bad bargain in expenditures to protect
himself.

     b) Large segments of the population now receive acknowledgedly
poor standards of health care.
    
     c) Health care is a small fraction of the economic burden of 
marginal health.  The figure of $200 billion is intended to estimate the
difference between our existing national productivity and what would
obtain if every individual enjoyed the highest credible level of
robust good health.  Most of the real cost of health impairment probably
derives from the reduced efficiency of people who are  nominally 
"healthy" but are, in fact, significantly impaired.  Part of the
enormous costs of social and political  conflict that may be connected
with deviations in physical and mental health might be added to this
estimate.

     2. The considerable heritable component of many common diseases,
taken together with the strong and clear genetic component of many
other handicaps, suggests that as much as 50% of our health burden can
be attributed to genetic difficulties.  This assumption states that,
of the entire population enjoyed an optimal genotype, including factors
that bear on cardiovascular disease , diabetes, cancer, and mental
disease, our health bill would be reduced by at least half.

     3. For sake of argument I will postulate a direct linear 
relationship between the mutation rate and the prevalence of genetic
defect.  This states that after a period of several generations to
reach equilibrium a doubling of the mutation rate would result in a
doubling of the genetic load.

     We can then make a simple calculation.  At 10% increase in mutation
rate would eventually give rise to an increase in health cost of
10%, times $200 billion (total health cost), times 1/2 (the genetic
component of disease).  This product (0.1 x 200B x 0.5) comes to $10 billion
per annum.  With a population of about 200 million people this works
out to an increase in annual health cost of $50 per person for an in-
crease in radiation exposure of 0.1 rad per annum.  We thus come to
$500 per man-rad as the eventual cost of radiation exposure.

     However, most of this bill is deferred for future payment, since
many genetic defects are in recessive mutant genes.  These are latent
until reshuffled in the population so that a child receives one from
each of his two parents.  The time course of expression of new
mutations is an extremely complicated calculation.  Most authors have
assumed an interval of 5 to 10 generations for most of that payment to
be imposed.

     Should we do a formal discount analysis of such a future cost?

     At a 6% discount rate a cost of $500 one hundred years hence
would have a present value of only $1.47.  On the other hand, the 
economic cost of health (and intellectual) impairment will also be
increasing with time at a rate that must also be discounted.  Further-
more, a fair portion of the cost will be expressed in earlier 
generations as dominant and semi-dominant effects and chromosome 
aberration.

     Having exposed these assumptions I will put 1/5 of $500, or $100
per man-rad, as a reasonable estimate of the present value of future 
genetic costs of radiation.

     These costs can surely be mitigated by compensatory research in
radiation biology and in fundamental genetics, but only if it is 
adequately funded and vigorously pursued.  A possible policy approach to
this question would be to tax the use of nuclear energy for the benefit
of such compensatory research, and for the care of more proximate
victims, to the extent that the costs of side-effect exposure to
radiation can be estimated.  This suggestion is not to exculpate 
pollution stemming from fossil fuels from a similar redress.

     The estimation of the cost of ill health is extremely precarious
since so much of it involves values that are beyond conventional
economic analysis and are outside the customary marketplace.  "The
value of a life" cannot be taken merely as the present value of his
future earnings if for no other reason than that a considerable part
of those earnings are applied to the consumption of resources and
other products.  The same consideration applies to the expected tax
yield from an individual's economic activity.  The attempt to do a
cost benefit analysis of human life resembles a similar attempt to
analyze the values of government and of society, and is indeed 
inextricably connected with these issues.  One can ask "what would a
reasonable person pay for an incremental improvement in his own
health, if this could be purchased on the market place".  This answer
would necessarily be a function of his general economic situation
but we might then also attempt to make some predictions of the future
distribution of economic wealth.  This approach would give at least a
minimum estimate of the economic value of health.  It is minimal in so
far as so many aspects of good health are beyond purchase or appear to
be in the present technical and social context.

     We would then also have to consider the relationship between the
social and the individual valuation of this price.

     From a technical standpoint the most contentious postulate may be
the one assumed in paragraph 3.  The mutation rate surely does not 
account for the entire genetic load.  There may be no single optimal
genotype, in the sense that robust health in one arena may be unavoid-
ably associated with deficits in another.  Furthermore, many genetic 
defects undoubtedly are a result of segregation from heterozygotes
which have more robust genotypes but will inevitably produce progeny
with a range of biological competence.  On the other hand, the cost of
mutation may be expected to increase as we apply medical care towards
the partial amelioration of genetic defect and, for example, countermand
the natural selection that helps to keep mutants in balance in the
population.  (There is then a certain cost associated with the practice
of medicine along the same lines as the present analysis of
mutation.)  The question of the relative importance of mutation and
segregation from common polymorphisms is heatedly contested among
geneticists today.

     These considerations may suggest that the figure of $100 per
man-rad is inflated.  On the other hand, it totally ignores the non-
genetic damage imposed by radiation whose present value may be 
comparable.  All these considerations taken together, the proper value
(which is partly a question of definition, partly a question of
uncertain scientific fact) probably will be agreed to lie between $10
and $500 per man-rad.
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