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Mr. Emilio Daddario AY
2524 Q Street, N.W. tr. OT
Washington, D.C. 20007

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Dear Mr. Daddario,

I have in mind a more detailed discussion that I will send you
in some few weeks about the problematics of a technology assessment
of prenatal screening. Meantime, however, I thought I should send you
some calculations tkkt John O'Brien has made for the specific case of
Tay-Sachs disease. You will see that he reaches a conclusion that
population screening and selective abortion would be quite cost effective
for the Jewish population, with a benefit cost ratio of 2.6 whereas it
would not be for the population at large with a corresponding ratio of
only .03.

I should point out that this is a rather special case in which a
deleterious gene ig concentrated within a particular group and where a
serum assay enables one to find the rather infrequent carriers. You will
see that a very large part of the total cost would be extended in the
serum assays and that these are relatively unproductive except for the
concentrated population group in this case the Ashkenazi Jews. One must
also point out that the costs and benefits are calculated in strictly
medical terms and that such intangibles as a) the non-monetary impact
of the damaged child on the parents and the family and b) the overall
cultural consequences of medically encouraged abortion and the intangible
costs of that procedure are neither of them gone into. This, of course,:
epitomizes the dilemma you will face many times in technology assessments,
the extra-economic values. I have gone into this rather superficially
in another paper that I am enclosing on "Radiobiology and the Cost of Life".
A recent paper by Mixhan develops a basically similar line of argument
rather further.

Se I was very warm to the idea of an intensive but low profile study

of these questions. Conversely I was rather less enthusiastic when Larry
Horowitz from Senator Kennedy's staff called ne yesterday to ask for public
testimony in connection with the Senator's current hearings on the abuses

of human subjects in medical experimentation. I am certainly not going to
defend some of the cruelties that have been promulgated in the name of

(bad) medicine but these hearings hardly promise to offer the most conducive
background for longer range considerations of biosocial policy nor of the
defense against the administration's attack on the budgeting for research
which is one of our most immediate survival issues.

over

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Mr. E. Daddario -~2~ 2/27/73

I will be in touch with you further. Meantime, if I could
have some psychological reinforcement from you giving some more
detail about what you might look for from me and how you might wish
me to bring in the colleagues whose names I mentioned to you

(O'Brien, Motulsky, Marge Shaw) I might be assured that I am heading
on the right track.

You probably are aware that Dr.Barton Childs, of Johns Hopkins,
is chairing an Academy committee on genetic screening. While I understand
that its major emphasis at present is intended to be on post-natal
screening for situations likePKU I suspect it would not be difficult to
get Barton to broaden his emphasis with some minimal encouragement from
you or from me. Let me know your pleasure about trying to pursue that.

Sincerely yours,

Joshua Lederberg
Professor of Genetics

JL/rr
Enclosure