"Better the devil you know": Are stated preferences over health and happiness determined by how healthy and happy people are?

Most people want to be both happy and healthy. But which matters most when there is a trade-off between them? This paper addresses this question by asking 4000 members of the UK and US public to make various choices between being happy or being physically healthy. The results suggest that these trade-offs are determined in substantial part by the respondent's own levels of happiness and health, with unhappy people more likely to choose unhappy lives and unhealthy people more likely to choose unhealthy ones: "better the devil you know, than the devil you don't". Age also plays an important role; older people are more likely to choose being healthy over being happy. Information about adaptation to physical health conditions matters too, but less so than respondent characteristics. These results further our understanding of public preferences with important implications for policymakers concerned with satisfying those preferences.

Fair innings? The utilitarian and prioritarian value of risk reduction over a whole lifetime.

The social value of risk reduction (SVRR) is the marginal social value of reducing an individual's fatality risk, as measured by some social welfare function (SWF). This Article investigates SVRR, using a lifetime utility model in which individuals are differentiated by age, lifetime income profile, and lifetime risk profile. We consider both the utilitarian SWF and a "prioritarian" SWF, which applies a strictly increasing and strictly concave transformation to individual utility. We show that the prioritarian SVRR provides a rigorous basis in economic theory for the "fair innings" concept, proposed in the public health literature: as between an older individual and a similarly situated younger individual (one with the same income and risk profile), a risk reduction for the younger individual is accorded greater social weight even if the gains to expected lifetime utility are equal. The comparative statics of prioritarian and utilitarian SVRRs with respect to age, and to (past, present, and future) income and baseline survival probability, are significantly different from the conventional value per statistical life (VSL). Our empirical simulation based upon the U.S. population survival curve and income distribution shows that prioritarian SVRRs with a moderate degree of concavity in the transformation function conform to widely held views regarding lifesaving policies: the young should take priority but income should make no difference.

Quality adjusted life years based on health and consumption: A summary wellbeing measure for cross-sectoral economic evaluation.

We introduce a summary wellbeing measure for economic evaluation of cross-sectoral public policies with impacts on health and living standards. We show how to calculate period-specific and lifetime wellbeing using quality-adjusted life years based on widely available data on health-related quality of life and consumption and normative assumptions about three parameters-minimal consumption, standard consumption, and the elasticity of the marginal value of consumption. We also illustrate how these three parameters can be tailored to the decision-making context and varied in sensitivity analysis to provide information about the implications of alternative value judgments. As well as providing a general measure for cost-effectiveness analysis and cost-benefit analysis in terms of wellbeing, this approach also facilitates distributional analysis in terms of how many good years different population subgroups can expect to live under different policy scenarios.

The social value of mortality risk reduction: VSL versus the social welfare function approach.

We examine how different welfarist frameworks evaluate the social value of mortality risk reduction. These frameworks include classical, distributively unweighted cost-benefit analysis--i.e., the "value per statistical life" (VSL) approach-and various social welfare functions (SWFs). The SWFs are either utilitarian or prioritarian, applied to policy choice under risk in either an "ex post" or "ex ante" manner. We examine the conditions on individual utility and on the SWF under which these frameworks display sensitivity to wealth and to baseline risk. Moreover, we discuss whether these frameworks satisfy related properties that have received some attention in the literature, namely equal value of risk reduction, preference for risk equity, and catastrophe aversion. We show that the particular manner in which VSL ranks risk-reduction measures is not necessarily shared by other welfarist frameworks.

Gastrointestinal sarcoidosis. A review.

BACKGROUND AND AIMS: Sarcoidosis is a multisystem granulomatous disorder. The gastrointestinal system is not commonly involved and is frequently asymptomatic. It can be associated with significant morbidity and indeed mortality. The aim of this article is to review the common and rare gastrointestinal and hepatobiliary manifestations of sarcoidosis. METHODS: All literature on gastrointestinal sarcoidosis was found using a computerized Pubmed search from 1966 to January 2006. The keywords used were 'Gastrointestinal', 'Hepatobiliary', and 'Sarcoidosis'. RESULTS: The article reviews each 'section' of the gastrointestinal and hepatobiliary tracts in turn, discusses difficulties in achieving a diagnosis, differential diagnoses and treatment options. CONCLUSIONS: This review highlights the difficulties in establishing a firm diagnosis of gastrointestinal sarcoidosis as it is frequently asymptomatic and can often mimic other non-caseating diseases. It also highlights some of the other disease associations such as with other biliary tract disorders and provides information on treatments, particularly the role of biologic therapies.

Working together to improve rheumatology services.

The fast-moving changes in the NHS, particularly with respect to patients with chronic diseases, are a challenge and will have major financial and practical costs. For these changes to be successful the potential threat posed by PBR, PBC and CAB for smaller acute hospitals needs to be evaluated. Most importantly, bridging the primary and secondary care interface will be essential for the 'new' NHS to be successful. The shape of rheumatology in the future is also likely to depend on the national musculoskeletal strategy due to be published in the coming weeks.