2 The Delaney Clause prohibits the use of any amount of any food additive found to cause tumors in laboratory animals. This law does not recognize any margin of safety for extremely small doses.back

3 Alon Rosenthal, George M. Gray and John D. Graham, <">Legislating Acceptable Cancer Risk From Exposure to Toxic Chemicals, Ecology Law Quarterly, Vol. 19, 1992, pp. 269-362.back

4 Ron Winslow,<"> Medical Costs Are Increasing at a Low Rate, Wall Street Journal, July 14, 1994, p. A2;<"> Environmental Spending Set at $142.1 Billion in 1993; Yearly Growth in 1994-97 Seen at 9%, Air/Water Pollution Report, June 13, 1994, p.195.back

5 Senator Daniel Patrick Moynihan (D-NY), <">Environmental Risk Reduction Act, Congressional Record, January 21, 1993, p. S550.back

6 Tammy O. Tengs, Miriam Adams, Joseph S. Pliskin, Dana G. Safran, Joanna E. Siegel, Milton C. Weinstein and John D. Graham, <">Five Hundred Lifesaving Interventions and Their Cost-Effectiveness, Risk Analysis, June 1995, in press.back

7 See, for example, David M. Eddy, <">Screening for Cervical Cancer, Annals of Internal Medicine, Vol. 113, 1990, pp. 214-26.back

8 W. Kip Viscusi, <">The Value of Risks to Life and Health, Journal of Economic Literature, 1993, pp. 1912-46; W. Kip Viscusi, Fatal Trade-offs: Public and Private Responsibilities for Risk (New York: Oxford University Press, 1992).back

9 U. S. Environmental Protection Agency, <">National Emission Standards for Hazardous Air Pollutants: Benzene; Rule and Proposed Rule, Federal Register, Vol. 54, September 14, 1989, pp. 38044-72; Timothy J. Considine, Graham A. Davis and Donita Marakovits, <">Costs and Benefits of Coke Oven Emission Control, Final Report to U. S. EPA, Washington, DC, December 17, 1992.back

10 Tengs et al., <">Five Hundred Lifesaving Interventions and Their Cost-Effectiveness.back

11 Michael F. Drummond, Greg L. Stoddart and George W. Torrance, Methods for the Economic Evaluation of Health Care Programmes (New York: Oxford Medical Publications, 1987); and Milton C. Weinstein and William B. Stason, <">Foundations of Cost-Effectiveness Analysis for Health and Medical Practices, New England Journal of Medicine, Vol. 296, 1977, pp. 716-21.back

12 All costs are expressed in 1993 dollars, with future costs and effectiveness discounted to present value at an annual rate of 5 percent. The same assumptions are applied (to the extent possible) to all programs in order to allow comparison of multiple programs.back

13 Readers interested in learning more about the database can obtain a program summary by contacting the Harvard Center for Risk Analysis.back

14 P. Doubilet, M.C. Weinstein and B. J. McNeil, <">Use and Misuse of the Term ‘Cost-Effective’ in Medicine, New England Journal of Medicine, Vol. 314, 1986, pp. 253-56.back

15 R. Crandall, H. Gruenspecht, T. Keeler and L. Lave, Regulating the Automobile (Washington, DC: Brookings Institution, 1986).back

16 The Lifesaving Database considered 310 medical programs, 133 injury prevention programs and 144 toxin control programs. Since the degree of uncertainty in these estimates is substantial, differences that are less than a factor of two should be ignored.back

17 U. S. Environmental Protection Agency, The Costs and Benefits of Reducing Lead in Gasoline, Final Regulatory Impact Analysis, Washington, D. C., 1985.back

18 Tammy O. Tengs, <">Optimizing Societal Investments in Preventing Premature Death, doctoral dissertation, Harvard School of Public Health, Boston, June 1994.back

19 Center for Risk Analysis, A Historical Perspective on Risk Assessment in the Federal Government (Boston: Harvard School of Public Health, 1994).back

20 Ibid., pp. 49-50.back

21 G. W. Torrance, "Measurement of Health State Utilities for Economic Appraisal," Journal of Health Economics, Vol. 5, 1986, pp. 1-30.back

22 Baruch Fischhoff et al, "How Safe Is Safe Enough? A Psychometric Study of Attitudes Toward Technological Risks and Benefits, "Policy Sciences, Vol. 8, 1978, p.127.back

23 Center for Risk Analysis, Reform of Risk Regulation: Achieving More Protection at Less Cost (Boston: Harvard School of Public Health, 1995); R. Pildes and C. Sunstein, "Reinventing the Regulatory State, "University of Chicago Law Review, Vol. 62, 1995, p.1.back

24 F. Cross, "The Public Role In Risk Control," Environmental Law, Vol. 24, 1994, pp. 888-969.back

25 John Mendeloff and Robert M. Kaplan, "Are Large Differences in ‘Lifesaving’ Costs Justified? A Psychometric Study of the Relative Value Placed on Preventing Deaths," Risk Analysis, Vol. 9, 1989, pp. 349-63; Maureen L. Cropper and Uma Subramanian, "Public Choices Between Lifesaving Programs: How Important Are Qualitative Factors Versus Lives Saved?" draft report, Resources for the Future, Washington, DC, March 1994.back

26 R. J. Zeckhauser and W. Kip Viscusi, "Risk Within Reason," Science, Vol. 238, 1990, pp. 559-64.back

27 Louise B. Russell, Is Prevention Better Than Cure? (Washington, DC: Brookings Institution, 1986), p.5.back

28 Report of the Harvard Group on Risk Management Reform, Reform of Risk Regulation: Achieving More Protection at Less Cost (Boston: Harvard Center for Risk Analysis, 1995).back

29 J. D. Graham and M. Sadowitz, "Superfund Reform: Reducing Risk Through Community Choice," Issues in Science and Technology, Summer 1994, pp. 35-40.back