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Letters are welcomed and will be pub-
lished, if fimnd suitable, as space permits.
The editors reserve the right to edit and
abridge lettes, to publish replies, and to
solicit respon~'es from attthors and others.
Letters shotdd be submitted in duplicate,
doubk.-spa~'ed (including references), and
generally ahould not exceed 400 words.
We agree with Hartunian, et al,
(see Different Views section, this issue
of the Journal) lhat the incidence and
prevalence approaches differ in their
abilily lo answer different questions.
For the incidence approach, the ques-
tion is what is the present value of the
cost of all new cases of a disease prob-
lem? This question relates to the value
of (the potential savings from) preven-
tion or preventive programs. For the
prevalence approach, the relevant
question is what is the annual burden of
a disease problem. Our response was
prompted by our referenced Wall
Street Journal article which shows how
the Harlunian sludy results were used
to reflecl lhe total cost or annual cost of
a disease problem, when in fact their
cosl data relate to the burden of new
cases only. Our view is that the preva-
lence and incidence approaches are
both sub-methods of a general human
capital approach lo cost of disease esti-
mation that has several components:
the present value of direct and morbid-
ity costs of all existing (prevalence)
cases, lhe present value of direct and
morbidity cost of new cases not includ-
ing immediate deaths, and the present
value of the cost of immediate and
future deaths due to the disease. From
this holi..lic ,~tandpoint, both the inci-
dence and prevalence methods give in-
Editor's Note: See al~o relz~tcd papcf~ p
1392 and 1394 thi~ i~,.ue.
complele answers to the question of the
total cost of disease.
We feel strongly that a discussion
of disease cost estimation methods is
important and, indeed, our communi-
cation was a step toward this discus-
sion. Our "back of the envelope" cal-
culations were intended to augment the
coronary heart disease figures present-
ed by the authors toward reflecting the
incide~we burden of all cardiovascular
disease to more readily make compari-
son with the familiar prevalence ap-
proach calculations available in the lit-
erature. As they note, we do not have
all the data. For example, although
CVD mortality rates have fallen by
almost 30 per cent since 1968, there is
no clear cut evidence of a decline in
incidence of events.
Of course, we encourage efforts to
improve the rationality and the ease of
estimating of disease costs. However,
in something of the manner of Sisy-
phus, all of us must make every effort
to minimize (what may be the inevita-
ble) misinterpretation of our results.
Edward Sondik, PhD
Chief, Program Analysis and
Marvin M. Kristein, PkD
Natioa,l Heart, Lung,
and Blood Institute
Bethesda, hiD 20205
Tap Water Burns
Recent articles have clearly docu-
mented the severe scalds Ihal can re-
sult from hot tap water.~.~ Pipes con-
veying excessively hot water also pose
a threat to children. A five-year review
of burns pre~cnting to the Winnipeg
Children's Hospital Emergency Room
found three children who required a
dres.',ing after coming into co~lact with
an exposed, uninsulated hot water pipe
to either a sink or a bathtub. In all three
instances, the homes were either sub-
standard or undergoing renovations.
These tap water burns, like tap water
scalds, could be eliminated by simply
reducing the temperature setting of ho.t
Richard S. Stanwick, MD, FRCP (C)
Departments of Pediatrics and Sot'hH
and Preventive Medicine
Utffversity of Manitoba
685 Bannatyne Avenue
Winnipeg, Manitoba R3E OWl
I. I3aptiste MS, Feck G: Preventing tap
water burns. Am J Public Health 1980;
2. Feldman KW, Schaller RT, Feldman JA.
et al: Tap water scald burns in children.
Pediatrics 1978; 62:1-7.
Appeal for Phased World
The British organization, The
Medical Association for the Prevention
of War, whose current Prcsidenl is Sir
Richard Doll, has asked the Journal to
print the f~llowing appeal (excerpted
from The Lancet, October 4, 1980. p.
There is no adequate protcclion against
a nuclear attack2 and an all-out nuclear v, ar
could des|roy civilization and even threaten
the survival of our species.~
Some countries i~ossess chemical weap-
ons and others have the materials ~ltd tech-
nology to produce them at short notice.:
Other inhumane and indiscriminate weap-
ons remain uncontrolled. The deployment of
the neutron bomb remains a possibility.
"Small" wars, such as those in Afghan-
istan, the Middle East, the Horn of Africa.
and south-east Asia. continue to take place.
There is Ihe danger thai such local wars
co~dd spark Im~.er conflicts, including a nu-
clear war, c~peeially by mi..calculation and
AJPH December 1981, VoL 71. No. 12