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Letters to 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. A Rejoinder 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 Evaluation Branch Marvin M. Kristein, PkD Visiting Ec'onornist 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 water tanks. Richard S. Stanwick, MD, FRCP (C) Departments of Pediatrics and Sot'hH and Preventive Medicine Utffversity of Manitoba Children's Hospital 685 Bannatyne Avenue Winnipeg, Manitoba R3E OWl REFERENCES I. I3aptiste MS, Feck G: Preventing tap water burns. Am J Public Health 1980; 70:727-729. 2. Feldman KW, Schaller RT, Feldman JA. et al: Tap water scald burns in children. Pediatrics 1978; 62:1-7. Appeal for Phased World Disarmament 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. 739): 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 mischance.• 1408 AJPH December 1981, VoL 71. No. 12 T105390049