The article by Sprinkle et al1 published in the May issue of the Archives is an example of how the "science" of economics can be employed to justify most any conclusion. Costs and benefits depend on what factors are laid on the scale. In this case, some of the important ingredients were left on the shelf.
The authors criticize other work that focuses solely on the decreased risk of pneumococcal sepsis in infants receiving prophylactic penicillin after the diagnosis of sickle-cell disease (SCD) was made. They say, [This approach] does not account for a range of other unambiguously valuable effects. The early diagnosis of non-SCD conditions such as sickle trait, nonsickle hemoglobinopathies, and some thalassemias allows the timely provision of genetic, medical, and social-services counseling."
A valid cost-benefit analysis would attempt to factor in the extent of harm inflicted on the huge number of infants with false-positive results, as