My Quality Adjusted Life Year may be different than your Quality Adjustment Life Year

Slate's Darshak Sanghavi discusses some of the problems with the way health care economists judge the cost-effectiveness of various health treatments, within our culture and across cultures. Paul Farmer's Partners-in-Health group is used as anecdotal evidence (as Sanghavi's critique is almost verbatim the one that Paul Farmer gives in his lectures), and Farmer's infamous "before-HAART" picture is included in the article. Farmer hates the QALY (quality adjusted life year) metric, mainly because the QALY assumptions break down the more unlike the treatments are in their target population, and easily damns treating anyone in an impoverished nation with anything more expensive than penicillin and a mosquito net. Despite being an excellent primer in global cost-effectiveness, the article does a great job exploring the extent to which the assumptions of economics, like any statistical science, greatly limit our ability to generalize the results it produces to real policy decisions.