Since 9/11, railroads have spent millions to install fences and security cameras and add additional officers around the state, but industry officials concede that their facilities are far too large to be completely sealed. Leaders of railroad workers' unions say it is not uncommon for tanker cars to be left unattended for days, and that security along the rails is frighteningly inadequate. And the sight of graffiti-covered tank cars filled with deadly gases is a reminder of the holes in the security system.

State and local officials say they are limited in what they can do to regulate the thousands of tank cars of deadly gases hauled around New Jersey each year. In other cities and states, proposals to reroute dangerous chemicals away from major population centers, most notably in Washington, D.C., have faced fierce opposition and legal challenges from both the railroads and local communities where the chemicals would be rerouted. The courts have also upheld the railroads' assertion that only the federal government can regulate rail traffic.

Moreover, the toxic cargo transported by railroads means an attack could be devastating; a Navy study cited in the article predicts that a single car of chlorine near a densely populated area could kill as many as 100,000 people.”

Just as troubling, a drill conducted last year by the U.S. government and involving hundreds of public officials and private corporations revealed major flaws in communication and preparedness. According to the New Jersey Media Group:

"It was a testament to how unprepared people really are," said Wilmer Alvarez, a director at Columbia University's National Center for Disaster Preparedness. "The mistakes that occurred caused almost a complete shutdown of the public health system. They tested the public health system and it got ransacked."

As the one-year anniversary of the drill -- known as TopOff3 -- approaches, neither the state nor federal government has issued final reports detailing the problems -- or successes -- of the terror simulation. But interviews with government officials and expert observers in recent weeks have drawn parallels to the much-maligned federal response to Hurricane Katrina.

Despite this disturbing evidence that we are woefully unprepared should another attack occur, DHS has made little progress on chemical security, according to a recent GAO report.

Read more about our unmet security needs.
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Questioning QALYs and CEA
Merrill Goozner of CSPI has a blog with an entry helpfully going through Quality Adjusted Life Years:

Medical economists conduct these cost-benefit studies to determine if a new drug, medical device or surgical procedure is worth its pricetag. But how do they determine benefits? Over the years, the profession has developed a tool for measuring medical value known as the quality adjusted life year, or QALY. One year of perfect health gets a score of one QALY. If a patient is bedridden and in constant pain for that entire year, it might be considered a .3 (three-tenths of a year) QALY.

Let's use a hypothetical example to show how this works. If a medical intervention can, say, eliminate the pain, but not get that patient out of bed, it might raise the QALY for that year to .5 or a half-year. The economists then compare the improvement (.2 QALY) to the cost of the intervention and adjust it to show its price tag in terms of how much it would cost to achieve one QALY.

In this example, say the pain medication cost $12,000 a year. The cost per QALY would be $60,000. While it is by no means a hard and fast rule, most discussions about the value of achieving a QALY peg the acceptable cost threshold at $50,000 (based on the amount Medicare pays each year for dialysis patients on average). Below that and your technology gets paid for; above that and the insurers pull out the green eyeshades.

The problem with this approach is its inherent subjectivity. Who said reducing pain was only worth two-tenths of a year? Why not three-tenths? Though still in bed, the patient is enjoying a painfree existence, right? That’s got to be a .6 on the QALY scale. If the cost-benefit analyzer uses that measure, the cost per QALY for the pain medication drops to $40,000 per QALY, which just happens to be under the $50,000 threshold and likely to meet with the approval of the green eyeshade crowd.

But there's a little more to the story of QALYs. We've long known that regulated industry tends to overestimate the costs of compliance with a proposed rule. Now there's word that industry is distorting not just CBA but also CEAs:

The vast majority of the QALY studies that appear in the medical literature say the interventions are worth the price. And, according to the Tufts University study that appeared last week in the BMJ, only 18 percent of more than 500 studies evaluated by the researchers (most were conducted in the late 1990s) were funded by industry.

But sorting those studies by funding source showed a remarkable disparity in outcomes. “Studies sponsored by industry were more than twice as likely as studies sponsored by non-industry sources to report ratios below $20 000/QALY and over three times more likely to report ratios below $50 000/QALY,” the study’s authors said. “It is unclear whether publication bias occurs at a conscious or unconscious level. In any case, our results support concerns about the presence of significant and persistent bias in both the conduct and reporting of cost effectiveness analyses.”

Chaim Bell of St. Michael’s Hospital in Toronto, the lead author of the study, concluded that “more rigor and openness is needed in the discipline of health economics before decision makers and the public can be confident that cost effectiveness analyses are conducted and published in an unbiased manner."

He was too polite to ask, in the manner of Marcia Angell’s attack on academic medicine a few years ago, whether medical economics is for sale.

What is government for? It is to protect the commons, all the things we own together and none of us owns individually, such as air, water, wildlife, the human gene pool, the accumulated human knowledge that we each inherit at birth, and more. Can protecting the commons be expressed in a simple set of guidelines? Here's a start...