Abstract
In Reply. —We agree with the suggestion of Pantell et al that information on the effectiveness and cost of measures to prevent morbidity should be used in formulating recommendations. However, we feel that their discussion of screening for childhood lead poisoning ignores some important facets of this complex issue. The cursory cost-effectiveness analysis by Pantell et al has a number of limitations. First, they imply that $3396 would be too much to spend to find a lead-poisoned child, given the size of the effect of lead on IQ. In fact, on the basis of the effect of lead exposure on IQ and educational attainment, it has been estimated that preventing an increase of 0.48 μmol/L (10 μg/dL) in a child's blood lead level would produce an average increase of $11470 in the net present value of that child's expected lifetime earnings. 1 Pantell et al also exclude the costs of
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