Coinvestigators at the University of Utah and the University of California, Davis and Berkeley, estimated the indirect mortality and morbidity costs, as well as the direct costs of medical care, developmental services, and special education over the entire lifespan of those born with each birth defect in California in 1988. They found that net per capita medical costs in 1988 dollars are largest for spina bifida ($99 000); heart defects such as truncus arteriosus ($209 000), tetralogy of Fallot ($109 000), and single ventricle ($99 000); and cerebral palsy ($142 000). Long-term care costs for those with cerebral palsy and Down syndrome are high, largely reflecting expenditures for State developmental services. Total special education costs in California are substantial, exceeding 20% of total medical costs for many conditions. They are particularly high for those with Down syndrome ($37.1 million), cerebral palsy ($28.6 million), and spina bifida (5.3 million). Athrough birth defects are the leading cause of infant death in the United States, most children with birth defects do not die in infancy, note the researchers. They conclude that, based on their estimates of societal costs, additional research on the etiology and epidemiology of birth defects could lead to new strategies and, thus, have a net economic benefit. For more information, see "Estimates of the Economic Costs of Birth Defects," by Norman J. Waitzman, PhD, Patrick S. Romano, MPH, and Richard M. Scheffler, PhD, in the Summer 1994 issue of Inquiry 31, pp. 188-204. Research Activities, A.H.C.P.R., October/November 1994