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  1. The Triumvirate

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This month’s airwaves has a festive flavour…

Incremental costs and Ebenezer Scrooge

“If they would rather die, they had better do it, and decrease the surplus population.”

So said Ebenezer Scrooge in Charles Dickens’ “A Christmas Carol”. His views may be a fictional reflection of those of the political economist Thomas Malthus. A different kind of economics is presented in this month’s Thorax. Chen and colleagues (see page 1113) consider the economic burden of severe asthma – particularly multimorbidity. Using data from British Columbia, which cover a 20 year period, they conclude that the incremental cost of severe asthma (compared with no asthma) is $2779 per person-year. The authors attribute more than half incremental cost to co-morbidities – mainly respiratory co-morbidities. The incremental cost of severe asthma was comprised of: hospitalisations for comorbidities; medications for asthma and medication for comorbidities. Scrooge was very aware of incremental costs and paid his clerk, Bob Cratchit only 15 shillings a week. He paid this derisory salary while knowing that Cratchit’s son, Tiny Tim, suffered multimorbidity. “Bah Humbug!”

Airway obstruction past, present and yet to come

In “A Christmas Carol” Scrooge is visited by the ghosts of Christmas past, present and Christmas yet to come. The ghost of Christmas yet to come shows Scrooge his likely prognosis: …

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