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Closely linked with the concept of risk ef ciency is the possibility of making trade-offs between alternative risk ef cient project plans. Return for the moment to the assumption that expected cost and associated cost risk are adequate measures of performance. For most-risk ef cient plans, the level of cost risk can be decreased given an increase in expected cost, and the level of expected cost can be decreased given an increase in cost risk. In relation to Figure 3.1, point G represents the minimum expected cost project plan, with a high level of cost risk despite its risk ef ciency. Point C represents the minimum cost risk project plan, with a high level of expected cost despite its risk ef ciency. If an organization can afford to take the risk, G is the preferred solution. If the risk associated with G is too great, it must be reduced by moving toward C . In general, successive movements will prove less and less cost-effective, larger increases in expected cost being required to achieve the same reduction in absolute or relative risk. In practice, an intermediate point like E usually needs to be sought, providing a cost-effective balance between risk and expected cost, the exact point depending on the organization s ability to take risk. The scale of the project relative to the organization in question is a key issue in terms of the relevance of plans D, E , F , or G . If the project is one of hundreds, none of which could threaten the organization, plan G may be a sensible choice. If the organization is a one-project organization and failure of the project means failure of the organization, a more prudent stance may seem to be appropriate, closer to C than G .

Working in the manufacturing sector surely must have provided me with some sense of what was going on, generally, and if I did not believe in the boom, then what did I believe about China, exactly Michael was my friend; he didn t want me to run out statistics He wanted an impression, some kind of nal word He wanted to know where I stood on things and hoped that I would make the sort of comment that we could tuck away and later recall in a future conversation You think that China is going to crash, Michael said, trying to put words in my mouth I didn t say that He kept pressing the point, playing with some of the ideas that I had been bouncing around.

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As far as he was concerned, it had to be just as others insisted that China would either rise like a balloon or sink like a stone in a pond He took my criticisms as a suggestion that I predicted the latter..

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(Continued) Possible Measure (Battery, if Part of a Battery) Adaptive Behavior Assessment Scale, Second Edition (ABAS-2) Social Skills Rating Scale Social Responsiveness Scale ADHD Rating Scale for Adults Personality Inventory for Children, Second Edition Various Structured Diagnostic Interviews (e.g., Diagnostic Interview for Children and Adolescents, Fourth Edition; Diagnostic Interview Schedule for Children, Fourth Edition; Children s Interview for Psychiatric Syndromes [ChIPS] Direct Observation)

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The cost associated with genetic counseling may well dwarf the direct expenditure on testing The most obvious testing cost is the direct cost of the genotyping, that is, the price of testing a population for the presence of speci c alleles Given the likely economies of scale that will be realized from population-based (or at least large segments of the population) testing, genetic tests should not be very expensive According to one estimate, the costs of genetic tests are likely to range from about $10 for single mutations to $250 for multiple genetic screens (Flockhart, 2001) A signi cant increase in health care expenditure will ow from the increased demand for genetic testing Screening and diagnostic testing will precede the use of pharmacogenomics-based drugs and will create an additional economic burden on the health care system.

When diagnostic and screening tests become available, it is reasonable to expect at least some individuals to demand the tests even if treatments are not yet available Once pharmacogenomics-based drugs become available, an additional increase in testing cost will be from derived demand That is, the demand for testing will grow in concert with the demand for pharmacogenomics-based drugs The economic impact of the costs of services associated with testing could be substantial Additional physician or clinic visits will be needed in conjunction with individual testing Also, genetic counseling will be required for many individuals once the genotype has been determined The magnitude of the economic effects will be driven by how many tests a person will receive.

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