Note to Bill Clinton, Elton John, Madonna, Bono, Sting, Ashley Judd and all their Hollywood friends: Stop killing Africans.

And here you probably thought that all these people - with their concerts, fundraising campaigns and AIDS awareness activities - were actually doing something good. Welcome to the world of political correctness.

If you're a regular reader of Health Alerts, in all probability you are not a subscriber to the kind of literature that would clue you in on socially acceptable charitable giving. So you can be forgiven for not knowing that (1) AIDS is a politically correct thing to be concerned about (in fact, it is far and away the most politically correct disease) and (2) making a distinction between AIDS prevention and AIDS treatment is boorish, gauche, insensitive, uncaring, unfeeling and completely politically incorrect. 

[Aren't you glad you have me to guide you through the nonsyllogistic world of Hollywood thought?]

First things first. It is too bad that all these celebrities did not get involved 25 years ago when virtually all the experts were predicting that AIDS would kill millions of Africans. But, hey, what's the point of getting involved in a cause if none of your friends knows anything about it? Anyway, now that 29 million Africans are HIV positive, what is the best use of scarce health care dollars?

It turns out that most of the hoopla in the West and most of the actual AIDS dollars are focused on AIDS treatment, whereas there is a much better return to be had on AIDS prevention and an even better payoff from the treatment and prevention of other diseases. Further, by the very act of spending billions of dollars on AIDS treatment, resources will be drawn away from AIDS prevention and other health needs. In this way, African AIDS programs almost certainly cost more lives than they save!

• The World Health Organization estimates the cost of treating a patient with AIDS with the "triple drug cocktail" known as highly active antiretroviral therapy is about $1,500 per patient per year; and this treatment adds only 3 to 5 years to each patient's life.
• By contrast, a study in the British medical journal, The Lancet, estimates that prevention interventions such as condom distribution, blocking mother-to-child transmission, and voluntary counseling and testing could cost as little as $1 to $20 per year of life saved.
• The medicines that cure tuberculosis cost about $10 per case.
• A package of interventions designed to prevent maternal and infant deaths costs less than $3 per person.
• Worldwide, 3 million children die every year because they do not get vaccines that cost pennies per dose.

A study by Harvard economist Michael Kremer estimates that for every year of life gained by giving antiretroviral therapy to an AIDS patient, 25 to 110 (quality adjusted) years of life could have been saved by spending those same dollars in more productive ways.

Even AIDS prevention is not always cost effective. An article in The Lancet lamented that 5.5 million child deaths could have been prevented using the same money that was aimed at preventing the small number of child deaths due to AIDS.

If all this is ruining your day, I have more bad news. Over the past five decades, the developed countries of the world have given less-developed countries $2.3 trillion in foreign aid. What difference has all this money made? Amazingly, economists aren't sure. How can you spend $2.3 trillion and not have any obvious beneficial effects? That's a subject for next week's Health Alert.

PS #1: I intentionally left Bill Gates off the list. Why? Because he has at least read the four must-read books for anyone contemplating giving money to Africa (and one hopes he learned from them). See, however, Bill Easterly's op-ed on Gates in The Wall Street Journal.http://online.wsj.com/article/SB120235183917849631.html

PS #2: Here are the four must-read books:

William Easterly, The White Man's Burden http://www.amazon.com/White-Mans-Burden-Efforts-Little/dp/1594200378

Gregory Clark, A Farewell to Alms http://www.amazon.com/Farewell-Alms-Economic-History-Princeton/dp/0691121354/ref=pd_bbs_1?ie=UTF8&s=books&qid=1202489401&sr=1-1

Paul Collier, The Bottom Billion http://www.amazon.com/Bottom-Billion-Poorest-Countries-Failing/dp/0195311450/ref=pd_bbs_1?ie=UTF8&s=books&qid=1202489361&sr=1-1

Jeffery Sachs, The End of Poverty http://www.amazon.com/End-Poverty-Economic-Possibilities-Time/dp/1594200459

The Sachs book represents conventional - and almost certainly wrong - thinking. I include it only for balance. These books are summarized along with other material in John Goodman, "Message to Debaters" http://www.debate-central.org/ and Christa Bieker, "Topic Overview" http://www.debate-central.org/2007/research/overview-of-the-2007-2008-cx-topic at the NCPA's high school debate site.