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There are many ways to configure our health system and the outcomes we expect of it, but we do have choices to make. For families faced with those rarest diseases, it is understandable that one life saved is worth a comprehensive and expensive screening program. From a public health perspective, I see a moral and practical imperative for applying equitably within society that which we know, as well as the new knowledge we will gain in the future. (I’m in favor of what Jim Fries at Stanford has called the rectangularization of the life cycle- meaning that when displayed as a graph, keep the quality of life as high as possible to a time very near death, when a very precipitous decline in health occurs followed rapidly by death. Or, restated – having a healthy well functioning life until a ripe old age, and then a quick, painless exit...)