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And it would be startlingly cheap. IV estimates the “Save the Arctic” plan could be set up in just two years at a cost of roughly $20 million, with an annual operating cost of about $10 million. If cooling the poles alone proved insufficient, IV has drawn up a “Save the Planet” version, with five worldwide base stations instead of two, and three hoses at each site. This would put about three to five times the amount of sulfur dioxide into the stratosphere. Even so, that would still represent less than 1 percent of current worldwide sulfur emissions. IV estimates this plan could be up and running in about three years, with a startup cost of $150 million and annual operating costs of $100 million. So Budyko’s Blanket could effectively reverse global warming at a total cost of $250 million. Compared with the $1.2 trillion that Nicholas Stern proposes spending each year to attack the problem, IV’s idea is, well, practically free. It would cost $50 million less to stop global warming than what Al Gore’s foundation is paying just to increase public awareness about global warming. And there lies the key to the question we asked at the beginning of this chapter: What do Al Gore and Mount Pinatubo have in common? The answer is that Gore and Pinatubo both suggest a way to cool the planet, albeit with methods whose cost-effectiveness are a universe apart.

For interested consumers, there are many health pricing tools. For starters, I recommend The Wall Street Journal’s “Medicare Unmasked” tools,2 although they may be behind a paywall. The Health Care Cost Institute3 is a health-insurer funded effort to compare the cost of various procedures around the country.4 ProPublica, a non-profit news site, is one of several consumer sites that has used the CMS databases to build tools that are not exactly beloved by health care providers, including Dollars for Docs5 and Surgeon Scorecard.6

Consider, for example, the landmark 2004 study that followed several hundred patients treated with one of three popular antidepressants: Zoloft, Paxil, or Prozac. Among those who took the drugs as prescribed, only 23% were depression-free after six months of treatment. (As you might expect, patients who failed to take their meds did even worse.) And all three medications yielded roughly the same dismal results. A fluke result, perhaps? It’s actually pretty typical. The recovery rate with antidepressants in similar studies usually falls somewhere between 20% and 35%. Clinical researchers at forty-one treatment sites across the country have just completed the largest real-world study of antidepressants ever conducted, and the results fit the same overall pattern. This multimillion dollar project, sponsored by the National Institutes of Mental Health, followed about three thousand depressed patients who initially took the drug citalopram (marketed under the trade name Celexa) for about twelve weeks. By the end of that short-term treatment period, only 28% of study patients had fully recovered. The study’s 28% response rate might even be an overestimate of the medication’s true effectiveness, because patients received higher drug doses and had more frequent doctor’s visits than people do in everyday clinical practice. (In real life, insurance companies sharply restrict the frequency of “med check” follow-up appointments). Remarkably, the study’s authors—a veritable All-Star team of clinical researchers—noted that the observed 28% recovery rate was about what they had expected to see based on comparable studies. That’s right: They weren’t surprised to find that the majority of study patients failed to recover on an antidepressant. In the study’s published write-up, the researchers also raised a provocative question: What percentage of their patients might have recovered if they had received a sugar pill—a placebo—instead of the medication? Could it possibly have been as high as 28%?