As a premed student in undergraduate school, I struggled through the economics courses required for graduation, comforting myself with the thought that economics has nothing to do with health care. Twenty-five years later, I have come to recognize the delusion under which I was working. The article by Phibbs et al1 in this issue of JAMA confirms what many practitioners have long suspected: maternal drug use, especially the use of crack cocaine, is driving the cost of care for the exposed infants beyond any reasonable level.
From a national perspective, the total cost implications of drug and alcohol, and especially cocaine, use during pregnancy elude us, primarily because we really do not know how many exposed infants are being born each year. The earliest study looking at this issue found that 11% of infants born in 36 selected hospitals across the country had