A consumer trip into the world of the DALY calculations: an Alice-in-Wonderland experience.

For a consumer advocate, entering the world of the disability-adjusted life years (DALYs) calculations was a surreal experience. What began with the noble aim of working out how to overcome the tyranny of death as the only way of 'measuring' health, has led to an exercise where people weigh the relative value of health conditions without death as a feature. However, life-threatening diseases, if they no longer carry the threat of death, are no longer themselves. These valuations of 'altered health states' then, can become absurd. While data often fail to measure real life very well, and distort as well as illuminate, the ranking of disease in this way is particularly problematic. It has been said to disadvantage the poor, the very young and very old, and women. It privileges short-term interventions over prevention and long-term strategies. Can this really improve decision-making about resource allocation in health?