Background: Sodium consumption raises blood pressure, increasing the risk for heart attack and stroke. Several countries, including the United States, are considering strategies to decrease population sodium intake.

Objective: To assess the cost-effectiveness of 2 population strategies to reduce sodium intake: government collaboration with food manufacturers to voluntarily cut sodium in processed foods, modeled on the United Kingdom experience, and a sodium tax.

Design: A Markov model was constructed with 4 health states: well, acute myocardial infarction (MI), acute stroke, and history of MI or stroke.

Data Sources: Medical Panel Expenditure Survey (2006), Framingham Heart Study (1980 to 2003), Dietary Approaches to Stop Hypertension trial, and other published data.

Target Population: U.S. adults aged 40 to 85 years.

Time Horizon: Lifetime.

Perspective: Societal.

Outcome Measures: Incremental costs (2008 U.S. dollars), quality-adjusted life-years (QALYs), and MIs and strokes averted.

Results of Base-case Analysis: Collaboration with industry that decreases mean population sodium intake by 9.5% averts 513 885 strokes and 480 358 MIs over the lifetime of adults aged 40 to 85 years who are alive today compared with the status quo, increasing QALYs by 2.1 million and saving $32.1 billion in medical costs. A tax on sodium that decreases population sodium intake by 6% increases QALYs by 1.3 million and saves $22.4 billion over the same period.

Results of Sensitivity Analysis: Results are sensitive to the assumption that consumers have no disutility with modest reductions in sodium intake.

Limitation: Efforts to reduce population sodium intake could result in other dietary changes that are difficult to predict.

Conclusion: Strategies to reduce sodium intake on a population level in the United States are likely to substantially reduce stroke and MI incidence, which would save billions of dollars in medical expenses.

Primary Funding Source: Department of Veterans Affairs, Stanford University, and the National Science Foundation.

In May 1998, India and Pakistan put to rest years of speculation as to whether they possessed nuclear technology and openly tested their weapons. Some believed nuclearization would stabilize South Asia; others prophesized disaster. Authors of two of the most comprehensive books on South Asia's new nuclear era, Šumit Ganguly and S. Paul Kapur, offer competing theories on the transformation of the region and what these patterns mean for the world's next proliferators.

Ganguly begins with an outcome-based approach emphasizing the results of militarized conflict. In his opinion, nuclear weapons have prevented Indo-Pakistani disputes from blossoming into full-scale war. Kapur counters with a process-based approach stressing the specific pathways that lead to conflict and escalation. From his perspective, nuclear weapons have fueled a violent cycle of Pakistani provocation and Indian response, giving rise to a number of crises that might easily have spun into chaos. Kapur thus believes nuclear weapons have been a destabilizing force in South Asia and could similarly affect other parts of the world.

With these two major interpretations, Ganguly and Kapur tackle all sides of an urgent issue that has profound regional and global consequences. Sure to spark discussion and debate, India, Pakistan, and the Bomb thoroughly maps the potential impact of nuclear proliferation.

Reviews

"Did the spread of nuclear weapons to India and Pakistan deter war or provoke aggression? Two prominent scholars of South Asian politics address this important question in a debate filled with insight and wit. Some readers will agree with Šumit Ganguly's optimistic assessment, and some will agree with S. Paul Kapur's more pessimistic appraisal. All will come away with a more nuanced understanding of the complex political effects of nuclear weapons."
- Scott D. Sagan, The Caroline S.G. Munro Professor of Political Science, Stanford University

"India, Pakistan, and the Bomb is remarkably well written. Šumit Ganguly and S. Paul Kapur discuss complex issues and contested history in a nuanced and lucid fashion."
- Arthur Rubinoff, University of Toronto

"Šumit Ganguly and S. Paul Kapur give us an unusually productive dialogue between deeply informed scholars who disagree about an issue of great theoretical interest and policy relevance. The stability of the South Asian nuclear balance is debated with such a fruitful combination of analytical rigor and empirical evidence that students of both the region and the general topic of proliferation will learn a great deal."
- Robert Jervis, Columbia University

"This is a great book for learning about the India-Pakistan conflict as well as nuclear deterrence theory. Šumit Ganguly and S. Paul Kapur, both first-class strategists, examine the effects of nuclear weapons on the rivalry between Islamabad and New Delhi and reach carefully reasoned yet opposing conclusions."
- John J. Mearsheimer, University of Chicago

"These eminent scholars of nuclear proliferation achieve a masterful blend of policy-relevant theory, empirical research, and rigorous analysis. In doing so, they drive the optimism/pessimism debate to a refreshing new level of subtlety and sophistication. Policymakers and professors alike will be delighted to have this compelling book at hand." - Devin T. Hagerty, University of Maryland