The tale of poor countries squandering resources on high-technology medicine is by now too familiar: the hospital in the capital city consuming 90 percent of the health budget while the countryside lacks safe water; the CT scanner perched virtually atop a malarious swamp. The explanations of this recurring problem are also commonplace: doctors like to play with exotic and expensive toys; the self-interested local elite dominates decisions about medical spending; a few spectacular cures are more easily comprehended (and publicized) than a host of public health problems.But such pronouncements treat only half the issue — the consumption of medical . . .