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OBSTACLES AND OPPORTUNITIES IN THE APPLICATION OF SCIENCE AND TECHNOLOGY TO DEVELOPMENT



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OBSTACLES AND OPPORTUNITIES IN THE APPLICATION OF SCIENCE AND TECHNOLOGY TO DEVELOPMENT

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Technology for Health: Are There Any Limits? Economic, Ethical, and Overall Societal Implications KENNETH SHINE The Uniersity of Texas System I n the first part of the twenty-first century, biological research will increas- ingly shift from reductionist approaches to the integration of knowledge. This implies the transition from genomics to proteomics to systems biology. The new “space” frontier will be neuroscience, with a focus on memory, mind, and learning. These efforts will be facilitated through the continuing application of mathematics, modeling, increasingly powerful computer capacity, and applica- tions from physics, chemistry, materials science, and engineering to biology. Advances in science will increasingly depend upon critical masses of sci- entists from multiple disciplines working together around highly focused areas. These groups will require expensive core facilities and increasingly expensive equipment and technology. Return on investment in science, including translation of basic discoveries to improve health, will become increasingly emphasized. The application of stem cell biology and genetic therapy and the explosive growth of minimally invasive procedures, such as fiber-optic surgery, have the potential to be very effective therapies. Some of the therapies will have lower unit costs but will lead to increasing societal demand. This will mean that overall health care costs will rise as the volume of procedures increases. These developments will require increasingly difficult decisions about priori- ties and programs and their funding. Institutions and their scientists will increas- ingly seek collaborations in order to achieve the required scientific expertise and to afford core facilities and infrastructure. Increasingly, societies will be obligated to make explicit decisions about cost-effective therapies and choices about what therapies are made available and to whom. It will be essential to focus on innovations that produce significant and substantial advances as opposed to expensive incremental approaches such as 

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 OBSTACLES AND OPPORTUNTIES IN THE APPLICATION OF S&T marginal modification of drugs or devices. Even in very-high-technology environ- ments, improvements in patient outcomes often depend upon simpler interven- tions, such as aspirin or beta-blockers in patients with myocardial infarction. Patients and their families will achieve increasing knowledge of science and medical options through the Internet, chat rooms, and other communication devices. This knowledge will increasingly prepare them to participate in joint patient–doctor decision making. Dr. John E. Wennberg has demonstrated that such joint decision making often leads a significant proportion of patients to choose less radical and less expensive therapies (see, e.g., O’Connor et al., 2007). Health care delivery and science in the first part of the twenty-first century is a “team sport” in which all members of the team must understand each others’ goals, objectives, backgrounds, and expectations in order that science progresses and health improves. The proliferation of scientific options will increase the pressure to make appropriate decisions for patients toward the end of life and those with poor medical prognoses. Information technology, which is essential to improved health care, also poses major problems in security and privacy. Increased incentives for the creation and application of interventions to prevent illness will be essential, not only to improve health but also to limit the rate of rise of health care costs. Preparing a health care workforce for a changing paradigm of delivering services and research will be a major challenge. Interactions with industry to achieve a translation of research to products are essential but will continue to present many moral and ethical challenges. The range of scientific and technological opportunities and discoveries will continue to require careful ethical judgments, which should be independent of preconceived political and theological ideologies. REFERENCE O’Connor, A. M., J. E. Wennberg, F. Legare, H. A. Llewellyn-Thomas, B. W. Moulton, K. R. Sepucha, A. G. Sodano, and J. S. King. 2007. Toward the “tipping point”: Decision aids and informed patient choice. Health Affairs 26(3):716–725.