Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
APPENDIX A DISSENTING OPINION A William S. Yamamoto While I do not disagree with the findings or recommendations of the committee either singly or in their collective consequence, I am nevertheless left with a sense of disquiet. I am moved to write to try to identify the nature of that difficulty, which may concern others who examine this report. The limitations of the study and its scope are fully stated in the introduction. The limitations, on the one hand, justify the character of the entire report, but also avoid examination in this report of med- ical technology from other perspectives. After carefully cataloging items that belong under the rubric "equipment-embodied technology," we treat it as a conceptually simple aggregate like "merchandise." This approach ignores crit- ical differences such as: (l) how development of technology re- lates to advances in the sciences and medicine, (2) who made each item and why, (3) what medical purposes they are intended to serve, and (4) how other technological innovations not directed to the concept of large scale address the same medical problems. The report seems to assume that technology is an entity in existence and that the issue of technology in medical care is that of disposition, distribution, cost, and management. It does not inquire as to how new equipment-embodied technology should come into existence, but rather into how the motivations of those who use the technology manage it in order to be respon- sive to the current preoccupation of the society with medical care costs. However well considered, this report is most suc- cintly described as a document that states: Technology exists; it should be controlled for the purpose of keeping down costs. Its principal recommendations are directed at the production of disincentives through economic, financing, and, to a lesser 99
98 l34. Walton, Peter L. PROMTS: The Problem-Oriented Medical Information SystemâAn Overview. Rockville, Md.: U.S. Department of Health, Education, and Welfare, Public Health Service, Health Resources Administration, l973. l35. Wardell, William M., and Lasagna, Louis. Regulation and Drug Development. Washington, D.C.: American Enterprise Institute for Public Policy Research, l975. l36. Warner, Kenneth E. "Treatment Decision Making in Cata- strophic Illness." Medical Care l5(l977):l9-33. l37. Weiner, Stephen M. "State Regulation and Health Technol- ogy." Background paper prepared for the Conference on Health Care Technology and Quality of Care, Boston Uni- versity, l9-20 November l976. Boston: Boston University, Program on Public Policy for Quality Health Care, l976. l38. Weinstein, Milton, Shepard, Donald, and Pliskin, Joseph. The Economic Value of Changing Mortality Probabilities: A Decision-Theoretic Approach. Boston: John Fitzgerald Kennedy School of Government, Harvard University, l976. l39. Wessen, Albert F. "On the Demand for Graduate Medical Education Positions by Specialty." In Policy Analysis for Physician Manpower Planning: The Supply of and Demand for Graduate Medical Education Positions, ed. Kerry E. Kil- patrick. Washington, D.C.: U.S. Department of Health, Education, and Welfare, l977. l40. Westin, Alan F. Computers, Health Records, and Citizen Rights. Washington, D.C.: U.S. Department of Commerce, National Bureau of Standards, l976. l4l. White, Kerr. "International Comparisons of Health Ser- vices Systems." Milbank Memorial Fund 46(l968):ll7. l42. Wolfe, Sidney, and Bogue, Ted. Hospital-based Physicians Report. Washington, D.C.: Public Citizens' Health Re- search Group, l977. l43. Worthington, Nancy L. "Expenditures for Hospital Care and Physicians' Services: Factors Affecting Annual Changes." Social Security Bulletin 38(l975):3-l5. l44. "Why Most MDs Practice 'Defensive Medicine.'" AMA News, March 28, l977.