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Suggested Citation:"APPENDIX A: A DISSENTING OPINION." National Research Council and Institute of Medicine. 1979. Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology. Washington, DC: The National Academies Press. doi: 10.17226/18439.
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Page 99
Suggested Citation:"APPENDIX A: A DISSENTING OPINION." National Research Council and Institute of Medicine. 1979. Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology. Washington, DC: The National Academies Press. doi: 10.17226/18439.
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Page 98

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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 System—An 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.

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Medical technology has unquestionably advanced at a prodigious pace in the past 20 years, changing both the capability of American medicine to detect and treat disease and the public’s expectations of medical care. The continued rapid growth in biomedical and related scientific knowledge is likely to stimulate further significant advances.

Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology examines the policy and research issues basic to the relationship between new medical technology and the efficiency and effectiveness of the health care system. This report assesses the process by which technology finds its way into the health care system and indentifies and analyzes successes and failures in the process of technological change. Ideally, the more effective and efficient technologies should be introduced quickly; others should not. This report considers the extent to which the ideal results actually do occur and when they don’t, why not.

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