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MANAGING TECHNOLOGY
 
The recent short course on technological assessment organised by the Department of COFM and supported by the Ministry of Health provided a practical insight into this subject of growing importance. We had the opportunity to interview Professor David Banta who taught on the course. His interview is found in page N4.

The importance of technological assessment is crisply stated in a BMJ editorial in 1992: “The rule should be ‘no evaluation - no technology’” (Jennett, 1992).

One of the challenges for society is to use technologies in the care of people appropriately, in association with other approaches and strategies, and to make wise choices between the different methods that are available.

Much of the criticism of technology today is fuelled by the inappropriate application of tools that have considerable potential benefit if only they were properly deployed.

Roughly three-quarters of the non-surgical physician’s care today is supportive and there is a clear difference between technologies for prevention, control and cure of disease and those for palliation or repair. When technologies for prevention, control and cure are developed, they are relatively simple and inexpensive, whereas the most spectacular of the technologies for palliation and repair, such as open heart surgery, are very costly and often of only marginal benefit to the patient. We should therefore not be persuaded without good reason.

Increasingly in the future, as technology interferes with life processes such as life, death and reproduction; as resource pressures raise problems of solidarity and equity, there will be a greater need for a systematic consideration of the social aspects of technology.

This in turn implies the adequate provision of information to the public and the profession on evidence based medicine. Entrepreneurs need also to be warned that investing in technologies that are yet to be proven may run the risk of failure.

The profession needs useful statements to guide practice. On this page is a local example of clinical guidelines. This is a consensus statement by the Clinical Neurosciences Society that there is inadequate data in the world literature on the safety and efficacy of carotid artery stenting.

The elderly is a group where health technology has special social impact. Health technologies provide major potential to improve the quality of life, other health outcomes and the extent to which older people can maintain an independent lifestyle. However, clearly all technology have their limitations. Technologies will be able to go only so far in meeting the demands for treatment and support associated with the ageing process. With many technologies, optimum use in the health care will require the availability and involvement of health care professionals, suitable integration with other health and social services and appropriate education of the older patient.

Reference 
1.  Jennett B. Health technology assessment. (editorial). BMJ 11 July 1992; 305:67-68.