Ullyot_AHHJ - Article template 28/01/2010 10:39 Page 82
Original Contribution Am Heart Hosp J. 2009;7(2):82–86
Technology Assessment Is the
Key to Healthcare Reform
Daniel J Ullyot, MD
mericans love technology, especially new medical At the heart of this dilemma is the distinctly American
technology. The cliché ‘America has the best love affair with technology. Technology in health is
Ahealthcare in the world’ really means that defined broadly to include drugs, devices, procedures,
American healthcare uses the most advanced technology and organized care such as chronic disease management
to an extent that surpasses any other healthcare delivery systems. ‘New is better’ is powerful psychology for
system in the developed world. Our federal and state patients who want and need access to the ‘best.’ To be
government programs in biomedical research, our sure, the triumph of modern medicine is the adoption of
universities and affiliated medical schools, and our vast the scientific method and the application of science to
medical/industrial complex, including our pharmaceutical medical practice. Much medical technology truly is life-
and device manufacturing companies, produce thousands saving and brings enormous benefits to patients. One
of new technologies each year. The National Institutes of has only to consider antibiotics, insulin, blood
Health (NIH) is the primary agency of the US Government transfusion, vaccination, heart valves, artificial joints,
responsible for biomedical and health-related research. As open heart surgery, cancer screening, and chronic disease
of 2003, the NIH was responsible for 28%—about $26.4 management systems for heart failure and asthma, to
billion—of total annual biomedical research funding in the name just a few.
US, with most of the rest coming from industry.
Conversely, a great deal of technology is actually of little
This supremacy in the development, dissemination, and benefit, often duplicative, and sometimes even harmful.
clinical application of technology is also the reason our Examples are plentiful: ‘me too’ pharmaceuticals; drugs
per capita expenditure on healthcare exceeds that of such as Vioxx, which, after initial introduction, US Food
other ‘first-world’ countries by a factor of two or more. and Drug Administration (FDA) approval, widespread use,
For those with rare afflictions or who have conditions and exuberant marketing, was later withdrawn as safety
requiring high-tech, sophisticated diagnostic and/or issues came to light; devices such as defective heart valves
therapeutic interventions (if they are wealthy or happen and pacemaker lead systems; and surgical procedures
to enjoy good health insurance coverage), America is the such as carotid sinus denervation for asthma and
place to be. lobotomy for schizophrenia.
However, does this bounty of technology mean Even technologies that have been shown to be safe and
Americans enjoy better health—or medical care—than effective for specified indications can be inappropriately
the rest of the world? The fact is that we are not getting applied, over-used, misused (as in some ‘off-label’ use), or
our money’s worth. While our per capita spending under-used. The Wennberg and the Dartmouth group study
exceeds that of other developed nations, we rank well of documented variation in medical practice pointed out
below other ‘first-world’ countries in measures of public significant local and regional differences in the use of
health such as life expectancy, infant mortality, maternal medical technology, concluding that much medical practice
mortality, and others. is arbitrary and lacking convincing supportive evidence.
This manuscript is based on Dr Ullyot’s September 16, 2009 presentation in The Distinguished Lecturer Series sponsored by the Dayton Heart Institute of
the Good Samaritan Hospital.
Healthcare Reform Winter 200982
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68