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Daniel J Ullyot
American Heart Journal Volume 7 No.2

Americans love technology, especially new medical technology. The cliché 'America has the best healthcare in the world' really means that American healthcare uses the most advanced technology to an extent that surpasses any other healthcare delivery system in the developed world. Our federal and state government programs in biomedical research, our universities and affiliated medical schools, and our vast medical/industrial complex, including our pharmaceutical and device manufacturing companies, produce thousands of new technologies each year. The National Institutes of Health (NIH) is the primary agency of the US Government responsible for biomedical and health-related research. As of 2003, the NIH was responsible for 28%-about $26.4 billion-of total annual biomedical research funding in the US, with most of the rest coming from industry. This supremacy in the development, dissemination, and clinical application of technology is also the reason our per capita expenditure on healthcare exceeds that of other 'first-world' countries by a factor of two or more. For those with rare afflictions or who have conditions requiring high-tech, sophisticated diagnostic and/or therapeutic interventions (if they are wealthy or happen to enjoy good health insurance coverage), America is the place to be.

However, does this bounty of technology mean Americans enjoy better health-or medical care-than the rest of the world? The fact is that we are not getting our money's worth. While our per capita spending exceeds that of other developed nations, we rank well below other 'first-world' countries in measures of public health such as life expectancy, infant mortality, maternal mortality, and others.

At the heart of this dilemma is the distinctly American love affair with technology. Technology in health is defined broadly to include drugs, devices, procedures, and organized care such as chronic disease management systems. 'New is better' is powerful psychology for patients who want and need access to the 'best.' To be sure, the triumph of modern medicine is the adoption of the scientific method and the application of science to medical practice. Much medical technology truly is lifesaving and brings enormous benefits to patients. One has only to consider antibiotics, insulin, blood transfusion, vaccination, heart valves, artificial joints, open heart surgery, cancer screening, and chronic disease management systems for heart failure and asthma, to name just a few.

Conversely, a great deal of technology is actually of little benefit, often duplicative, and sometimes even harmful. Examples are plentiful: 'me too' pharmaceuticals; drugs such as Vioxx, which, after initial introduction, US Food and Drug Administration (FDA) approval, widespread use, and exuberant marketing, was later withdrawn as safety issues came to light; devices such as defective heart valves and pacemaker lead systems; and surgical procedures such as carotid sinus denervation for asthma and lobotomy for schizophrenia.

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