The technologies of medicine.

A periodic, hard-lheaded assessment of technology has become a routine and plrofitable exercise for most of the large industrial enterprises of the nation. Otur methiods for securing energy, for example, whethier from fossil fuels or atoms or straighlt from the stLin, are subjected to regular review by panels of experts, in and otut of government, in order to make forecasts for the future and arrive at pru-(lenit decisions about long-range budgets. Technology assessment is an essential feature of ouir progress in space, defense, transport, agriculture and environmental protection. The blroad field of medicine lhas, tup to now, received very little of this kind of treatment. We lhave tended to accept the technology of medicine as a given, as sometlhing that is simply there, for better or worse, to be taken for granted. Wlhen we have used the term technology it has in fact usually been in the sense-a very limited sense, in my view-of the technology involved in the actual delivery of health services. It might be useful for all of us, in and out of medicine, to take a careful look at all the actual measures employed in the management of (lisease and the preservation of health, and to make, periodically, the same objective appraisals of their effectiveness as are ma(le by other national enterprises based on science. It would be a lot easier to work out long-range policies and set future goals if we had some system in operation to tell us, at any given moment, where we stand in our capacity to (leal with specific, major diseases of man, what these measures are costing us, and whether there are any options in sight, i.e., whether there is new 'Ihis paper was presented, in part, as testimony in hearings of the United States Setiate