In the mid-1970s, after decades of clinical use, the utility of electrocardiographic exercise testing for the evaluation of patients with suspected ischemic heart disease was critically examined and questioned. Concurrent with this critique, two sophisticated, more expensive and powerful “nuclear” exercise tests were introduced sequentially for clinical use: myocardial perfusion imaging with thallium-201 and radionuclide ventriculography with technetium 99m. The published indications for the two tests are similar, and both have been shown to offer advantages over ECG stress testing in selected populations. However, few data are available regarding the comparative utility of thallium versus ventriculographic imaging. As part of a prospective study to assess the efficacy of cardiovascular nuclear medicine studies, we undertook the present analysis to assess the clinical evolution of these tests and to elucidate factors responsible for clinicians' choice for the often competing examinations. The study examined 213 consecutive patient referrals for thallium scintigraphy and 183 referrals for ventriculography, ranging from patients with no symptoms or highly non-specific chest pain syndromes (21% of referrals) to patients with proven coronary disease (28% of the referrals). Twenty-one percent of patients were referred to confirm the clinical impression that the patient did not have coronary disease, 40% to confirm its presence, and 37% to determine its severity.

Analyses were undertaken to determine the factors that dictated a preference for thallium scintigraphy rather than ventriculography; only the physician's intent in testing and level of training were significant predictors for a particular nuclear test.

The impact of consensus conferences on physicians was studied in 1985 for the first four conferences Sweden held in 1982–1985. For each conference a main target group was defined as hospital-based physicians in supervisory positions within relevant clinics. Data were collected through a postal survey of all 1,668 members of the four different target groups. The total response rate was 86%. Reported awareness of a particular consensus conference as well as professed knowledge of a single conference statement was high—roughly 90%—for all four conferences. The consensus statement evoked changes in clinical practice according to 7%–10% of the respondents and changes were proportionally higher for physicians in smaller hospitals. Most of the respondents (61%–83%) reported no change, claiming that the consensus statement reflected clinical practices established prior to the conference. The validity of self-reported data is discussed.

This paper presents data on the diffusion to dentists of information from the May 1981 American Dental Association conference and December 1983 National Institutes of Health (NIH) conference on pit and fissure sealants. A mail survey was sent to 521 (72.2¼ returned) randomly selected dentists in general practice and all 47 (76.6¼ returned) pedodontists in the State of Washington. Approximately 70¼ of the dentists were aware that the conferences had taken place and a little over 50¼ were aware of the conference recommendations. Awareness was related to: being a pedodontist, number of continuing education hours taken, number of refereed journals read, and being an officer in a dental organization

The purpose of this paper is to present an update on biomedical technology assessment activities from a United States perspective. In 1985, I described in detail (a) a primary vehicle for technology assessment—the Consensus Development Program (CDP) of the National Institutes of Health (NIH)— and also discussed, in a second paper, (b) the transfer of consensus-enhanced scientific information and some of its impact on U.S. medical practice. Here, I focus on what has transpired during the past year: the changes in the climate in which U.S. technology assessment efforts are being conducted, the consequences of these changes, and the challenges that they pose for all concerned with the provision of quality health care. The first part of this paper centers on the broader framework within which technology assessment plays a role ir the United States. Later, it addresses the specific technology assessment and transfer activities in which the NIH is engaged.

Despite many gains, the United States could do better in preventing health problems in infants and young children, says the congressional Office of Technology Assessment (OTA) in its new report, Healthy Children: Investing in the Future.

Rep. Henry Waxman (D-Calif.), Chairman, Subcommittee on Health and the Environment, Committee on Energy and Commerce, released the report at a hearing.

Through the postmortem examination, pathologists offer the ultimate clinico-pathologic assessment of the efficacy of medical care. Similarly, pathologists can offer a clinico-pathologic assessment of the efficacy of health care technology. Assessment by pathologists has diagnostic authority because it draws on the resources of the laboratories of surgical and necropsy pathology. In this essay we argue for enhancing the accuracy of medical device and biomaterials technology assessment by systematically collecting pathology-oriented data. We recommend the establishment of a pathology-based medical device registry to assess implantable medical device technology by accumulating reports routinely issued by pathology departments throughout the country. We further suggest the establishment of a university-based, industry-supported Medical Device and Biomaterials Pathology Institute to operate the registry, collect recovered, used health care devices, and generate definitive, pathology-based, primary data for he lth care technology assessment

An interagency task force would be the best way to coordinate the many research and technology development projects aimed at mapping and sequencing genes, according to a report released by the Office of Technology Assessment at a hearing of the House Committee on Energy and Commerce. The immediate goal of these projects is not to completely understand human genetic information, but to create tools and lay a foundation to understand human genetics in the 21st century, OTA reports.

Professional societies in general are designed to support and raise the prestige of the professions they represent, and the most overt way in which they do this is by attempting to keep the level of information concerning their profession as high as possible.

Traditionally, the predominant type of transfer of information has been scientific papers presented at meetings for the memebership, and this it still so in many cases. The large amount of information communication in this way, and its significance, is beyoned doubt.

The Council on Health Care Technology of the Institute of Medicine, National Academy of Sciences, has published the Medical Technology Assessment Directory. The 712 page directory is an extensive compilation and description of activities in the field.

The publication is designed to help crystallize the subject matter of medical technology assessment and to identify and serve the emerging network of individuals, organizations, and institutions that generate and use technology assessments. The directory provides access to assessment people, programs, and resources to keep users up to date on developments in the field. It should be useful for reviewing available assessments of a particular technology before beginning an assessment project or making a decision on coverage, reimbursement, acquisition, medical practice, or standard setting.

The directory includes profiles of 68 assessment programs and a total of approximately 3,200 bibliographic citations of their assessment reports. These programs are located in public and private sector organizations, including professional, scientific, and industry associations, biomedical research institutions, educational institutions, government advisory bodies, regulatory agencies, third party payers, policy institutes, and for-profit corporations.

Technology assessment in its broadest sense is essential if the highest quality of health care is to be matched to available resources. The results of technology assessment will be meaningful only if they can be transferred in a manner that affects practice as well as policy. Therefore, although we are still far short of an effective system for technology assessment, it is not too early to begin grappling with the problems of transferring the results of such a system when it exists.

In considering future developments in information transfer, it is important to keep several caveats in mind.

Prior to the nationwide diffusion of a new technology, evidence must be assembled to demonstrate that a new technology is, in the terminology of WHO, appropriate. Not everything that is new in health technology is good; not all that is good is needed. It is by no means unethical to demand adequate assessment of new technology before it is diffused. On the contrary, it is unethical to squander resources on hazardous and uneffective treatment. Of the methods available for assessment, the randomized clinical trial is among the most valuable. Randomized clinical trials cannot, however, solve all problems. Speed is a critical element. It is not ethical to permit excessive delay. Balanced, relevant, and informative studies must be conducted as quickly as possible and with a maximum of international collaboration. WHO has a valuable role to play in advising on, coordinating, supporting, and disseminating the findings of such studies.

Human growth hormone (GH) has until recently been prepared commercially from pituitary glands collected at autopsy. Availability has been limited and cost high, so the indications for GH treatment have had to be “tight.” Owing to recent development in hybrid DNA technology, the availability of GH has increased dramatically. At the same time, the manufacturers have maintained constant prices, so that treatment costs continue to influence decision making about its use. This rapid transition has generated an interesting change of strategy, which is outlined in this review.