August 1972

Cost Allocation and the Evaluation of New Procedures

Arch Intern Med. 1972;130(2):295-296. doi:10.1001/archinte.1972.03650020111020

Recently Dr. Lewis Thomas brought sharp focus to bear on the issue of the relative costs of the various technologies available for the practice of medicine.1 He succinctly summarized three forms of technology that physicians now use: the first is the "supportive therapies," or essentially the "nontechnology," which is designed primarily to make patients comfortable and is best illustrated by how we treat "... untreatable intractable cancer, severe rheumatoid arthritis, multiple sclerosis, stroke and advanced cirrhosis," and also how we reassure patients when they are anxious and concerned; the second, are the "halfway technologies," the steps that treat the consequences of illness once it has been established, such as implantable pacemakers for heart block, hip replacement for destructive arthritis, chronic hemodialysis for end-stage glomerulonephritis; and the third are the definitive technologies, such as antimicrobial therapy for bacterial disease, hormone replacement for specific deficiency states, and vaccination to prevent the illness

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