International Journal of Technology Assessment in Health Care (review)

BOOK REVIEW InternationalJournal of Technology Assessment in Health Care. A newjournal edited by Egon Jonnson and Stanley J. Reiser. Quarterly, Cambridge University Press, London. Perhaps no specialty faces more acutely the problem of safely and effectively using new techniques and technologies, and the need to objectively and critically evaluate their performance, than intensive-care medicine. The new International Journal of Technology Assessment in Health Care has as its aims the "generation, evaluation, diffusion, and use of health care technology." The journal is intended for a diverse audience including health-care providers, decision makers in government, industry, health-care organizations, and scholarly disciplines of ethics, economics, law, history, sociology, and engineering. Does this journal have claim to the attention of the busy clinician who cares for critically ill patients ? Each issue is planned to contain a special section focused on a particular topic, general articles, and regular feature sections. The inaugural issue's special topic is technology and health care for the elderly, and this section includes articles on "Intensive Care for the Elderly," "Medical Technology for the Elderly inJapan," "End-stage Renal Failure and the Aged in the United Kingdom," "Orthopedic Technology for the Elderly," "Pacemakers," "Visual Rehabilitation for the Elderly through Improved Surgical Technology," "Neuronal Replacement after Traumatic or Age-dependent Brain Damage," "Audio-visual Programs in the Reality-Orientation Training of Alzheimer's Victims," and "Aspects of Psychological Aging and Technology." Two general essays in this issue are "Medical Technology Assessment: The Evaluation of Coronary Artery Bypass Graft Surgery Using Data Synthesis Techniques," and "Diagnosing Suspected Stroke: A Cost Effectiveness Analysis." The section on technology assessment reports on findings from the United States Office of Technology Assessment, the Clinical Efficacy Assessment Project of the American College of Physicians, the National Institutes of Health's Consensus Development Conference on Fresh Frozen Plasma, and the Swedish Medical Council and Swedish Planning and Rationalization Institute's Consensus Statement on Sight Improving Surgery. The emerging technology section has two articles on extracorporeal shock wave lithotripsy. Issues will contain regular sections on world perspectives, statistics, reviews, short reports, meetings and announcements, and a section entided the sorcerer's apprentice that will consider less formal topics including "parodies, satires, and other humorous items." Permission to reprint a book review printed in this section may be obtained only from the author. Perspectives in Biology and Medicine, 31, 1 ¦ Autumn 1987 \ 151 The article on "Intensive Care for the Elderly" by BryanJennett, M.D., of the University of Glasgow lists five categories of illness that bring adult patients to intensive-care units: myocardial infarction; postoperative care; respiratory, renal , or hepatic failure; coma; and hemorrhage or shock. He reviews studies of the outcome of intensive care and concludes "what such studies of outcome of intensive care indicate is that in patients whose outcome can be influenced, the details of the regimes and technologies matter less than the advantage that accrues from attracting the intensive attention of doctors and nurses." While it may be true that alternative therapeutic regimes can achieve similar outcomes, it is the intensivist's skillful attention to detail that achieves these outcomes. A framework for discussing controversial ethical issues in intensive-care decision making is outlined based on the principles of beneficence, nonmaleficence, patient autonomy, andjustice. The article is followed by two commentaries. David Barnard, Ph.D., of the Institute for Medical Humanities, University of Texas Medical Branch, elaborates on the partial truth of the equivalence of technical and moral excellence in medicine. A second commentary byJohannes O. Vang, M.D., Ph.D., of the Office of Health Technology Assessment of the World Health Organization places the economic cost of intensive care in the context of other technologies for health care and criticizes Dr. Jennett for omitting questions of discomfort, suffering, and dignity in intensive care. The article and commentaries are interesting and thought provoking, but their brevity limits their ability to elucidate the complex issues involved in intensive care. I would prefer longer articles with more attention to the subdeties that physicians face in their use of technologies for individual patients. Future issues will cover advanced technology and health care in the home, nuclear magnetic resonance, prenatal care, use and abuse of routine...