Technology follies. The uncritical acceptance of medical innovation

"WHAT procedures or practices are we involved in now which will rank with bloodletting as a folly of our time?"1 The need for ongoing assessment of both new and old medical technologies is undisputed.2-6Nevertheless, much, if not most, of contemporary medical practice still lacks a scientific foundation.7,8Recent reviews of emerging technologies suggest that little progress has been made in requiring rigorous evidence of efficacy or validity before adoption and dissemination of new technologies.9-11 The road to medical progress has been littered with potholes—or, more accurately, craters. While some new technologies have clearly improved health and reduced costs, others have not. For example, the introduction of D immune globulin dramatically reduced hemolytic disease of the newborn in the United States, as did the use of vaccines for several infectious diseases. Similarly, the advent of laparoscopic tubal sterilization improved the safety of this operation and made