Technological Imperatives and Paradoxes

That concepts and techniques for the assessment of diagnostic technologies have been well described since Yerushalmy's article1about total body roentgenography2-4and that these concepts and techniques seem to have had relatively little influence on the diffusion of diagnostic technology in medicine5are paradoxical observations inconsistent with both the scientific basis of medicine and the rhetoric of health care planners and administrators. While science and rhetoric provide a picture of the ideal (which admittedly in the "real" world is rarely achieved) and though the number of decision-makers (each with his or her perspective) influencing the diffusion of health care technology is large, the persistence of this paradox should be of concern. Although one assumes that various decision-makers are well intentioned and seek to promote the use of the best possible health care technology, it must be remembered that behavior rather than intention is of critical importance: "The