Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-23T09:26:30.063Z Has data issue: false hasContentIssue false

Obstacles to Developing and Using Technology: The Case of the Artificial Heart

Published online by Cambridge University Press:  10 March 2009

James H. Maxwell
Affiliation:
M.I.T.
David Blumenthal
Affiliation:
Harvard University
Harvey M. Sapolsky
Affiliation:
M.I.T.

Extract

For some observers, the artificial heart represents the latest, and perhaps the most flagrant example of the health system's tendency to favor the rapid introduction of expensive but ineffective technologies over efforts to prevent disease and to improve access to care (5;6;19;44;45). Even if it can be perfected, they argue, its opportunity cost in terms of other foregone health benefits would be exorbitant. The ultimate failing of the health care system, it would seem, is its failure to establish mechanisms to select among alternative uses of resources. If such mechanisms had existed, some critics believe that the quest for an artificial heart never would have begun and certainly its premature clinical uses could have been prevented (6;45).

Type
Special Section: Transplantation and Artificial Organs
Copyright
Copyright © Cambridge University Press 1986

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Altman, L. K.Utah surgeon moving heart implant program to Kentucky. New York Times, 08 1, 1984, A19.Google Scholar
2.Artificial Heart Assessment Panel of the National Heart Lung and Blood Institute. The totally implantable artificial heart. 06, 1973.Google Scholar
3.Barron, J.Humana focus: Technology. New York Times, 08 14, 1984, D1.Google Scholar
4.Beem, J. R.Artificial heart program considerations. National Heart Institute, 04 6, 1965.Google Scholar
5.Bernstein, B. J.The artificial heart program. Center Magazine, 05/06, 1981, 2241.Google ScholarPubMed
6.Bernstein, B. J.The misguided quest for the artificial heart. Technology Review, 1984, 87, 1219.Google Scholar
7.Bunker, J. P., Fowles, J., & Schaffarzick, R.Evaluation of medical technology strategies: Effects of coverage and reimbursement New England Journal of Medicine, 1982, 306, 620–24.Google Scholar
8.Business Week. Should profit drive artificial hearts? December 10, 1984, 3839.Google Scholar
9.Carter, M.The business behind Barney Clark. Money, 04 1983, 130–44.Google Scholar
10.Chase, M.Firm that builds artificial heart seeks to build bionic market. Wall Street Journal, 07 24, 1984.Google Scholar
11.Cole, H.Artificial heart still holds promise, DeVries says; Program continues. Journal of the American Medical Association, 1985, 253, 2805–13.CrossRefGoogle ScholarPubMed
12. Committee on Interstate and Foreign Commerce. Legislative history of the medical device amendments of 1976.Google Scholar
13.Cooley, D. A.Staged cardiac transplantation: Report of three cases. Heart Transplantation, 1982, 1, 145–53.Google Scholar
14.Cooley, D. A.Heart substitution: Transplantation and total artificial heart. The Texas Heart Institute experience. Artificial Organs, 1985, 9, 1216.Google Scholar
15.Davis, K.Anderson, G., & Steinberg, E.Diagnosis related group prospective payment: Implications for health care and medical technology. Health Policy, 1984, 4, 139–47.Google Scholar
16.DeBakey, M. Cited in J. A. Shannon, Memorandum to the Director of the National Heart Institute with Regard to a Meeting of the National Advisory Heart Council, 1963.Google Scholar
17.DeVries, W. Total artificial heart replacement in man. A proposal to the Review Committee for Research on Human Subjects, University of Utah, February 27, 1981.Google Scholar
18.Edson, L.The search for a bionic heart. New York Times Magazine, 05 23, 1979.Google Scholar
19.Fineberg, H.Irresistible medical technologies: Weighing the costs and benefits. Technology Review, 1984, 87, 1718.Google ScholarPubMed
20.Frommer, P. L. Letter to Glen A. Rahmoeller Regarding Clinical Application of the Artificial Heart, 1981.Google Scholar
21.Grant, R. P. Artificial heart program, attachment: The Artificial Heart Myocardial Infarction Program of the National Institutes of Health. Memorandum of Director, National Institutes of Health from the Director National Heart Institute, April 1, 1966.Google Scholar
22.Green, H.An NIH panel's early warnings. Hastings Center Report, 1984, 14, 1315.Google Scholar
23.Greenberg, G. & Feldman, P. New federalism and state support for technology assessment. In Institute of Medicine, Assessing medical technologies. Washington, DC: National Academy Press, 1985.Google Scholar
24.Harvard Community Health Plan, 1984 Annual Report. A change of heart. 710.Google Scholar
25.Hittman Associates Inc. Final summary report on six studies basic to consideration of the artificial heart program. Baltimore, MD. October 24, 1966.Google Scholar
26.Horecker, B. L. Letter to John F. Sherman, Deputy Director, National Institutes of Health, November 25, 1968.Google Scholar
27.Huffman, F. Thermoelectron Corporation. Interview May 1984.Google Scholar
28.Institute of Medicine. Assessing medical technologies. Washington, DC: National Academy of Sciences Press, 1985.Google Scholar
29.Jarvik, R.The artificial heart. Scientific American, 1981, 244, 7480.Google Scholar
30.Journal of the American Medical Association. Another artificial heart receives FDA approval for clinical trials. 1985, 253, 2617–22.Google Scholar
31.Kolff, W.For the clinical application of the artificial heart. Heart Transplantation, 1982, 1, 159–60.Google Scholar
32.Lane, H., Beddows, R., & Lawrence, P.Managing large research and development programs. Albany, NY: State University of New York Press, 1980.Google Scholar
33.Lenfant, C. & Roth, C.Advances in cardiology and escalating costs to the patient: A view from government. Circulation, 1985, 71, 424–33.Google Scholar
34.Lubeck, D. & Bunker, J.The implications of cost effectiveness analysis of medical technology. Background paper No. 2. Case studies of medical technologies: Case study 9: the artificial heart: costs, risks and benefits. Washington, DC: U.S. Congress Office of Technology Assessment, 1982.Google Scholar
35.Medical World News. Artificial hearts. 06 27, 1985, 26, 4151.Google Scholar
36.Moorehead, R. Warburg Pincus Inc., Interview May 1984.Google Scholar
37.National Heart Lung and Blood Institute, Devices and Technology Branch. Memorandum to Glen A. Rahmoeller, Food and Drug Administration, March 9, 1981.Google Scholar
38.National Heart Lung and Blood Institute. Financial history of the NHLBI Artificial Heart Program. 03, 5, 1984.Google Scholar
39.NIH Guide for Grants and Contracts. Criteria for clinical investigative use for therapeutic devices under contract to the National Heart and Lung Institute. 3, 08 7, 1974.Google Scholar
40.New York Times. U.S. to emphasize heart pump study: Forgoes project to develop complete artificial organ. 11 29, 1966.Google Scholar
41.Norman, J. C. Eighth Annual Hastings Lecture. Devices and Technology Branch Contractors Meetings, National Heart Lung and Blood Institute, December 1984.Google Scholar
42.Office of Technology Assessment. Medical technology and the costs of the Medicare program. Washington, DC, OTA-H–227, 07 1984.Google Scholar
43.Pierce, W.Artificial hearts and blood pumps in the treatment of profound heart failure. Circulation, 1983, 68, 883–88.Google Scholar
44.Preston, T. A.The case against the artificial heart. Utah Holiday, 1983.Google Scholar
45.Preston, T.Who benefits from the artificial heart? Hasting Center Report, 1984, 14, 1317.Google Scholar
46.Rahmoeller, G. Letter to Peter Frommer, Deputy Director of the NHLBI, Regarding the Clinical Application of the Total Artificial Heart, March 5, 1981.Google Scholar
47.Relman, A. S.Privatizing artificial heart research. Connecticut Medicine, 1985, 49, 135.Google ScholarPubMed
48.Report of the Massachusetts Task Force on Organ Transplantation. Department of Public Health, Commonwealth of Massachusetts, October 1984.Google Scholar
49.Rettig, R.The policy debate on patient care financing for victims of end stage renal disease. Law and Contemporary Problems, 1976, 40, 196–31.Google Scholar
50.Richards, B. & Mills, D.Humana's implant of the artificial heart brings capital and competition to growing industry. Wall Street Journal, 02 7, 1985, 4.Google Scholar
51.Ringler, R. L. The artificial heart program: An historical overview. Prepared for the 1969 N.H.I. Task Force on Cardiac Replacement, 1969.Google Scholar
52.Sapolsky, H. M.Government and the development of the artificial heart. In National Heart and Lung Institute. The totally implantable artificial heart: economic, ethical, legal, medical, psychiatric, and social implications, 1973.Google Scholar
53.Sapolsky, H. M.Here comes the artificial heart. The Sciences, 1978, 2527.Google Scholar
54.Shannon, J. A. Artificial heart program. Memorandum to the Secretary, Department of Health, Education, and Welfare. October 4, 1966.Google Scholar
55.Smith, T.Taming high technology. British Medical Journal, 1984, 289, 393–94.CrossRefGoogle ScholarPubMed
56.Springarn, N.Heartbeat: the politics of health research. Washington, DC: Robert B. Luce, 1976.Google Scholar
57.Strauss, M. J.Political history of the artificial heart. New England Journal of Medicine, 1984, 310, 332–36.Google Scholar
58.Strickland, S.Politics, science and dread disease: a short history of United States medical research policy. Cambridge, MA: Harvard University Press, 1972.Google Scholar
59.Thomas, L. The artificial heart. In Late Night Thoughts Listening to Mahler's Ninth Symphony. New York: The Viking Press, 1983, 6468.Google Scholar
60.Watson, J. T.The present and future of cardiac assist devices. Artificial Organs, 1985, 9, 138–43.Google Scholar
61.Woolley, F. R.Ethical issues in the implantation of the total artificial heart. New England Journal of Medicine, 1984, 310, 292–96.CrossRefGoogle ScholarPubMed