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Technology & Medicine |
PROLOGUE
Technology And Medicine
PROLOGUE: From the advent of the scalpel to the mapping of the human genome, scientific and technological breakthroughs that feed the medical enterprise have grown increasingly sophisticated and sublime, with correspondingly greater power to serve the ends of medicine. Among the more spectacular developments of the twentieth century are the rise of electronic information and communications systems and the science of genetics. The former are transforming the ways in which patients and doctors use medical information and are reshaping physician-patient interactions, while the latter offers the promise of a revolution in therapeutic and diagnostic techniques that is the stuff of science fiction. But emerging technologies are not without a dark side, as evidenced by a recent Equal Employment Opportunity Commission lawsuit against the Burlington Northern and Santa Fe Railway Company in which thirty-six employees accused the railway of covert genetic testing. The case recently ended in a settlement, with the railway paying $2.2 million to the plaintiffs. What might be most clear at this point is that understanding the full benefits and dangers of modern developments is no small task, and questions involving the exploitation and optimization of their uses will likely keep entrepreneurs, researchers, physicians, lawyers, and policymakers occupied for years to come.
The following papers explore in depth several policy issues surrounding communication and information technologies as they are used in health care and the use of genetic information in pharmacotherapy. The papers are must reading for anyone interested in the future of health policy. In the lead essay John Robertson, Baruch Brady, Allen Buchanan, Jeffrey Kahn, and Elizabeth McPherson point out that while genetic science has the potential to customize pharmacotherapy to a point where adverse drug events are a thing of the past, a host of scientific, economic, ethical, and legal issues must be resolved before the science can be put to responsible, fair, and effective use. The authors lay out challenges for the drug industry, regulators, physicians, patients, and insurers.
Next, Tracy Miller and Arthur Derse acknowledge that online communication between physicians and patients can be an effective part of medical care. However, they urge lawmakers to recognize the distinction between the provision of information, on the one hand, and the practice of medicine, on the other hand, and to institute new standards by which to regulate online medicine, rather than forcing the new practices onto a Procrustean bed of outmoded thinking.
Finally, David Doolan and David Bates observe that despite evidence that computerized physician order entry systems reduce medication errors in hospitals, few hospitals use such systems. The authors explore the reasons for this and offer suggestions for removing barriers to more widespread adoption of this technology.
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