Multiple Endpoints in the Assessment of Non-Invasive Technology

Abstract

In 1966, $42.1 billion or 5.9 percent of the Gross National Product (GNP) was spent on health care. By fiscal year 1976, health care spending had more than tripled — growing to $139.9 billion — and consumed about 8.6 percent of the GNP. (See Washington Post, May 8, 1977, p. Al et seq.) Between 1965 and 1974, according to a congressional estimate, half of the 27.7 billion increase in hospital care costs could be accounted for directly or indirectly by the introduction of new medical technology as cited by Culliton (1977). Despite these large dollar increases, data showing that more spending has resulted in improved health are unavailable. The biomedical community and clinical medicine especially can no longer afford the luxury of costly development, wasted initial expenditure, and ultimate attrition by disrepute — a sequence characterized in gastric freezing techniques for the control of upper gastrointestinal hemorrhage and in hyperbaric oxygen chambers, to name two fairly recent medical fiascos.