EVALUATION OF MEDICAL PRACTICES - CASE FOR TECHNOLOGY-ASSESSMENT

We believe that the systematic evaluation of medical practices, especially those that are risky or costly, deserves more attention. Available methods are limited, and definitive assessments of innovative or controversial practices are infrequent. Nevertheless, some evaluations have successfully enhanced the use of effective practices and diminished the reliance on ineffective ones. Greater efforts at evaluation can improve the quality of patient care, avoid waste and promote the more rational use of health resources. The cost of assessing new practices should be viewed as an intrinsic part of the cost of medical care. Physicians and medical societies bear primary responsibility for recognizing the need for this evaluation, for enlisting other experts, participating in technology assessment and working to translate the results of evaluation into practice. The commitment of government agencies, insurance companies and teaching institutions is also essential to an effective program of evaluation. (N Engl J Med 301:1086–1091, 1979) A FRONT-PAGE story in The New York Times recently reported the claim of a Congressional subcommittee that there were 2 million unneeded surgical operations in 1978, at a cost of $4 billion and more than 10,000 lives.1 The subcommittee recommended several legislative steps to ameliorate the problem. The American Medical Association objected vigorously to the subcommittee's approach and conclusion, citing several ongoing efforts to study the matter and to remedy present deficiencies. The issue of unnecessary surgery evoked passionate, opposing views, highlighting the enormous uncertainty about the appropriate application of surgical practices.2 The questions about unnecessary surgery could have been. © 1979, Massachusetts Medical Society. All rights reserved.