Time's Harvest: Exploring the Future; Technology's Heartbeat

<v Speaker>The following is a presentation of the National University Consortium. <v narrator>The human heart mechanically, a simple pump <v narrator>beating 100000 times a day, billions of times in a lifetime.

<v narrator>This center of human life, not just for what it does, but for the symbolism <v narrator>we attach to it. <v narrator>It aches when we miss a loved one, breaks when we lose a lover. <v narrator>Its beat is the symbol of life itself. <v narrator>And now we can replace it. <v narrator>In 1965, a year in which seven hundred twelve thousand Americans died <v narrator>of heart disease. The U.S. Congress made the development of a totally implantable <v narrator>artificial heart, a national goal. <v narrator>It was supposed to take five years and cost 40 to one hundred million dollars. <v narrator>Predictions that have missed by some 13 years and one hundred million dollars

<v narrator>so far, this heart is not totally implantable. <v narrator>The patient must be tethered to the power source. <v narrator>Nevertheless, it is an impressive achievement. <v Chase Peterson, M.D.>Dr. De Vries has been in surgery now for five and a half <v Chase Peterson, M.D.>hours. The patient is doing well at the present time. <v Chase Peterson, M.D.>And I'm pleased to say that it's been now 50 minutes since the patient was off. <v Chase Peterson, M.D.>The heart lung machine, namely the last 50 minutes. <v Chase Peterson, M.D.>The patient has been sustained by his own new heart. <v narrator>Like all technologies, the artificial heart raises questions of cost, <v narrator>benefits and risks, ethical and social questions, questions that require <v narrator>careful consideration in studies known as technology assessments. <v narrator>For if we are to manage the future.

<v narrator>We must anticipate the effects of technology and prepare. <v narrator>With the artificial heart, we haven't done either. <v narrator>Very well. <v narrator>The first artificial heart study was completed in 1966, a time <v narrator>of great technological confidence. <v narrator>If we could launch rockets, surely it would be easy to duplicate a simple blood <v narrator>pump. <v John Bunker, M.D.>In the absence of good data <v John Bunker, M.D.>we've systematically tended <v John Bunker, M.D.>to be optimistic. <v John Bunker, M.D.>In fact, very systematically, it's now been well-documented. <v John Bunker, M.D.>The poorer the evidence on which our evaluations are formed, <v John Bunker, M.D.>the greater the enthusiasm or optimism that we have. <v John Bunker, M.D.>And I am absolutely convinced that <v John Bunker, M.D.>this is the single most important reason for the

<v John Bunker, M.D.>what we assume are what I believe is large <v John Bunker, M.D.>overutilization of medical and surgical procedures, hospitalizations. <v John Bunker, M.D.>Everything we do, I guess it's it's it's understandable. <v narrator>John Bunker has done numerous technology assessments, including one in 1979 <v narrator>on the artificial heart. <v John Bunker, M.D.>Want to get fixed-. <v Deborah Lubeck, Ph.D.>In those reports-. <v narrator>One of his colleagues is health economist Deborah Lubeck. <v narrator>She talks about that first artificial heart study in 1966. <v Deborah Lubeck, Ph.D.>These that report also assumed that the heart could be used by one <v Deborah Lubeck, Ph.D.>hundred thousand patients a year and that the cost would be about ten thousand <v Deborah Lubeck, Ph.D.>dollars per patient per year. Again, this is in 1966 dollars. <v Deborah Lubeck, Ph.D.>So those costs were very low in 1966 and are definitely extremely <v Deborah Lubeck, Ph.D.>low in in terms of the dollars today. <v Deborah Lubeck, Ph.D.>They also assume that the artificial heart implantation would not strain existing medical <v Deborah Lubeck, Ph.D.>resources or hospital resources at all. <v Deborah Lubeck, Ph.D.>And we found in 19-, 1980s that this isn't true, that many hospitals

<v Deborah Lubeck, Ph.D.>will not get involved in heart transplantation because it takes a large number <v Deborah Lubeck, Ph.D.>of surgeons and especially nurses and hospital assistants <v Deborah Lubeck, Ph.D.>and a great deal of post-operative recovery. <v Deborah Lubeck, Ph.D.>Time for a patient for one transplant that might be used by many other patients <v Deborah Lubeck, Ph.D.>who have other forms of heart surgery. <v narrator>In 1968, another review committee was formed to examine this objective heart <v narrator>replacement, including transplants and the artificial heart. <v narrator>Historian Barton Bernstein has studied the history of the artificial heart program. <v Barton Bernstein, Ph. D>By 68, 69 became clear that so far they had not found an acceptable <v Barton Bernstein, Ph. D>biomaterial which could interact safely with the blood. <v Barton Bernstein, Ph. D>They had not yet found an external and internal power source, <v Barton Bernstein, Ph. D>which would be reliable, compact, safe and cheap. <v Barton Bernstein, Ph. D>And furthermore, they had not yet learned how to simulate the autonomic nervous system. <v Barton Bernstein, Ph. D>That's the nervous system, which, among other things, regulates the heart in such a way

<v Barton Bernstein, Ph. D>that it gives us what we need to run or sit, climb stairs <v Barton Bernstein, Ph. D>or lie in bed. So basically what they're saying is there were fundamental scientific <v Barton Bernstein, Ph. D>problems which existed, had not been solved and were not imminently soluble. <v narrator>The first two studies had been done by technical specialists in 1973. <v narrator>A third group was formed to study the artificial heart. <v narrator>It was much different. <v Deborah Lubeck, Ph.D.>That group consisted of a priest ethicist, several economists, <v Deborah Lubeck, Ph.D.>several lawyers, as well as biomedical specialists. <v Deborah Lubeck, Ph.D.>And they were concerned with the technical problems of the artificial heart. <v Deborah Lubeck, Ph.D.>But they also raised questions about equitable distribution of the heart, the <v Deborah Lubeck, Ph.D.>protection of subjects of research involved in the artificial heart, <v Deborah Lubeck, Ph.D.>and address the issues of quality of life, the value of human life, <v Deborah Lubeck, Ph.D.>and whether an artificial heart might be the best way for an individual to to lead out <v Deborah Lubeck, Ph.D.>their lives. And these are issues that now are considered an essential

<v Deborah Lubeck, Ph.D.>part of a technology assessment that had not been considered in evaluations prior <v Deborah Lubeck, Ph.D.>to that time. <v Barton Bernstein, Ph. D>Generally, the enterprise of the quest for the artificial heart has assumed that if <v Barton Bernstein, Ph. D>and when they create a totally implantable artificial heart. <v Barton Bernstein, Ph. D>Everybody who receives it will live a long and comfortable life. <v Barton Bernstein, Ph. D>Now, that is a perfectly acceptable definition, is a peculiar notion <v Barton Bernstein, Ph. D>about reality. <v Barton Bernstein, Ph. D>There's nothing illogical about contending that everybody will live forever. <v Barton Bernstein, Ph. D>It just doesn't happen. Since people die in operations that are even minor. <v Barton Bernstein, Ph. D>Anesthesia is not always perfect and mistakes are made on the operating table <v Barton Bernstein, Ph. D>and devices, even in space shuttles, fail. <v Barton Bernstein, Ph. D>Why are some of the artificial heart would be the unique exception. <v Barton Bernstein, Ph. D>Only some combination of euphoria and unreality can propel <v Barton Bernstein, Ph. D>fuel and guide such peculiar kinds of technology assesments. <v narrator>The 1973 study, despite raising important questions for the first time,

<v narrator>continued to mandate the quest for the artificial heart. <v narrator>Another assessment in 1979 focused even more on matters of cost. <v narrator>If the technology works. <v narrator>Who will pay for it? Today, after four studies, this question still <v narrator>has not been answered for beneath it. <v narrator>There is a question we don't like to face. <v narrator>How much is human life worth? <v Richard Micherdzinski>I don't think you can equate that kind of thing with money. <v Richard Micherdzinski>Research, advancement of anything as <v Richard Micherdzinski>important as life itself or to the promotion of life or the development <v Richard Micherdzinski>of life. <v Richard Micherdzinski>I don't think you can do this with saying how much would it cost? <v Richard Micherdzinski>You know, because the mind, you know, it always goes back to the mind. <v Richard Micherdzinski>It's a very precious thing. Life is a very precious thing. <v Robert G. Mitchell>Money. The money will always be there. If it isn't funded by the government or the

<v Robert G. Mitchell>insurance companies, it'll come from someplace. It always has. <v Robert G. Mitchell>It always will. <v John Bunker, M.D.>Well, we are now at the point where we can do more in medicine <v John Bunker, M.D.>than we can pay for. At the moment. <v John Bunker, M.D.>Oh, we're approaching 10 percent of the GNP invested <v John Bunker, M.D.>in medicine and maybe society's willing to keep going. <v John Bunker, M.D.>But I don't think we can count on that in any event. <v John Bunker, M.D.>Society or its representatives in the Congress or somebody is going to have to decide <v John Bunker, M.D.>where it's got to stop and one of the things <v John Bunker, M.D.>which I would think was an appropriate question to ask the public is, <v John Bunker, M.D.>do you want this much money invested in an artificial heart? <v narrator>Despite concerns about cost. <v narrator>Development of the artificial heart continues here at Thoratec <v narrator>Laboratories in Emeryville, California. <v narrator>Scientists look forward to a less expensive artificial heart.

<v John H. Lawson, Ph. D>As for the cost of the artificial heart, it's it should be relatively inexpensive <v John H. Lawson, Ph. D>once it has been developed. <v John H. Lawson, Ph. D>If you compare it to other procedures that are done presently to take <v John H. Lawson, Ph. D>care of patients who have heart disease, one of the reasons we're working on artificial <v John H. Lawson, Ph. D>hearts is because when an- successful, artificial heart is developed. <v John H. Lawson, Ph. D>It can be manufactured. It can be stamped out unlike a heart transplant. <v narrator>At Temple University, Dr. Jacob Kolff has been developing surgical techniques <v narrator>for the implantation of the artificial heart. <v narrator>He questions the validity of any cost estimate. <v Jack Kolff, M.d>Unless you know exactly what the technology is able to do. <v Jack Kolff, M.d>And unless you can exactly determine the demand for that particular <v Jack Kolff, M.d>technology or the, or get a full understanding <v Jack Kolff, M.d>of all the applications of that particular technology. <v Jack Kolff, M.d>Its very difficult to assess where it's going

<v Jack Kolff, M.d>and the overall cost benefit effect that you might have. <v Jack Kolff, M.d>Now with the first application, but over the subsequent years. <v Jack Kolff, M.d>So if you ask economists, they'll come right back and ask, give us data. <v Jack Kolff, M.d>And so they come back to the scientist says, what's the data? <v Jack Kolff, M.d>And if we don't have the data like we don't have it for an artificial heart, <v Jack Kolff, M.d>they'd be very difficult to predict what it's going to cost, what its <v Jack Kolff, M.d>total effect is going to be. <v narrator>Nevertheless, for the people who are involved in technology assessment, the cost <v narrator>remains a major consideration. <v Deborah Lubeck, Ph.D.>If we look at only 32000 patients a year receiving the device at a very low cost, <v Deborah Lubeck, Ph.D.>we're talking about a program that would automatically run a billion dollars a year just <v Deborah Lubeck, Ph.D.>for the individual implantation itself. <v Deborah Lubeck, Ph.D.>Not counting continuing medical care. <v Deborah Lubeck, Ph.D.>But if we're talking about 60000 patients a year, we might run a program that <v Deborah Lubeck, Ph.D.>costs five billion dollars a year.

<v Deborah Lubeck, Ph.D.>Now, these are sums that are much larger than any other medical care program today. <v Deborah Lubeck, Ph.D.>That would be five times the cost of end stage renal disease program. <v Deborah Lubeck, Ph.D.>Five times the cost of coronary bypass surgery. <v Deborah Lubeck, Ph.D.>And then we need to be concerned with who will pay for artificial heart implantation <v Deborah Lubeck, Ph.D.>and continuing medical care, which might run several thousand dollars a year. <v Deborah Lubeck, Ph.D.>We experienced with the artificial kidney that when patients weren't able to pay. <v Deborah Lubeck, Ph.D.>We didn't want to deny them access to a device. <v Deborah Lubeck, Ph.D.>So the government agreed to cover the cost of the artificial kidney <v Deborah Lubeck, Ph.D.>through special amendments to the Social Security program. <v Deborah Lubeck, Ph.D.>If the government were to do that again today, that would be an enormous cost. <v Deborah Lubeck, Ph.D.>Each year, as we said, something from two to five billion dollars a year, that's <v Deborah Lubeck, Ph.D.>far dwarfs the sums that have been spent so far on research and development. <v Deborah Lubeck, Ph.D.>The same time, if we don't cover the procedure through government funding, <v Deborah Lubeck, Ph.D.>we might be denying the procedure to people who have supported <v Deborah Lubeck, Ph.D.>the research through their tax dollars.

<v Deborah Lubeck, Ph.D.>And we're going to be faced with an ethical dilemma about which approach we want to take. <v Daniel Callahan, Ph. D>We'll have to say we can't spend an infinite amount <v Daniel Callahan, Ph. D>of money on this this one disease. <v Daniel Callahan, Ph. D>Not only do we have other competing health needs, but of course we have competing social <v Daniel Callahan, Ph. D>needs as well. Education, transportation, national defense, the environment. <v Daniel Callahan, Ph. D>And I think the story in the future technologies is we'll probably <v Daniel Callahan, Ph. D>be in a position to say, yes, if we have more money, we could do more. <v Daniel Callahan, Ph. D>However, we can't spend all of our money here. <v Daniel Callahan, Ph. D>We have to find some way of rationing the resources we have. <v narrator>But even if society did decide that the cost of a technology such as the artificial <v narrator>heart would be too expensive. <v narrator>Could anyone really stop it? <v Barton Bernstein, Ph. D>The Congress had very little interest in the matter. <v Barton Bernstein, Ph. D>We're talking about a 10 million dollar a year project at a time when the NIH <v Barton Bernstein, Ph. D>budget was already well above a billion, when the national budget was running into

<v Barton Bernstein, Ph. D>the hundreds of billions. That's a case where the National Heart Institute and the <v Barton Bernstein, Ph. D>artificial heart program were generally the instigators, <v Barton Bernstein, Ph. D>conceivers, evaluators. <v Barton Bernstein, Ph. D>People who chose the contracts assessed fulfillment of contracts, in a sense, you can say <v Barton Bernstein, Ph. D>they had global responsibility designated by themselves, allowed by Congress, <v Barton Bernstein, Ph. D>promoted by the bureaucratic structure. <v Barton Bernstein, Ph. D>So they did everything. And therefore, they were assessing themselves. <v Barton Bernstein, Ph. D>Not surprisingly, they seldom assessed themselves critically and never harshly. <v Barton Bernstein, Ph. D>So it was a very easy matter as progress was less speedy than they had hoped. <v Barton Bernstein, Ph. D>Simply for them to readjust the schedule. <v Barton Bernstein, Ph. D>Many who deal with technology and this has been true in Western society <v Barton Bernstein, Ph. D>and reached a apex, I think in the 1950s and early 60s, <v Barton Bernstein, Ph. D>believe that most things that can be conceived can be done technologically. <v Barton Bernstein, Ph. D>It's only a matter of will, money, physical

<v Barton Bernstein, Ph. D>resources. And hence it, even when estimates prove wrong, <v Barton Bernstein, Ph. D>rather than not propelling reconsideration that propels instead <v Barton Bernstein, Ph. D>continued incentive. There's almost no events that can occur. <v Barton Bernstein, Ph. D>For most technologists, which will lead them to give up the quest. <v Barton Bernstein, Ph. D>So the quest for glory, the belief in the activity, <v Barton Bernstein, Ph. D>the fact that it's their vocation, their career and incomes depend <v Barton Bernstein, Ph. D>upon itm, all lead them comfortably in the same direction to continue. <v narrator>Considerations of cost lead to larger moral questions. <v narrator>For example, if artificial hearts are a scarce resource. <v narrator>How do we decide who gets one and who doesn't? <v Daniel Callahan, Ph. D>Let's say a scientist working in an artificial on bettering the artificial heart who <v Daniel Callahan, Ph. D>had no depends but representative a real national asset <v Daniel Callahan, Ph. D>and resource, well.

<v Daniel Callahan, Ph. D>At that point, I think anyone might find it very difficult to decide between that <v Daniel Callahan, Ph. D>person, say, and somebody who's lived a fairly poor lifestyle person, who <v Daniel Callahan, Ph. D>got the heart disease in the first place because he didn't take care of himself. <v Daniel Callahan, Ph. D>But who happens to have three or four children who are dependent on it, then I think you <v Daniel Callahan, Ph. D>could almost flip a coin. Morally speaking, because there there'd be no very clear, <v Daniel Callahan, Ph. D>rational way, I think, of coming to a perfect solution. <v Robert G. Mitchell>I don't believe you can differentiate between a doctor, a football player, <v Robert G. Mitchell>a locomotive engineer or anything else. If you are suffering, you're a human being. <v Robert G. Mitchell>And I believe it should go that way. <v Robert G. Mitchell>If you've got one or two or three months to live. <v Robert G. Mitchell>Give this person a heart. Give them a chance. <v Daniel Callahan, Ph. D>Perhaps the largest question is whether it's a good idea to do it at all. <v Daniel Callahan, Ph. D>What would the benefits be and what might some of the harms be? <v Daniel Callahan, Ph. D>Clearly, there are lots of people whose lives could be saved <v Daniel Callahan, Ph. D>for a time by an artificial heart, and their

<v Daniel Callahan, Ph. D>heart disease is one of the major killers in this country. <v Daniel Callahan, Ph. D>That that's clearly a benefit. <v Daniel Callahan, Ph. D>On the other hand, I suppose you might ask. <v Daniel Callahan, Ph. D>It may sound a little strange to do so, but, <v Daniel Callahan, Ph. D>you know, can we. How far can we go in trying to further <v Daniel Callahan, Ph. D>extend people's lifespan? <v Daniel Callahan, Ph. D>And that's, I think, a very hard question to answer. <v Daniel Callahan, Ph. D>Nobody wants to die. We'd all like to live longer. <v Daniel Callahan, Ph. D>On the other hand, of course, as our population lives longer and <v Daniel Callahan, Ph. D>longer we, we create a whole new set of social problems. <v narrator>Another important question involves allocation of resources. <v narrator>Why develop this particular technology rather than putting our money somewhere else? <v Barton Bernstein, Ph. D>There's at least some evidence that preventive medicine would have in the long run <v Barton Bernstein, Ph. D>advance the health and welfare more people and would be technologically <v Barton Bernstein, Ph. D>simpler and therefore some would contend, myself included, more appropriate. <v David J. Farrar, Ph. D.>Obviously, prevention is a very major area that would solve

<v David J. Farrar, Ph. D.>all of our problems. But even if we prevented disease tomorrow, <v David J. Farrar, Ph. D.>we have a number of generations that will be developing heart disease before <v David J. Farrar, Ph. D.>in the next 10, 20, 30 years. That would require some sort <v David J. Farrar, Ph. D.>of therapy in this area. <v Jack Kolff, M.d>There are a couple of factors that enter into it. <v Jack Kolff, M.d>One is, what is the probability that you will ever find <v Jack Kolff, M.d>a means by which to prevent the disease? <v Jack Kolff, M.d>If the probability is zero or one percent, then <v Jack Kolff, M.d>you can see that no matter how much money you put into it, it will never pay off. <v Jack Kolff, M.d>So then it becomes obvious that you are better off cost benefit speaking <v Jack Kolff, M.d>to cure the disease once it's developed. <v Jack Kolff, M.d>Or at least to ameliorate the effects of the disease once it's developed. <v narrator>Another question raised in assessments of the artificial heart concerns <v narrator>quality of life.

<v Barton Bernstein, Ph. D>What will it mean? To an individual to receive an artificial heart and suddenly to be <v Barton Bernstein, Ph. D>plucked from the number of death to be promised life. <v Barton Bernstein, Ph. D>Will artificial hearts last very long? <v Barton Bernstein, Ph. D>Will the suicide rate be higher? At present, we know that the suicide rate for people on <v Barton Bernstein, Ph. D>dialysis, kidney dialysis machines is somewhere between seven and eight times the normal <v Barton Bernstein, Ph. D>rate, holding everything else constant. <v Barton Bernstein, Ph. D>Will it happen for artificial heart recipients? <v Barton Bernstein, Ph. D>If so, what will it mean to them and to their families? <v Barton Bernstein, Ph. D>These are all the questions that warrant sustained analysis and <v Barton Bernstein, Ph. D>so far have received at best passing glances. <v interviewer>Just being short of breath meant much at the time. <v narrator>So far, only one man. <v narrator>Barney Clark, has had the experience of living with an artificial heart. <v interviewer>You remember what this whole thing might go. <v interviewer>Any words of advice for somebody who is going through this again? <v interviewer>If they were to come and sit and ask you what it was like, what would you tell him? <v Barney Clark>I'd tell him that it's worth it? It all turned out to either <v Barney Clark>die or to have it done.

<v interviewer>It's been hard for you, hasn't it, at times Barney? <v Barney Clark>Yes. It's been hard, but the heart <v Barney Clark>itself has pumped right along. <v Barney Clark>And I think it's doing well. <v Daniel Callahan, Ph. D>But clearly, most of the technologies, what they can often <v Daniel Callahan, Ph. D>do is they can extend our physical life, but they can't improve the conditions of our <v Daniel Callahan, Ph. D>life. They can't make us happy. <v Daniel Callahan, Ph. D>They only keep us alive. And what happens thereafter is quite a different <v Daniel Callahan, Ph. D>problem. <v narrator>One of the values of American society has been the technology, for its own sake <v narrator>is good, that it ought to be developed as a manifestation of the human possibility. <v narrator>But do we put too much emphasis on the quest and the achievement and too little <v narrator>on the effect of that achievement? <v narrator>It's important to note that the questions raised in assessing the artificial heart still <v narrator>have not been answered, nor have they slowed the development of the heart.

<v Daniel Callahan, Ph. D>We've we've become very hooked on technology in a basic way. <v Daniel Callahan, Ph. D>And of course, then you have to add onto that a kind of double <v Daniel Callahan, Ph. D>bind, namely that you create one technology to solve one problem, <v Daniel Callahan, Ph. D>and that then that technology creates a new problem. <v Daniel Callahan, Ph. D>Most obvious case, which are mainly one notices, is <v Daniel Callahan, Ph. D>we're, we're now seeing a very large and increasing population of <v Daniel Callahan, Ph. D>elderly in this country. That's good in one sense. <v Daniel Callahan, Ph. D>People are living longer. Meanwhile, however, we don't know how to deal with a <v Daniel Callahan, Ph. D>much larger, increasing number of the elderly. <v Daniel Callahan, Ph. D>Deal with them in any fashion now. <v Daniel Callahan, Ph. D>In that case, there don't seem to be any technological solutions that are <v Daniel Callahan, Ph. D>going to quickly come to the fore. <v Barton Bernstein, Ph. D>Historically, until the last ten or fifteen years, those who have questioned technology <v Barton Bernstein, Ph. D>have been seen as neanderthal. <v Barton Bernstein, Ph. D>As people who've been putting their head in the sand, resisting the waves of inevitable <v Barton Bernstein, Ph. D>and desirable progress, we've tended to forget historically and socially

<v Barton Bernstein, Ph. D>that much technology has injured as well was benefited. <v Barton Bernstein, Ph. D>I think in general we could say, looking at the process of industrialization. <v Barton Bernstein, Ph. D>The benefits have been greater than the injuries, but many were <v Barton Bernstein, Ph. D>injured more than they were benefited. <v Barton Bernstein, Ph. D>What's changing in the last 10 years is we fear that we're coming to the limits <v Barton Bernstein, Ph. D>of desirable technological solutions in many areas. <v Barton Bernstein, Ph. D>We're more aware of the costs, financial and social. <v Barton Bernstein, Ph. D>We're more shocked by costs, which earlier we did not recognize. <v Barton Bernstein, Ph. D>Love Canal poisons danger to the ecology, ruining the environment. <v Barton Bernstein, Ph. D>Injury to patients. All of these things were optimism, blocked us <v Barton Bernstein, Ph. D>from asking other questions and looking at pieces of evidence. <v Barton Bernstein, Ph. D>And sometimes the evidence was not all in. <v Barton Bernstein, Ph. D>All that has led to a process of reconsideration. <v Barton Bernstein, Ph. D>And I think the reconsideration is very healthy. <v Barton Bernstein, Ph. D>Doubts are very healthy, dialog is essential, and some of the

<v Barton Bernstein, Ph. D>projects being considered are undoubtedly dubious. <v narrator>The artificial heart, without question, is an impressive technological advance. <v narrator>But can we afford it? <v narrator>And by spending money to develop it, are we forgoing opportunities in other <v narrator>areas, opportunities that may, in the long run, help more people <v narrator>at a lower cost? <v narrator>These are the kinds of questions that need careful consideration in strenuous technology <v narrator>assessments. Once considered, they must be acted upon. <v narrator>The trouble is that assessing technology can be just as hard as developing it. <v Deborah Lubeck, Ph.D.>Technology assessment is a new methods that we're still exploring <v Deborah Lubeck, Ph.D.>in the best way to do it and to try and set up standards for a technology assessment. <v Deborah Lubeck, Ph.D.>We do know from past experience that a broad based group is really critical and <v Deborah Lubeck, Ph.D.>particularly a group that will look at the long term impacts and the indirect impacts of <v Deborah Lubeck, Ph.D.>a technology assessment.

<v Deborah Lubeck, Ph.D.>We also know that presenting the alternatives to a technology is a critical portion <v Deborah Lubeck, Ph.D.>of a technology assessment so that when we evaluate the artificial heart. <v Deborah Lubeck, Ph.D.>We also want to look at other alternatives to achieve increased <v Deborah Lubeck, Ph.D.>life expectancy for people who might have coronary heart disease, like heart disease <v Deborah Lubeck, Ph.D.>prevention programs. <v Deborah Lubeck, Ph.D.>We also need to gather more information about the best timing for technology <v Deborah Lubeck, Ph.D.>assessments. Worry one of stop a technology and its development and try <v Deborah Lubeck, Ph.D.>and evaluate its future impacts, its future cost, efficacy <v Deborah Lubeck, Ph.D.>and safety. And we also want to be concerned with the best way to diffuse <v Deborah Lubeck, Ph.D.>the results of technology assessments so that we can get it back to clinicians <v Deborah Lubeck, Ph.D.>operating in all areas of the countries and to the health care consumer so that they can <v Deborah Lubeck, Ph.D.>become better educated about the choices they make in their medical technology. <v Speaker>The National University Consortium has been funded in part by a grant from

<v Speaker>the Carnegie Corporation.