The title which I have been given suggests that in my particular consideration of technology the emphasis should be not on professional attitudes, but on public attitudes, and what might be done to inform and if necessary improve them. At first glance, a sensible approach might be to conduct some kind of survey among “the public” to discover what proportion of people hold particular attitudes towards technology. With little in the way of regret, I shall foreswear that approach, not because I am unacquainted with such surveys, but because I perhaps know them too well. If you ask a completely unloaded question, such as “What is your view of medical technology?”, you will probably get answers, but you will not be able to determine how much they are preconditioned by how much the person knows, and in particular how any recent experience of medical investigation has turned out. That in turn may owe more to the nature of his problem than to the skill with which investigations have been selected and performed. On the other hand, if you ask loaded questions, such as “Is medical technology free of risks?,” you will bias the proportion of replies, and still find the answer no easier to interpret.

The French health system is a complex organization that has developed since 1945 as the result of a subtle combination of two fundamental principles: liberal medicine — the freedom of both the consumers and the producers of care, and solidarity — universal access to health care — embodied in a quasi-generalized system of health insurance (4).

Today, this balance, to which the French are uncontestably dedicated, appears to be precarious. It has gradually become apparent that the financing system—80% of which is based on mandatory deductions and is intended to guarantee the balance between freedom of choice and universal access — is not consistent with the dynamic of health expenditures. The growing costs of care, as witnessed by the increase of health expenses as a percentage of total household expenses from 4.5% in 1950 to 13.3 in 1985, has led to increased state control over the health care system since 1975.

Drs. Weinstein and Wulff (in issue 1:3) have raised legitimate and important concerns about the ethical acceptability and feasibility of randomized control trials (RCTs) of diagnostic technologies. Their criticisms are all the more compelling in light of their strong advocacy of rigorous evaluation, and their insights into the advantages of RCTs and potential problems with alternative approaches as outlined with great clarity in Dr. Weinstein's paper. We shall not attempt a point by point rebuttal (partly because we are in full or partial agreement with most of their comments) but instead will highlight several issues which we believe merit further discussion.

Standardized conditions for blood pressure measurements and strict definitions of systolic and diastolic blood pressure are essential for a consequent management of hypertension during pregnancy. In Sweden, it has been agreed to measure blood pressure with the pregnant women sitting in upright position. Home-monitoring of blood pressure is recommended in women at risk of preeclampsia.

We performed a cost-effectiveness analysis to evaluate whether a pediatrician who suspects an inherited disease of amino acid metabolism should refer the child to a specialist in inborn errors of amino acid metabolism or should prescribe the usual screening test, chromatography of amino acids. Actual hospital costs were used to value the referral, the tests, and the complications that occur when the diagnosis is not recognized. The percent of confirmed diagnoses was chosen as a measure of effectiveness. We conclude that it is more cost-effective for a pediatrician to refer the child to a specialist, that the best strategy in the absence of a referral is to prescribe thin-layer chromatography, and that the least cost-effective strategy is to perform ion-exchange chromatography immediately.

During the last 12 years, most Middle Eastern countries, particularly those focused upon in this study (Algeria, Egypt, prerevolutionary Iran, Iraq, Kuwait, and Saudi Arabia), have placed increasing emphasis on improved health care. This emphasis has been reflected in both budgetary and public policy plans. The strides made in medical care during this period have been enormous, but much remains to be done. Some of the major health problems today involve diseases that have largely been conquered in industrialized countries, such as infectious and parasitic diseases, respiratory infections, problems related to childbirth, and diarrheal disease. Chronic diseases, such as heart disease, which have become common in industrialized countries and to which much of the newer medical technology is addressed, are, by many accounts, far down on the list of health problems in the Middle East. Many Middle Eastern countries need comprehensive public health programs to help meet their goals.

The two components of low birth weight — preterm delivery and fetal growth retardation — lead singly or in combination to a heavy burden of mortality, short- and long-term morbidity, and high medical and social costs. Although different types of long-term morbidity are still being identified, the primary focus of concern has been neurodevelopmental disability resulting from the cerebral palsies, hydrocephalus, and visual and auditory deficits among survivors of very low birth weight. Additional special risks in such infants include chronic lung disease, acute lower respiratory infections, and rehospitalization in infancy and early childhood.

The use of computers in primary care in the United Kingdom has developed without coordination. The present situation is described. The proposal is that policies for improving primary care will be enhanced by appropriate application of information technology. Benefits and obstacles are identified; practical proposals for effective development are listed.

French drug policy is closely controlled by the government to achieve two main purposes: to ensure therapeutic efficacy and safety, and to control pricing. Manufacturers usually price new drugs at the amount the French Sécurité Sociale (Social Security) agrees to reimburse the consumer. The specific steps a new ethical drug must go through in order to be released on the French market, and the process of negotiation between the government and the manufacturer are discussed in this paper.

Statistical analyses that involve regression methods often encounter data in which some observations have substantial influence. This article presents a nontechnical discussion of influence and of two techniques, based on leaving out each individual observation in turn, for diagnosing influential data. An example illustrates the techniques in an analysis of recurrence rates in endoscopic treatment of bleeding peptic ulcers.

It has been suggested that efficacy and safety are the core issues for technology assessment in health care (1). To this must be added the issue of appropriateness (2). Efficacy remains the first issue nonetheless, for surely no one would knowingly evaluate the safety of an ineffective technology.

Although a relative latecomer in the industrialization process, Japan has managed to catch up with the more advanced nations and become a major competitor in the international marketplace for goods and services. As a result of their excellent economic performance and rapid technological development, the Japanese people enjoy a level of general well-being that is among the highest in the world. This is especially true with respect to health status. In terms of most commonly accepted indicators, Japan compares quite favorably with other industrial nations. Indeed, the life expectancy for males of 74.20 years and that for females of 79.78 years in 1984 were the highest in the world.

This study investigates recent changes related to the import and export of medical technology and their results in Turkey. Between 1980 and 1993 the number of medical technology imports in Turkey rose, and there was a parallel rise in its ratio to total imports and health expenditures. In contrast the ratio of medical technology exports to total exports decreased significantly in the same period. The liberalization of foreign trade and the changes of health services toward free market policy has caused growing import of medical technology in Turkey.