The Dutch physicist Gorter predicted in 1936, on theoretical grounds, the existence of the magnetic resonance (MR) phenomenon. This was ten years before Felix Bloch and Edward Purcell, independently of each other in different experimental settings, demonstrated it. Current medical and biological applications of magnetic resonance imaging and spectroscopy are directly derived from in vitro tissue studies performed in the 1960s and 1970s. Although Odelbiad and co-workers published as early as 1956 an MR study of human red blood cells, this and other early work was limited by the unavailability of suitable MR instrumentation.

It has been repeated ad nauseam in recent years that health care is changing rapidly. Today even the pattern of change itself is in flux: modifications seem to be accelerating and shifts are of a more profound nature. Moreover, the prevailing changes are highly interactive and send ripples through a health care arena which presents all the symptoms of turmoil.

Prenatal care is all of the care that a pregnant woman receives from organized health care services, as well as from family, relatives, and friends. It begins with planning for pregnancy, and should be seen by those who give it as part of a process that continues through labor and delivery and into the neonatal period. The primary aim of prenatal care is promotion of maternal and fetal health, viewed as a unit until the pregnancy reaches full term (3). This encompasses the goals of reducing maternal and infant mortality and morbidity, detecting early factors that heighten the perinatal risk in both individual pregnancies and vulnerable groups, intervening to improve outcomes, educating all who provide or receive prenatal care, and helping women make their pregnancies and birth a positive life experience.

In 1979, maternal and child health issues were discussed during the annual meeting of the 33 Member States of the European Region of the World Health Organization. During this discussion many countries expressed concern about the services offered for pregnancy, birth and the period following birth. The countries recognized that, as yet, unsolved problems remain which must be examined and they asked the European Regional Office of WHO to mount activities to study and report on these problems surrounding birth and birth care. In response to this request, the maternal and child health unit of the European Regional Office organized a Perinatal Study Group. The Group's 15 members came from 10 countries and spanned 10 professional disciplines: economics, epidemiology, health administration, midwifery, nursing, obstetrics, pediatrics, psychology, sociology, and statistics. For five years the Group conducted surveys, reviewed the literature and brought its own personal and professional experience to discussions of the health services for women and their babies, during pregnancy and birth, and after birth. The entire group met together at least once a year, at which time findings from the previous year's work were presented, followed by lengthy, sometimes heated, open and free discussions.

In the United States, there is growing determination among health care institutions to slow down cost increases, particularly in acute hospital situations.

One major strategy is to finance and deliver more health care in the home, which is seen as less expensive than institutional alternatives, of equal quality, often more humane, and preferred by many patients. As a result, this practice will most likely become more prevalent as long as quality of care is sustained, even if the costs are comparable to hospital care.

The physical phenomenon of nuclear magnetic resonance (NMR) was first characterized almost forty years ago in 1946 by the simultaneous but independent experimental successes of American scientists Felix Bloch and Edward Purcell. Their discoveries prompted development of conventional NMR spectroscopy. a technique used to describe the molecular composition and behavior of chemical compounds. Twenty-five years later, in 1971, Damadian used NMR to demonstrate differences in the behavior of water in malignant and benign tissues, and he suggested that NMR possessed “many of the desirable features of an external probe for the detection of internal cancer” (7). In the same year, Lauterbur produced the first two-dimensional NMR image, a cross-sectional portrait of two tubes of water (25). The potential utility of this technique to medical imaging was obvious, and soon afterwards multiple researchers began development of clinical NMR imaging systems. The first human whole-body NMR scan was accomplished by 1977. Improvements in the scanning process and image quality continue with, as yet, no limits in sight. In this clinical context, NMR techniques have experienced a name change to the current prevailing appellation, magnetic resonance imaging (MRI).

In 1852 Florence Nightingale wrote, “It is valuable to have one place in the hospital where postoperative and other patients needing close attention can be watched”. Almost 100 years later, an American “anesthesia study commission” concluded that one-third of postoperative deaths in the first 24 hours could have been prevented by better nursing care. Yet it is only in the last 25 years that designated intensive care units have become a feature of acute hospitals in developed countries. In the United States, intensive care beds now comprise 15% of acute beds, and they cost at least two to three times more than ordinary ward beds. Over half the difference between “activity and treatment” in hospitals in the United States and in the United Kingdom is attributed to the much lower provision of intensive care in Britain (1), where such units comprise only 1% of acute hospital beds. Selection for intensive care is therefore more stringent than in the United States, as it is for other high technology procedures (e.g., coronary artery surgery and renal dialysis). However, even in the United States there is now reluctant recognition not only that health care as a whole has to be rationed, but also that unlimited access to high technology medicine is not always in the best interests of patients and their families. In particular the cost-benefit ratio of intensive care for certain types of patients has recently come under scrutiny at an NIH Consensus Development Conference (2) and at the Massachusetts General Hospital (3).

Magnetic resonance (MR) imaging is an exciting new diagnostic modality that has created tremendous interest in the medical profession. Although not unparalleled, the excitement engendered by MR imaging conjures up memories of the “CAT fever” induced by introduction of X-ray computed tomography (CT) scanners in 1973 (19).

Of the many ways to conceptualize the relationship between modern medicine and moral principles, by far the most reassuring is the idea that technically good and morally good medical care are one and the same. There are no contradictions, in other words, between the claims of moral obligation and the canons of scientific medical practice. In a trivial sense, this is undoubtedly correct. It is immoral to profess medical competence that one does not have. Ethical medicine presupposes technical knowledge and skill. But what of the far stronger proposition that authentic technical competence inevitably generates ethical practice? As might be expected in complicated human affairs, this statement is only partially true.

Latin America and the Caribbean had about 370 million inhabitants in 1980 (8), and about 10 million births occurred in this population that year. Even if, as expected, the birth rate drops 14% between 1980 and the year 2000, the population exposed to reproductive risks would still increase by 26%, because Latin America's population is expected to rise to 600 million by the year 2000 (17). Thirteen million births are expected in the year 2000.

As in many industrialized countries, the national health insurance system of Belgium is concerned about endemic financial losses. In response, the government has probably resorted to the final revenue-producing remedy, an increase in social security contributions, and several reductions in reimbursement rates have been instituted. This classic remedy cannot be repeated again, because some professionals either will not survive or will react with a consumption increase. Other ways must be found rapidly to provide enough savings. This is the essential issue that concerns the policy maker in Belgium, and probably in most developed countries as well.

Improvements in nutrition, sanitation, housing, and medical care have been associated with reductions in infectious diseases of infancy, such as diarrhea, and, concomitantly, with a decline in infant mortality. Although deaths from congenital abnormalities have also decreased, the rate of their decline has not kept pace with the overall rate. Thus in the United States they have become the most frequent cause of infant death (58). For abnormalities detected in the newborn period, which comprise 3% of all births, about 8 per cent are due to single gene disorders, 6 to 12% to chromosome abnormalities, and less than 5% to viral infections of the mother (39,69). Little is known about underlying causes in the remainder; polygenic factors, environmental agents, and, probably the most common, genetic-environmental interactions, account for them. Congenital abnormalities also contribute substantially to childhood hospitalizations in several developed countries (17). One chromosome disorder, Down's syndrome, accounts for about 16 to 30% of all severe mental retardation, with other genetic and chromosome disorders contributing another 15 to 20% (58). Although the incidence of congenital abnormalities differs to some extent geographically (39), it seems likely that as any country develops, the proportion of infant mortality and childhood disability due to congenital abnormalities will increase.

Magnetic resonance imaging (MRI) is a rapidly evolving medical technology which has become widely diffused before comprehensive assessment of its safety, efficacy, cost-effectiveness, and relative cost-effectiveness compared with diagnostic modalities that it seems most likely to replace could be made. In early 1982 there were fewer than ten units worldwide. In August 1984, there were about 150 units and the figure will be closer to 300 by the end of 1985.

Professor Brian Jennett has written a thoughtful and comprehensive article on Intensive Care for the Elderly, mainly from the British and North American perspective. In my commentary I shall try to look at the issue from a Scandinavian perspective, especially a Swedish one.

Throughout the industrialized world—from the United States to Japan, from Scandinavia to Australia—the theme of cost containment dominates the discourse on health care. This issue is the offspring of successful past efforts to ensure all patients effective medical care. While many countries have groups with special health disadvantages, the great majority of people in the industrialized nations have access to modern medical care and make ready use of it. The problem now is its cost, as aging populations, increasing in number as the result of advanced techniques that are more effective in prolonging life, place considerable strains on health care budgets.