BACKGROUND
The 1970s and early 1980s was the period in which high technology medicine became dominant. It had begun in the late 1950s with the introduction of effective artificial respiratory technology. This gave physicians, patients, and families the hope that the threats to fundamental life processes such as breathing could be countered by technology, and the dilemma of both meeting its costs and the ethical challenges of how to remove it when its use no longer produced benefits.
Other technologies soon joined the respirator as high-cost agents of care such as the artificial kidney (1960s), the computerized tomography scanner (CT) in 1972, and nuclear magnetic resonance imaging (MRI) in 1977. In addition to such significant inventions, technological health care was supported by an array of other technologies with more modest costs which, nonetheless, exerted large effects on the nature and cost of practice. These included the numerous laboratory tests, which automated analyzers permitted to be ordered in groups of twenty to forty at a time, as well as a large increase in pharmaceutical products claimed to be effective in treating the functional and pathological aspects of illness.
During the 1970s and into the early 1980s, national institutions in the United States were forming to study and issue reports on how society should apply and pay for these innovations, most notably the Office of Technology Assessment (OTA) at the U.S. Congress, and the National Center for Health Care Technology, established in the federal government and directed by Seymour Perry.
At this time, informal discussions took place among different groups of people about the need of a forum for exchange of ideas in the field. In 1979, Egon Jonsson organized the first international conference on HTA in Stockholm, Sweden (2). Tore Schersten, a Swede who was later the President of the International Society for Technology Assessment in Health Care (ISTAHC), was chairman of the conference. Participants in the conference included Johannes Vang, David Banta, and Per Buch Andreasen. Schersten, Banta, and Buch Andreasen were all subsequently elected President of ISTAHC. More than thirty participants from several countries, including Sweden, the United States, Denmark, Norway, the Netherlands, Finland, and Switzerland took part in the conference. At this conference, the first discussions began about the necessity to have active and structured international contacts for the field of HTA.
Subsequently, David Banta, working at OTA, developed a series of papers on how healthcare technology was being dealt with in nine countries. The publication of these papers led to a Rockefeller Foundation-funded “Bellagio Conference” in 1980 that made it possible for further international contacts to be made (Reference Banta1). In addition to Banta, Jonsson, Clyde Behney, and others already working in HTA, representatives of the World Health Organization and the World Bank took part.
THE SORCERER'S APPRENTICE
One of the recommendations of the Bellagio conference was that OTA start a newsletter on HTA, which was launched in January 1981, under the editorship of Clyde Behney. The name, The Sorcerer's Apprentice was chosen “. . .to imply the immense, seemingly magical power that technology can possess.”
The newsletter was private, with a subscription cost of $12 a year, and it was published 3 times a year. By 1983, the newsletter had grown to thirty pages and had ten network correspondents from nine countries. It contained both overviews of technology assessments, and personal commentary in the form of writing and cartoons about the use and effects of technologies. The Sorcerer's Apprentice can rightly claim honors as the first regular publication in the technology assessment field.
THE INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE
The success of The Sorcerer's Apprentice, along with growing international interest in HTA, led directly to a discussion about the need for a scientific journal to assess healthcare technology at the same time as there was an agreement of the need for an international society in the field. The main individuals participating in devising ways to bring together the international technology assessment community at this time included David Banta, Clyde Behney, Tore Schersten, Johannes Vang, Ruth Hanft, Seymour Perry, Miriam Orleans, Barbara Stocking, Norman Weissman, Bernard Bloom, Egon Jonsson, and Stanley Reiser.
When Stanley Reiser and Egon Jonsson first met, at Harvard University in 1982, they discussed the prospects of launching an international scientific journal on technology assessment in health care. Because Reiser recently had published the book Medicine and the Reign of Technology, with Cambridge University Press in New York (Reference Reiser4), he approached the Press about their interest in publishing such a journal.
An agreement was quickly made with Cambridge University Press and its supportive American Director, Barbara Colson (who by coincidence had been considering the need for such a publication), to produce a journal, and Jonsson and Reiser began their work in organizing the Journal's function the same year. The first task was creating an Editorial Board. Its major challenge was melding the need to gain representation from countries with established or nascent assessment activities, with the requirement of having as members the best available individuals in the field who also were willing to give time to the Journal. Our expectations were met on both counts as the composition of the Journal's first Board shows (Table 1). The current Editorial Board of the Journal includes representatives of twenty-two countries, and of WHO (Table 2).
Table 1. Editorial Board of the International Journal of Technology Assessment in Health Care 1985
Table 2. Country Representation on the Editorial Board of the International Journal of Technology Assessment in Health Care as of 2009
Task two was deciding basic purpose and content. We recognized that the Journal must serve the critical functions of not only encouraging the best possible analysis of the issues facing health technology assessment, but of also bringing together its far-flung constituents and forging a community of them. These purposes critically shaped its content. For we needed articles that had not only scholarly excellence but also portrayed the viewpoints and values that shaped technology assessment in all parts of its international constituency. Achieving a balance between these two requirements at times made for difficult judgments.
Over the years, the Journal has grown substantially from a couple of hundred subscribers, to the circulation of today of approximately 4,000 including online subscriptions. “An impressive amount of scholarly articles in the field of health technology assessment has been published in these years; approximately 2,000 manuscripts, authored by approximately 6,000 people, covering more than 20,000 printed pages in close to 100 issues. The Journal has contributed greatly to the development of the field of HTA.” (Reference Jonsson and Reiser3).
A unique feature of the Journal that proved to be significant was in-depth, multiple-essay analyses of key issues and developments in the field, put together by guest editors and overseen by the editors-in-chief. They were soon titled “Special Sections,” and appeared in the Journal from its first Volume in 1985 until 2002. At times, their scope was so large that it was necessary to publish an additional issue of the Journal to hold their content. In all, forty-eight Special Sections were produced, whose subjects ranged from assessing how technology could effectively aid the elderly not only to be healthy but to live independently, to how different countries organized assessment activities and influenced their nation's policies (Table 3).
Table 3. ISTAHC Journal Special Sections (1985 to 2002)
In the 25-year history of the Journal, begun in 1985, it has had a close relationship with the International Society of Technology Assessment in Health Care (ISTAHC) and later with Health Technology Assessment International (HTAi). The ISTAHC was formed a year after the Journal's creation, and made the Journal its official publication. Indeed after several years of independent existence, all Society memberships included the price of a Journal subscription. Clearly, the Journal represented the Society not only to its members, many of whom published articles within it, but also to the world at large.
During this long association, there have been at times questions raised by the Society about the Journal's independence. Some argued for the society's control of the publication, because it was designated as its official public scholarly organ. Legally, of course, the issue is nondebatable. Cambridge University Press owns the Journal. Practically the Society's history, particularly as it ran into financial difficulties in 2002, showed the advantage of a separate ownership. Intellectually, the greatest danger facing any journal is becoming what historians call a “court” publication. This is the peril of the representatives of the organization owning and funding a journal unduly influencing its content and editorial board judgments. That the Society continues to favor such ownership and editorial separation augers well for the Journal's future.
Our service to the Society and the growing community that reads the pages of the Journal, and our work and friendships over the years with Editorial Board members and authors have been highlights of our professional careers and personal lives. That the Journal shall continue to flourish is a hope we hold deeply.
CONTACT INFORMATION
Egon Jonsson, PhD (ejonsson@ihe.ca), Professor, University of Alberta, and University of Calgary, Editor-in-Chief, International Journal of Technology Assessment in Health Care, Executive Director & CEO, Institute of Health Economics, #1200, 10405 Jasper Avenue, Edmonton, Alberta T5J 3N4, Canada
Stanley J. Reiser, MD, MPA, PhD (msdsjr@gwumc.edu), Clinical Professor of Health Care Sciences, The George Washington University School of Medicine and Health Sciences, 324 Ross Hall, Washington, DC 20037
