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s415.c07.fa10 - SOCIOLOGY 415 Technology and Society...

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Unformatted text preview: SOCIOLOGY 415: Technology and Society University of Hawai‘i at Mānoa, Fall 2010 Textbook: Volti, Rudi. 2009. Society and Technological Change. 6th edition. Worth Publishers Inc. REVIEW, PT. III: HOW TECHNOLOGY AFFECTS THE HEALTH OF THE EARTH AND ITS INHABITANTS. (118-136) CHAPTER 7: MEDICAL AND BIOLOGICAL TECHNOLOGIES For all its unquestioned benefits, advances in medical technology have generated some vexing problems. Understanding the nature of these problems may help us come to a deeper awareness of how technological advance can take with one hand as it gives with another (118). Although, during the last 300 years, there have been significant advances in medical care (organ transplants, vaccination, antibiotics), the positive impact of all these advances has been comparatively small. The real gains in life span and improvements in the physical quality of life have been due to better nutrition, sanitation, and personal hygiene, along with higher standards of living in general (118-9). A recent study of Medicare patients found considerable regional variations in the treatment of patients with serious illnesses during the last two years of their lives, with aggressive medical treatments much more common in some parts of the country than in others. But patients in these regions were less satisfied with their care and died at a slightly higher rate than patients in regions with less aggressive care. One of the chief reasons for this anomaly is the higher concentration of medical specialists in the most “aggressive” regions along with medical care characterized by excessive use of tests and procedures, extended periods of hospitalization, and a fragmented approach to patient care that sharply contrasts with the holistic approach of primary-care physicians (119). Nonetheless, many people are alive today due to technological advances — kidney dialysis, computerized tomography, and antibiotics. While costs of medical care have been escalating, they have become largely irrelevant to most individuals because government and private insurance programs have paid for the bulk of medical expenditures: UNITED STATES HEALTH-CARE COSTS PERCENTAGE PAID BY In 1960 50.0% Patients and families. In 2004 35.4% 17.2% 16.0% 17.7% 13.7% Private insurance plans. Medicare Medicaid Other private and government programs. Left for individuals to pay. Under these circumstances, there is a strong tendency for increasing amounts of medical care to be provided, and for a country’s medical costs to increase with no apparent endpoint (119-120). Read: New Medical Technologies: Choices and Trade-offs (120-125) — the problem of controlling access to expensive and potentially life-saving technologies, and the capricious way in which technologies are sometimes supported. Artificial hearts and Left Ventricular Assist Devices (LVADs) are the epitome of high-tech, highcost medical technology — extensive use would add billions of dollars to a national medical bill that already absorbs nearly 15% of the nation income of the U.S. (126). The selection or exclusion of recipients is not the only equity issue that the use of expensive medical technologies pushes to the forefront. With limited resources, there is no escaping the fact that expenditure in one area means the foreclosing of expenditure in another. Example: Some of Page 1 of 2 SOCIOLOGY 415: Technology and Society University of Hawai‘i at Mānoa , Fall 2010 the funds absorbed by an artificial heart program could i nstead have been used for anti-tobacco d education campaigns — smoking is a major contributor t heart disease (126). to The escalation of medical costs is one of the most prob lematic consequences of the advance of medical technologies. A variety of diagnostic technologies have substantially advanced physicians’ ability to determine the source of medical problems — at the same time, altering the nature of medical practice, sometimes with unfortunate results (12 7). For centuries, medical diagnosis had been based on the observation of external symptoms, patients’ narratives of their illness, and the application of dubious theories. A major orientation began in the 1820s when doctors began to use a simple tube to hear heartbeat and other sounds within the patient’s chest — the stethoscope. Within a few years, other instruments for apprehending hitherto hidden parts of the body were invented — ophthalmoscope for observing the interior of the eye, the laryngoscope for the throat; followed by diagnostic technologies (X-ray machines, and electrocardiographs. By the beginning of the 20th century, physicians were using instruments for measuring everything from blood pressure to the electr onic currents generated by the nervous system. Accuracy of diagnosis was further advanced by the development of laboratory tests (127). The use of diagnostic tests exemplifies the tendency of technologies to create their own needs. f According to one study of a teaching hospital, 47% of tests performed could have been eliminated with no evident loss in the quality of patient care. Som e of the increase in lab tests is directly attributable to the practice of “defensive medicine.” Do ctors are justifiably nervous about the threat of malpractice suits — so the safest course seem s to be the over-prescription of tests in order to avoid accusations of not having used every ava ilable diagnostic tool (127). Sophisticated technologies have encouraged the treatm ent of specific disorders rather than the treatment of patients. In many cases, an accurate diagn osis can be produced by examining an X-ray plate or microscope slide even when the patien t is not physically present or when the physician is not personally acquainted with the patient . Standard tests also help to promote a standardized medical practice, removing the biases an d blind spots of individual practitioners. o Nevertheless, judgment, experience, and even “intuition” can be of vast importance for a successful medical practice. A focus on “objective” data to the exc lusion of all else can lead a physician to miss some crucial clues regarding the source of a patien t’s illness (128-9). Major ethical dilemmas are closely related to the application of contemporary medical technologies and have given rise to the field of medical ethics. Read New Ways of Making and Sustaining Babies and When Does Life End? When Should it? (130-3). Economic calculations cannot substitute for e thically-based judgments, but both will have to be taken into account as advanced medical t echnologies solve one set of problems while giving rise to others (133). Many of today’s technological advances in medicine ha ve extended life spans and eased pain but have done little to address the causes of disorders themselves. Escalating costs of medical care driven by “halfway technologies” (such as dialysis, heart transplants) constitute a formidable problem. Development of new technologies will present increasingly difficult choices concerning their application — intensifying existing ethical quandarie s and creat ting some new ones (133). Page 2 of 2 ...
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