Notes from Chapter 7:

Society and Technological Change, 3rd ed.

Rudi Volti

The ideas and examples referenced below are notes compiled by Robert Keel and Shannon Mayer in their reading of Volti's, Society and Technological Change, 3rd ed., St. Martin's Press, 1995. They are intended for classroom use.

• Despite problems, most agree technology has improved medicine and longevity for human beings
• Technology has also reduced agony associated with illness
  1. Dialysis for kidneys
  2. Artificial Hearts and transplants
• Technology not solely responsible for improvement in health
• Nutrition, sanitation, personal hygiene has made significant impact
• As long as we live, experience illness and die there will be a demand for medical (technological) intervention

Expenditures for medical attention are Not weighed against other expenditures:

• We may forgo a car for a down payment on a new house
• But we will not forgo heart surgery for some other good or service

BUT, nonetheless, technology has created new health problems

• Despite rising cost of medical technology, the individual is largely unaffected
• 1950: private insurance paid less than half of medical expense
• 1990: Medicare/Medicaid pays over 90%
• Given spiraling costs, medical technology may not always be a solution
• Medical technology inappropriate when:
  1. Unnecessary: Patient has condition too advanced to respond to treatment
  2. Unsafe: Complications outweigh possible benefits
  3. Unkind--After treatment, quality of life no better or worse than before
  4. Unwise--Resources could be better used on other patients

We tend to minimize or ignore costs when someone we love may improve by the use of medical Technology

Kidney Dialysis

• Kidney Failure (end-state renal disease) significantly improved by medical technology
• U.S. fourth largest killer
• Development of Dialysis Machine: Willem Kolff--Dutch doctor (1940’s),salvaged bathtub and parts to create dialysis machine
• Machine cleanses blood
• Artificial kidney became possible because of machine
• Demand for dialysis greatly outnumbered machines available à some patients had to be rejected
• Seattle Artificial Kidney Center (leading institution in field) decided who would get kidney treatment
• Making this "life or death" decision based on certain criteria aroused much consternation
• Children and adults over 45 excluded
• People chosen on the basis of gender, marital status dependants, emotional stability
• Treatment very expensive--1970 2X/week $3,000.- 5,000
• Start up expenses à $9,000- 13,000
• 1987--U.S. gov’t spends 24 billion/year
• As population ages, demand for dialysis will increase
• Current: 1/3 of dialysis patients > 65 yrs.
• Britain: no one over 55 receives dialysis
• U.S.: much more liberal distribution of treatment
• Which system is better???

• Bypass Surgery – segment of vein is removed from leg or chest and is spliced into one or more of the five coronary arteries that transport blood to the heart
• Treatment has become routine, but expense not equal to population treatment serves:
• Bypass: 1% of national medical expenditure but serves only .04% of population
• Often bypass is not helpful because heart is already too weak from disease
• Heart transplant is a possibility but not a viable solution
• 75,000 need heart transplant à 2,000 donors available
• Artificial hearts (Jarvik-7 – 1970’s U. of Utah) not effective--caused seizures and host of problems
• Means hardly justified by end result
• Artificial hearts can be "bridge" for those awaiting human heart, but no permanent solution
• Transplant very costly à $160,000/transplant.

How should funds for costly medical procedures be allocated?

• Artificial heart program – or – anti-tobacco education program?
• Sustain life of premature infants – or – invest in prenatal education programs?

Halfway Technologies

• Medical technologies often palliative--treats kidney disease but not the causes of disease.
• Technology has extended life and made it more comfortable but has not addresses causes and conditions

Diagnostic Technologies

• Stethoscope, X-ray machine, ophthalmoscope, laryngoscope have taken mystery and "guess work" out of medical diagnosis.
• No longer do we rely on 4 humors.
• These new technologies have often created their own need.
• Fetal heart monitors have no evident benefit, but number of Cesarean section deliveries increased.
• Doctors often over-prescribe technology for fear of mal-practice lawsuits.
• Tests can make patient worse than when they initially were à especially true for the elderly
• Sociologically, diagnostic tests and technologies helped to create an "objective disease"
• Physician: no longer is it necessary to talk with the patient and obtain their account of their illness.
• Technology has objectified and legitimated the medical profession.
• Technology doesn’t account for the psychological component to illness

The Genetic Fix

• Medicine is badly in need of technology that is more than palliative.
• Fundamental Scientific insight behind new medical Technologies--The Gene.
• Gene manipulation became possibility in this century as new information emerged.
• Watson and Crick: The Double Helix.
• Gene manipulation seen as possible way of curing disease.
• Genetic Manipulation has LOADS of problems associated with it:
  1. Altering genes can affect suceeding generations à with no end in sight
  2. Errors can be made
  3. Strong moral implications
  4. BTW A recent poll of the top CEO’s reported that (of all people) Bill Gates was the only one who unreservedly opposed gene engineering. He was asked, "If you could clone yourself, would you?" No! Interesting, huh?

The Commercialization of DNA Technology

• Bio- technologies based on genetic discoveries have emerged as commercially significant enterprises.
• 15 biotechnology based drugs on market today.
• 1980: U.S. Supreme Court ruling (Diamond v. Chakrabarty) human made organisms entitled to full patent protection.
• Although profit is a motive, bio technology not sole driven by free enterprise.
• 1987 U.S. Gov’t spent $2.7 billion on bio-tech research, private industry spent $1.5-2 billion

Controlling biotechnology

• Few technologies have aroused as much debate as genetic engineering has.
• Eugenics--the attempt to perfect humanity through the reinforcing of "desirable" Traits and the suppression of "undesirable" ones (Nazi Germany, USA, too!).
• Genetics does not contain all the answers for solving disorders.
• A gene that malfunctions under one environment may be fine in other circumstances.
• We cannot always identify the "problem" gene.
• Not all disease are genetically caused (Alcoholism??).
• The "genetic fix" is seductive, maybe it can explain deviant behavior as well as disease of the body.

BUT,

"Fastening upon genetic endowments to the exclusion of everything else exemplifies the naïve belief that science has all the answers and that technology offers the best solutions for what troubles us as individuals and as members of society." (121)