Annetine Gelijns

The dynamics of innovation in minimally invasive therapy

The emergence of minimally invasive therapy (MIT), which provides alternatives to major open-surgery procedures, is affecting all aspects of medical care delivery. In the present environment of resource and cost constraint in health services, an uncommon consensus among patients, physicians, providers, and payers has evolved regarding the rapid acceptance of this area of medical intervention, an acceptance that, in turn, is stimulating further innovation. This paper discusses the dynamics of medical innovation and analyzes these forces in the context of three minimally invasive therapies: percutaneous transluminal coronary angioplasty, extracorporeal shock wave lithotripsy, and laparoscopic cholecystectomy. The different experiences of the United States and Europe are used to illustrate how scientific, medical, economic, and regulatory factors affect both the rate and direction of technological change in minimally invasive therapy.

Lasers in Health Care

After their development, lasers were rapidly applied to a variety of scientific ends in physics, meteorology, astronomy, medicine, and industry (36). Chemists quickly saw the value of devices that could stimulate molecules in specific ways and in short periods of time, compared with techniques available at the time. Specific knowledge of the role of chlorophyll in photosynthesis was one result (44). By now, the influence of lasers is pervasive in most scientific fields. They are used to monitor geological structures, to measure the constituents of the upper atmosphere, and to study the dynamics of the Solar System (44).

An inquiry concerning future health care technology: Methods and general results

New and future health care technology has important implications for the delivery and organization of health care. Furthermore, advances in health care technology are increasingly associated with social, ethical, and economic issues. Effective health planning needs to anticipate future health care technology and take into account such implications. This paper concerns an analysis of future health care technology undertaken in the Netherlands. The study involved: (a) the early identification of future developments in health care technology; and (b) prospective assessments of a number of high-priority technologies. The paper concludes that technology forecasting in health care should become an integral part of overall technology assessment activities in industrialized countries.

Future health care applications resulting from progress in the neurosciences: The significance of neural plasticity research

Neurological, communicative and behavioral disorders afflict a significant part of the population in industrialized countries, and these disorders can be expected to gain in importance in the coming decades. In a considerable number of these dis-orders impairments in plasticity, i.e. deficiencies in the adaptive and regenerative capacity of the nervous system, play a central role. This paper considers the possibilities and probabilities of future improvements in treatment and prevention for a number of nervous system disorders following from neural plasticity research. Subsequently, it discusses the overall health policy implications of progress in the area of neural plasticity research and development in particular, and the neurosciences in general.

The Present Use of Lasers in Health Care in the Netherlands

The present use of lasers in health care in the Netherlands is somewhat limited. There is no clinical laser center where several lasers (such as CO2, Nd-YAG, Argon, and Argon pumped dye) are in clinical use for the various medical specialties. There is also no research institute dealing with laser applications.

A Framework for Evaluating PAC Systems

The main issue for policy making in the evaluation of PACS tends to be that of societal efficacy. In other words, the policy maker wishes to know how much benefit has been achieved for how much cost (10). This question cannot be answered in the case of PAC systems. There is no existing PAC system, so no empiric evaluation has been done. Evaluations of sub-parts of such systems have only just begun.

Background on Computer Assisted Medical Imaging

Diagnosis is a critical part of health care. Diagnosis is the process of determining a patient’s illness from his or her complaints and from other sources of information. Most people go to physicians because of symptoms; it is then the role of the physician or other health care provider to find an explanation for those symptoms. Imaging is different in some respects from other diagnostic tools, since the location and size of a lesion can be determined, and sometimes its stage of development as well. In addition, the diagnosis determine the course of medical intervention, including the possibility of cure. Images are also often used in follow-up of therapy to determines its effectiveness. In addition, imaging is sometimes used in screening programs to identify early disease that has not yet caused symptoms.

Health Care Implications of Computer Assisted Medical Imaging

Computer assisted medical imaging has made new and dramatic diagnostic procedures available. These have had a variety of consequences both for the health care system and for patients. Consequences range from effects on health to changes in health care delivery patterns. Some of these consequences may intensify as computer assisted imaging spreads and PAC systems develop.

Lasers in the Future Treatment of Coronary Artery Disease

Cardiovascular disease is one of the most prevalent diseases in industrialized societies, and one type of cardiovascular disease, ischemic heart disease, is highly significant. In the Netherlands, ischemic heart disease (when the heart does not receive enough blood in relation to demand due to blood vessel blockage from coronary artery disease) accounted for 14,948 deaths in men and 9,657 deaths in women in 1983, 21 percent of all deaths that year (60). Ischemic heart disease is the leading cause of death in men over the age of 35 and in all persons after the age of 50 (61). Symptoms from such heart disease are common, but even more people have serious disease without clinical symptoms.

International Issues in Computer Assisted Imaging

As it was described in Volume I from the project, medical technology is an international issue. Health-related research and development is carried out internationally, and investments are spread widely over the world. Much technology is developed and marketed by the multinational industry. And technology assessment in health care is developing as an international activity to deal with these international aspects of technology development and diffusion.