Mixed feelings of fear, trust and entitlement have become heightened with the introduction of newly developed medical technologies. Magnetic resonance imaging, insulin pens and Prozac were all launched during the 1980s. But in this decade it was high-tech medicine that caused the greatest feelings of unease.
High-tech medicine was perceived by some to be costly, unproven and appropriate only for the small number of acutely ill patients. There was a feeling that the visibility of the disease influenced the use of technology – highly visible diseases such as cancer benefited from expensive diagnostic and therapeutic technology. Some argued that the funding of low-tech interventions, for the large number of chronically ill, was being neglected.
How did healthcare providers reach decisions about which technology was appropriate? The British Medical Journal published a series of articles in 1985 as a ‘guide to the sensible choice and use of resources’ in developing countries. In contrast to Britain, developing countries had fluctuating budgets and significant local variations in basic medical provision, making it harder to determine what was appropriate.
The BMJ suggested six criteria, which reveal many of the patients’ (and healthcare providers’) attitudes to technology in developing countries:
1) Effective – drugs nearing their use-by date would be ineffective by the time they reached remote rural areas.
2) Culturally acceptable – a ritual approach would be favoured over the technological for treating illnesses caused by ancestors or other non-biological agents.
3) Affordable – drugs manufactured locally would be more affordable than brand-name drugs produced by international pharmaceutical companies. Recent pressure on companies producing anti-retroviral drugs for HIV has led to reduced costs.
4) Locally sustainable – if there were no local technicians to manage maintenance and repair, technology such as CT or MRI scanners would not be appropriate.
5) Measurable – the impact and performance of technology should be thoroughly validated.
6) Politically responsible – recognition that the role of technological medicine in countries with multiple healing systems should be such that it avoids ‘disrupting the social fabric’ ‘in a way that might be counterproductive’.
The BMJ articles also argued that ‘the transfer of technology’ should not be a one-way process. Alternative healing practices could either be complementary to, or incorporated into, a Western technological approach.