Too much technology

Medical excess has been recognised as a key problem in modern healthcare.1 2 3 4 5 6 7 8 9 Overdiagnosis and overtreatment have been identified in a wide range of diseases,4 10 and medicalisation of ordinary human conditions has been heavily criticised.11 12 We seem to do too much of a good thing. Technology tends to have a crucial role in our propensity to excess.

From the invention of the stethoscope in Paris in 1816 to the whole genome sequencing of fetal cell-free DNA in a pregnant woman’s blood, technology has been a transforming factor in medicine. Technology has played a key part in moving medicine from the 2400 disease entities described in Sauvages’ 1793 Nosologica methodica to ICD-10 with more than 40 000 entries. Medical technology has also been a driving force in the growth of expenditure on health.13 14 15 It by far outweighs other price driving factors, such as an ageing population, increased public demand, income growth, raising prices, and reduced organisational efficiency. Half of the increase in the overall costs in healthcare are attributed to technology.16 Having a new technology raises the clout of hospitals and specialists and spurs a technological arms race.17 Technology is used beyond its benefit and sometimes even when it is harmful.18

No doubt, medical technology is a cornerstone in reducing ailment and improving health. Nevertheless, we need to address the challenges when the tool for improving health makes us diseased and when our means become our ends. Below I identify and analyse the mechanisms …