Sufficient assessment of interventions
To Gabbay's three methodological challenges for health technology
assessment I would add the challenge of providing sufficient evaluation.
New technologies, particularly pharmaceuticals, are rightly the subject of
relatively high levels of debate and research.
Some technologies fail to capture attention when new - and become
examples of 'technology linger' rather than 'technology creep'. Rarity
and cost make some surgical procedures particularly unattractive
candidates for large scale research. For example deep brain stimulation
for chronic pain has been used on a very small scale for decades, but
still lacks a robust evidence base to help determine its place in health
Commoner interventions may be evaluated when new, but long term
impacts are unknown. Morbid obesity surgery is growing rapidly and is
supported by NICE technology appraisal, but there are important unanswered
questions about optimum procedures and long term cost effectiveness.
Whilst there are many competing priorities, assessing the old may
sometimes be as important as assessing the new.
Bittar et al. Deep brain stimulation for pain relief: a meta
analysis. Journal of Clincal Neuroscience 2005;12(5):515-519
Technology Appraisal No 46. Guidance on the use of surgery to aid
weight reduction for people with morbid obesity. NICE London 2002
Courcoulas AP, Flum DR. Filling the gaps in bariatric surgical
research. JAMA 2005:294;1957-61
Competing interests: No competing interests