Debating the Desirability of New Biomedical Technologies: Lessons from the Introduction of Breast Cancer Screening in the Netherlands

Health technology assessment (HTA) was developed in the 1970s and 1980s to facilitate decision making on the desirability of new biomedical technologies. Since then, many of the standard tools and methods of HTA have been criticized for their implicit normativity. At the same time research into the character of technology in practice has motivated philosophers, sociologists and anthropologists to criticize the traditional view of technology as a neutral instrument designed to perform a specific function. Such research suggests that the tools and methods of more traditional forms of HTA are often inspired by an ‘instrumentalist’ conception of technology that does not fit the way technology actually works. This paper explores this hypothesis for a specific case: the assessments and deliberations leading to the introduction of breast cancer screening in the Netherlands. After reconstructing this history of HTA ‘in the making’ the stepwise model of HTA that emerged during the process is discussed. This model was rooted indeed in an instrumentalist conception of technology. However, a more detailed reconstruction of several episodes from this history reveals how the actors already experienced the inadequacy of some of the instrumentalist presuppositions. The historical case thus shows how an instrumentalist conception of technology may result in implicit normative effects. The paper concludes that an instrumentalist view of technology is not a good starting point for HTA and briefly suggests how the fit between HTA methods and the actual character of technology in practice might be improved

Lotgenotencontact bij kankerpatienten 1982-1983

What circumstances determine the need of contacts with fellow-cancer patients what is the meaning of these contacts. Impact of diagnosis of cancer to r's life / influence of r's disease on job, relation between job and well-being / doing volunteer work, motives / problems with domestic work, getting help / changes in social contacts / way how cancer was determined, reaction of r / treatment of cancer, consequences of treatment i.e.: surgery, radiotherapy, chemotherapy / psychological and physical pressure / side effects of treatment / making use of alternative treatments / evaluation of sickness, expectations for future / being informed on disease, sources of information, wishes for ( further ) information, uncertainty / involvement of r's partner: presence with doctor visits, contacts with partner and children/ tensions, changes in relation with partner / mastectomy-patients: reaction of partner on amputation / dietary pattern, smoking habits, use of alcohol / hobbies, activities / mental condition: quality of night's rest, feelings of loneliness, fear, aggression / going about fear and bad feelings / personal contacts with ex-fellow patients, contacts with volunteers ( ex-patients ) in connection with aftercare: how, where and when were contacts made and with whom, giving and receiving support, evaluation of contacts / Hodgkin-patients: participation in discussion group / reasons for having no contacts / written questionnaire: self-confidence / most important goals in life / who is responsible for cancer, how can progress of cancer be influenced. Background variables: basic characteristics/ household characteristics/ characteristics of parental family/household/ occupation/employment/ income/capital assets/ education/ organizational membershi