special skills and want to put them to use. They are more interested in the process perhaps than in the product. This was stressed in their apprenticeship as interns and residents. In this country the special skills in which one takes great pride are not the traditional crafts carried on from generation to generation but the newest skills, never before known; the latest, therefore in American mythology, the best. The customer agrees, he or she wants the latest technology available in a technocratic civilization. Both M.D. and customer are ever on the lookout for new technology, the final product of the industry of discovery and invention that is research and development: "the underlying bias of the technological mindset and its activity orientation . . . that newer must be better and that doing more must be better than doing less; hence the possibility of harm is always a second thought. . . ." 17
Health care has been dominated by the technological imperative--the belief that new drugs, new procedures, new treatment will cure nearly all disease, including the failures of will and character. This belief is most likely to prevail in teaching hospitals, and is independent of method of compensation. It caters to a desire to learn and a desire to play with new technological toys. If a patient were aware of the risks and uncertainties involved in new drugs and new procedures, he or she might opt against them. But, then, the M.D. may not know either.