Getting Doctors to Listen: Ethics and Outcomes Data in Context

By Philip J. Boyle | Go to book overview

SUSAN E. BELL


Technology Assessment, Outcomes
Data, and Social Context:
The Case of Hormone Therapy

Technology assessment (TA) is a way to understand, evaluate, and make decisions about medical interventions. 1 It includes the determination of safety, efficacy, and effectiveness, as well as "consideration of quality of life and patients' preferences, and especially the evaluation of costs and benefits." 2 Technology assessment, in other words, "offers the essential bridge between basic research and development and prudent practical application of medical technology." 3 In this essay, I provide a sociological perspective on the meaning of TA and its relationship to medical practice. My aim is threefold: to explore the assumptions about science that guide the development of TA, to consider how these assumptions make possible, shape, and limit TA, and, finally, to consider the implications of this analysis for understanding the link between TA and medical practice. These topics are explored by examining two texts: a TA of the use of hormone therapy to prevent disease and prolong life in asymptomatic postmenopausal women, 4 and clinical guidelines—a series of recommendations and specifications—for treating postmenopausal women with hormone therapy based on this TA. 5

My analysis draws upon recent historical and sociological scholarship that demonstrates the uncertainty of medical research and medical practice. 6 In some respects menopause is well understood, yet the study of menopause demonstrates how there are always elements of uncertainty in medical practice. For example, clinicians have prescribed hormone therapy in one form or another to women for almost sixty years, yet they still do not entirely understand the meaning of menopause or the role of estrogen in the development of menopausal symptoms. 7 At present, there is controversy in medicine over whether hormone therapy "should be used to treat menopausal symptoms for a short period of time, thereby reducing any risks associated with long‐ term treatment, or whether it should also be used to prevent future disease, thereby requiring longer treatment that could increase the risk of cancer." 8

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