A Marxian interpretation of the growth and development of coronary care technology.

Cost containment efforts will fail if they continue to ignore the structural relationships between health care costs and private profit in capitalist society. The recent history of coronary care shows that apparent irrationalities of health policy make sense from the standpoint of capitalist profit structure. Coronary care units (CCUs) gained wide acceptance, despite high costs. Studies of CCU effectiveness, using random controlled trials and epidemiologic techniques, do not show a consistent advantage of CCUs over non-intensive ward care or simple rest at home. From a Marxian perspective, the proliferation of CCUs and similar innovations is a complex historical process that includes initiatives by industrial corporations, cooperation by clinical investigators at academic medical centers, support by private philanthropies linked to corporate interests, intervention by state agencies, and changes in the health care labor force. Cost-effective methodology obscures the profit motive as a basic source of high costs and ineffective practices. Health-policy alternatives curtailing corporate involvement in medicine would reduce costs by restricting profit.