Rosenberg Aaron G
Department of Orthopaedic Surgery, Rush Medical College, Rush-Presbyterian-St Luke's Medical Center, Chicago, Illinois 60612, USA.
J Arthroplasty. 2007 Jun;22(4 Suppl 1):102-5. doi: 10.1016/j.arth.2006.12.114.
The relatively high complication rates associated with early prostheses and techniques eventually led to the improvement of implants and refinement of the surgical procedures. Almost all surgical techniques improve over time by leading to less invasive approaches. The modern era's communications technologies, coupled with more sophisticated marketing techniques, has dramatically influenced the speed with which new techniques are recognized, popularized, and thus demanded by an easily influenced public. Debate over the appropriate moral underpinnings of marketing medical practice is far from concluded, and the moral issue of when new technologies "should" be adopted is complex and challenging. Although the autonomy of medical practitioners and their ability to accurately assess the "scientific validity" of any given medical procedure have been gradually transferred over time from the bench, bedside, and consulting room to institutional formularies, clinical pathways, and federal authorities, it is likely that an appropriate balance of oversight, such as currently exists with Food and Drug Administration regulation, and the traditional autonomy of the physician are appropriate answers to the dilemma raised.
早期假体和技术所带来的相对较高的并发症发生率最终促使植入物得到改进,手术程序得以完善。几乎所有的外科技术都会随着时间的推移而改进,采用侵入性更小的方法。现代的通信技术,再加上更复杂的营销手段,极大地影响了新技术被认可、推广以及因此被易受影响的公众所需求的速度。关于营销医疗实践的适当道德基础的争论远未结束,而新技术“何时应该”被采用这一道德问题既复杂又具有挑战性。尽管随着时间的推移,医疗从业者的自主权以及他们准确评估任何特定医疗程序“科学有效性”的能力已逐渐从实验室、床边和诊室转移到机构处方集、临床路径和联邦当局,但很可能像目前食品药品监督管理局的监管那样的适当监督平衡与医生的传统自主权是解决这一困境的恰当答案。