Are we getting too high on technology?

October 17, 2001

I love machines—from my autofocus camera to the antilock brakes on my van. The higher the technology, the better. But lately I’ve come to question whether relying so much on technology is such a good idea. Technology has long promised to

I love machines-from my autofocus camera to the antilock brakes on my van. The higher the technology, the better. But lately I’ve come to question whether relying so much on technology is such a good idea. Technology has long promised to solve our day-to-day problems. Yet its solutions seem inevitably to create more and different problems.

The fear of hidden consequences was the reason federal regulators initially resisted digital mammography, and it eventually led them to require clinical tests to ensure that the digital products were equivalent to film-based systems. Regulators were worried that a more sensitive x-ray machine would send more women with benign lesions to biopsy.

My concerns are far broader and more difficult to get a handle on. They span all of imaging. They include physicians’ responses to the ultrasound scanner that uncovers tiny white specks where tiny white specks have never been seen. They are primed by the computer-aided detection systems that suggest diagnostic findings as part of their reporting function.

I worry that these two technological capabilities-to uncover new information and to algorithmically interpret findings-are diametrically opposed. A more subtle threat is the development of user-friendly equipment that optimizes images, taking the operator further out of the loop at precisely the time when expert diagnosticians are needed to determine what information should be eliminated and what should not.

We cannot be afraid to find new things in tissue and start all over in our understanding of what is and is not normal. Similarly, we cannot be lulled into a false sense of technological security by machines that make interpretations using rule-based logic. I am just as worried about algorithms that smooth and shape structures that maybe shouldn’t be so smooth or so nicely shaped.

The goals behind this optimization of course, are noble-to technologically boost the skill level of all operators so that results are more reproducible, diagnoses are more accurate, and exams are done more quickly. But I can’t help wondering if we’re taking the precautions necessary to prevent the biases of those who design equipment from distorting the diagnostic information conveyed to those who make life and death decisions. Perhaps even more sinister, I wonder, Are we dumbing ourselves down, becoming too reliant on machines-like the cashier who can’t give change when the electronic register goes on the fritz?

Can any of us be sure when too much technology is bad medicine? How many of us have even asked the question?