Letter to the editor
Editor, Professor Fletcher's thoughtful editorial on expensive medical technology (Aust Prescr 1994;17:54-5) was an excellent rejoinder to the article on thallium scanning (Aust Prescr 1994;17:57-61). I agree with Professor Fletcher that positron emission tomography may have a limited role in cardiology, but it looks promising in oncology and our evaluation has shown its clinical utility in epilepsy.
I believe, however, that Professor Fletcher's hope that all new technology will be backed by outcome studies is probably unrealistic. For example, to study the cardiovascular outcomes of an intervention procedure would cost a minimum of $30-$40 million. Governments are unlikely to make this money available. The real cost of new technology is, of course, not in its development in teaching hospitals, but in its proliferation elsewhere, particularly in the private sector, where restriction may be an unpalatable political decision.
Colin I. Johnston
Division of Medicine
University of Melbourne, Vic.