The Technological Imperative

Once a technology enters the mainstream, the technological imperative can make it difficult to avoid. The technological imperative refers to the belief—held by both doctors and consumers—that technology is almost always good, so it is almost always appropriate to use all existing technological interventions, regardless of their cost. This belief is deeply embedded in American culture (and to a lesser extent in Western culture more generally). The belief in intervention (including technological intervention) is also highly stressed in medical culture and training, as Chapter 11 discusses. In addition, and as the history of CPR illustrates, the technological imperative is often reinforced by corporations that have a vested economic interest in selling a particular technology and doctors with a vested interest in offering a technology. Finally, the technological imperative is cemented whenever insurance companies, government regulatory agencies, or medical asso- ciations identify use of a particular technology as the “standard of care” for treating or diagnosing a given illness. In these situations, doctors who don’t use that technology may risk malpractice suits.

Prostate cancer testing offers an excellent example of the technological im- perative. Among men, one almost inevitable consequence of aging is cancer of the prostate, a poorly understood bodily organ that produces chemicals believed necessary for reproduction. Most men develop prostate cancer by middle age, and virtually all do so if they live long enough. Few, however, are killed by the disease because it typically grows so slowly that most who have prostate cancer instead die from heart disease, stroke, or some other condition before the cancer can become dangerous.