The history of the International Journal of Technology Assessment in Health Care.

The 1970s and early 1980s was the period in which high technology medicine became dominant. It had begun in the late 1950s with the introduction of effective artificial respiratory technology. This gave physicians, patients, and families the hope that the threats to fundamental life processes such as breathing could be countered by technology, and the dilemma of both meeting its costs and the ethical challenges of how to remove it when its use no longer produced benefits. Other technologies soon joined the respirator as highcost agents of care such as the artificial kidney (1960s), the computerized tomography scanner (CT) in 1972, and nuclear magnetic resonance imaging (MRI) in 1977. In addition to such significant inventions, technological health care was supported by an array of other technologies with more modest costs which, nonetheless, exerted large effects on the nature and cost of practice. These included the numerous laboratory tests, which automated analyzers permitted to be ordered in groups of twenty to forty at a time, as well as a large increase in pharmaceutical products claimed to be effective in treating the functional and pathological aspects of illness. During the 1970s and into the early 1980s, national institutions in the United States were forming to study and issue reports on how society should apply and pay for these innovations, most notably the Office of Technology Assessment (OTA) at the U.S. Congress, and the National Center for Health Care Technology, established in the federal government and directed by Seymour Perry. At this time, informal discussions took place among different groups of people about the need of a forum for exchange of ideas in the field. In 1979, Egon Jonsson organized the first international conference on HTA in Stockholm, Sweden (2). Tore Schersten, a Swede who was later the President of the International Society for Technology Assessment in Health Care (ISTAHC), was chairman of the conference. Participants in the conference included Johannes Vang, David Banta, and Per Buch Andreasen. Schersten, Banta, and Buch Andreasen were all subsequently elected President of ISTAHC. More than thirty participants from several countries, including Sweden, the United States, Denmark, Norway, the Netherlands, Finland, and Switzerland took part in the conference. At this conference, the first discussions began about the necessity to have active and structured international contacts for the field of HTA. Subsequently, David Banta, working at OTA, developed a series of papers on how healthcare technology was being dealt with in nine countries. The publication of these papers led to a Rockefeller Foundation-funded “Bellagio Conference” in 1980 that made it possible for further international contacts to be made (1). In addition to Banta, Jonsson, Clyde Behney, and others already working in HTA, representatives of the World Health Organization and the World Bank took part.