Office Of Technology Assessment Research Articles

Who Will Advise Us? On Proper Relations between Science and Democratic Institutions

This essay will argue that, in place of the present hit-and-miss system of specialist advisement (the system of scientific experts performing case-by-case studies at numerous regulatory agencies, like for the instance the US Office of Technology Assessment), we require a corps of professional public servants for the dissemination of credible, learned, relevant and useful information pertaining to the issues of the day. This is necessary because first of all scientists are as a group poorly prepared for the task of advising (as contrasted with the quite different task of conducting research in the relevant subject area) and more importantly because governments cannot ask scientists to provide that information without also incentivizing third parties (albeit unintentionally) to compromise the institution of science itself. This corps must also be poised to perform such aggregations of opinion (or arbitrations between conflicting opinions and interests) when requests are duly submitted by both governmental and citizen bodies. The product of this corps will be a dynamic, massively cross-referential, virtual document that I shall refer to as the Citizenpedia. This essay is devoted to justifying the government subsidy of such a document, as well as to evaluating the best role for scientists in a democracy. It will contrast the Citizenpedia proposal with practices that have been tried: (1) governmental agencies; and (2) citizen panels. Most importantly, it is devoted to showing that a world in which Citizenpedia advises government is substantially different from one in which either citizens or “experts” do so, just as it is substantially different from a world (our own) in which the media plays the largest role in educating the public on science policy matters.

Office of Technology Assessment: History, implementation, and participatory critique

The Office of Technology Assessment (OTA), which was created by the Technology Assignment Act of 1972, was—and still remains even after its abolishment in 1995—a unique congressional agency. OTA provided members of Congress with their own means of understanding and evaluating complex science and technology matters—of which there are no shortages. It spurred an entire literature of academic research both about OTA and the idea of technology assessment more generally. Understanding the legislative history and implementation of the Technology Assessment Act is crucial not just for scholarship, though. OTA was a blueprint for institutionalizing politically accountable technology assessment. Even as technologies advance at rapid rates, OTA still offers valuable lessons that scholars and policy-makers alike ought to glean. This paper places OTA in a contemporary context of (institutionalized) technology assessment. It contributes to a better understanding of OTA's origins by tracing its lineage to a set of federal reports beginning in 1929. It then analyzes OTA's response to pragmatic implementation questions of how to strike a balance between speed, depth, scope, and temporal focus. Lastly, it uses a public values framework to critique OTA's failure to adequately incorporate participatory elements into its processes.

Who will advise us?

AbstractThis essay argues that, in place of the present hit-and-miss system of specialist advisement (a system of scientific experts performing case-by-case studies at numerous regulatory agencies, the US Office of Technology Assessment, for example), we require a corps of

Interview: A 20-year ‘search for evidence‘ leads to the Center for Medical Technology Policy

Sean R Tunis is the founder, President and Chief Executive Officer of the Center for Medical Technology Policy in Baltimore (MD, USA). The Center for Medical Technology Policy‘s main objective is to improve the quality, relevance and efficiency of clinical research by providing a neutral forum for collaboration among experts, stakeholders and decision-makers. Tunis was a member of the Institute of Medicine Committee on Initial National Priorities for Comparative Effectiveness Research. He advises a wide range of domestic and international public and private healthcare organizations on issues of comparative effectiveness, evidence-based medicine, clinical research, reimbursement and health technology policy. In September of 2005, Tunis was the Chief Medical Officer at the Centers for Medicare and Medicaid Services, where he had lead responsibility for clinical policy for the Medicare and Medicaid programs. Previously, he served as the Director of the Health Program at the Congressional Office of Technology Assessment and as a health policy advisor to the US Senate, where he worked on pharmaceutical and device policy issues. Tunis trained at the University of California in Los Angeles (CA, USA) and the University of Maryland in Internal Medicine and Emergency Medicine (MD, USA) and holds adjunct faculty positions at the Tufts University School of Medicine (MA, USA), the Department of Internal Medicine at the Johns Hopkins School of Medicine (MD, USA), and the Department of Surgery at the University of California at San Francisco (CA, USA).

Competences for Cyber-physical Systems in Manufacturing – First Findings and Scenarios

This paper presents research findings on competence needs for Cyber-Physical Systems (CPS) in manufacturing. These are from studies of the German Federal Ministry of Education and Research's initiative for early identification of skill needs (FreQueNz) as well as the Office of Technology Assessment at the German Bundestag (TAB). The findings are partly statements on possible future developments as – at least according to the mentioned studies during their periods of inquiry – the degree of CPS implementation in enterprises has been fairly low. Further development of CPS competence needs depends on which combinations of technologies and work organization will come to prevail in the enterprises in the course of broader implementation. As this seems rather open, two of the studies distinguish at least two ideal scenarios with regard to possible directions of competence developments.Within the first scenario more and more decisions would be taken by IT which would control the production employees. These are expected to intervene into the process in case of malfunctions only but cannot develop the respective competences during the trouble-free process. Within the second scenario the technology would serve as decision-supporting system to employees still expected to optimize and able to intervene into the process.Starting from a maturity model of innovations, the presentation of research findings in this paper is linked to a thesis on the added value of stronger links between technology forecasting and early identification of skill needs. By such links early identification of skill needs could be focused at an early stage on topics which are considered by technology forecasting to have major potential. This could help reducing skill gaps at the diffusion stage of technological innovations.

Senior Environments: When We Become Them

I have been involved in the design and evaluation of senior environments (or environments for aging, or design for dementia, or memory care, or elder friendly communities, or whatever your choice of language may be) for over 25 years. I've seen a lot of changes in our thinking on some topics. For instance, in the 1980s we thought that people living with Alzheimer's disease or other forms of dementia had unique needs that were and different from the needs of other people living in nursing homes or assisting living communities. I was part of an early Special Care Unit (SCU) initiative, urging care communities to support continuity of self, to individualize care, to create places that feel homelike (not a term I would use now), and to support safety, which usually meant securing doors with some electronic system. We discovered there were many things we could do to support these residents beyond what the typical medical model of care provided; we developed resources to help others learn what to do.There were books, including my own, Design for Dementia (1988); research, including the 11 NIA-SCU collaborative studies funded by the National Institute on Aging (NIA); governmentsponsored publications, for example, Losing a Million Minds (Office of Technology Assessment, University Press of the Pacific, 1987); special task forces and conferences; and so much more. Every conference seemed to have a track on dementia care-best practices, stafftraining resources, the built environment.These were helpful, but something was missing. So I spent time with individuals living with dementia and watched as they sometimes struggled to make sense of the world around them. I tried to learn what would bring on frustration or anxiety. I also saw their amazing gifts of insight, their ability to live in the moment, to still feel and respond to the world around them on their own terms. I learned so much just by being with them. I watched caregivers struggle to both do everything that needed to be done in terms of care and try to be like a best friend or family. The system seemed to pit these two goals against each other, however, and it was the residents who always lost.Have we made progress over the past 25 years? Maybe. Have we improved our ability to support a high quality of life for people living with Alzheimer's? Marginally. There has been little progress on the pharmacologic treatment of Alzheimer's disease over the past 20 years. The best drugs we have may stave offdecline for about 6 months, if you can tolerate the side effects. Not a huge benefit when people generally live with dementia for 12 to 20 years after diagnosis. Other categories of drugs are so overused it should be called abuse. A recent Centers for Medicare & Medicaid Services (CMS) nursing home resident report found that in 2010 almost 40% of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point, even though there was no diagnosis of psychosis. So here it is 2013 and a major initiative of the CMS was to reduce off-label antipsychotic drug use by 15% in 2012. Maybe by the end of 2013 we will only have 34% of residents living with dementia but not psychoses receiving antipsychotic drugs.What about all of the psycho-social-environmental interventions that were developed in special care units? The good news is that we have made progress in this area. First, many people in the field of aging services began to realize that the principles we had developed for special care units for people with dementia were equally applicable to anyone living in a shared residential setting. Everyone wants and deserves access both to privacy and to meaningful, engaging activities. Everyone wants to be able to spend time with people they know, and who know them. Everyone has the right to live with their own personal belongings, to choose their own daily routine, to have choice in when, where, and what they eat. Professionals in the field have accepted that these principles are not dementia-specific but reflect person-centered care practices applicable to everyone. …

Building Better Models

T landmark issue of Medical Decision Making summarizes important deliberations about best practices for simulation modeling. This body of work represents the third major set of recommendations for modeling best practices in the past 2 decades. The current project, sponsored jointly by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making, builds on and extends prior efforts to set standards for the conduct of modeling. These new articles provide modelers with guidance on building more useful models and consumers with benchmarks to judge the quality of the models. These thoughtful guidelines should strengthen the integrity of the model development process and encourage broader use of models in decision making. Modeling has long been embraced by the medical decision-making community and other researchers concerned with evidence-based practices and outcomes. In 2009, simulation modeling was recommended by the Institute of Medicine as a method to quantify the net impact of medical interventions. More recently, the Patient-Centered Outcomes Research Institute has been charged with using a variety of methods, including modeling, to evaluate the comparative effectiveness of medical interventions (www.pcori.org). In addition, more complex and biologically accurate models are now possible because of computing and information technology advances. Until recently, however, models affected few coverage and policy decisions in the United States. Models were used in setting American Cancer Society cervical cancer screening guidelines in the 1980s. In the late 1980s, the US Congress’ Office of Technology Assessment (OTA) commissioned models to evaluate screening for cervical and breast cancer under the Medicare program. The results were influential in the decisions to extend Medicare benefits to include Pap smears and mammography between 1988 and 1990. Unfortunately, the OTA was de-funded in 1995. Cancer modeling gained renewed support in 1999, when the Institute of Medicine released a report on the quality of care and called for greater inclusion of cancer outcomes research at the National Cancer Institute (NCI). Meanwhile, outside of the United States, modeling has been and continues to be used to guide policy on a routine basis. In the United Kingdom, for example, cost-effectiveness results from models are required for health care coverage decisions. Modeling of cancer interventions was advanced in the late 1990s with the funding of NCI’s Cancer Intervention and Surveillance Modeling Network (CISNET). Over the past 15 years, CISNET has gained traction in advancing the use of modeling to inform policy and clinical practice. Several aspects of the CISNET modeling approach have contributed to its success, including use of best modeling practices, similar to those outlined in this issue; deployment of more than one model to address a specific research question; development of a template for the description of the models; and commitment to transparency and collaboration. For example, by having Building Better Models: If We Build Them, Will Policy Makers Use Them? Toward Integrating Modeling into Health Care Decisions

A Congressional counterpoint: Challenging the Reagan Administration on the safety of blood and blood products

When the US Centers for Disease Control met a hard wall of political restraint in attempting a full response to the emergency of AIDS in the early 1980s, it was possible to move toward protection of blood and blood products from the legislative branch of government instead - despite resistance from the Red Cross, blood banks, and the Reagan Administration. A Congressional creation, the Office of Technology Assessment (OTA), received a request from the author, made on behalf of his employer, the Chairman of a Congressional Committee and a Member of the OTA Congressional Board. He asked the OTA to assess US blood policy in light of scientific and technological developments - most importantly the new disease, AIDS. The OTA issued its report in January 1985. In 1995, a new Republican majority in both legislative chambers eliminated the OTA - and thus a valuable source of policy analysis of scientific issues independent of the executive branch.

Policy Networks and the U.S. Congressional Efforts to Terminate Four Federal Agencies

The article develops a partial explanation for the varying fates of four federal agencies that the U.S. Congress targeted for elimination in the 1980s or 1990s: the Civil Aeronautics Board (CAB), Interstate Commerce Commission (ICC), Office of Technology Assessment (OTA), and the National Endowment for the Arts (NEA). Congress successfully eliminated the CAB, ICC, and OTA; the NEA, however, survived. The argument of the article is that a vibrant policy network surrounding an agency Congress has targeted for elimination provides resiliency to resist congressional termination efforts by weaving together the relevant institutions and organizations into a resilient policy network and generating critical political support during dire times. A model of policy network resiliency is presented and applied to congressional efforts to terminate the CAB, ICC, OTA, and NEA.

The Financial And Cost Accounting Implications Of The Increased Role Of Advanced Nurse Practitioners In U.S. Healthcare

On March 23, 2010, the Affordable Care Act became law. The need for healthcare reform was prompted by an imperative to reduce the relentless increase in spending on medical care in the United States. One approach to examining and solving the problem of escalating costs is to focus on applying proven principles of evidence-based practice and cost-effectiveness practices to find the least-expensive way to ensure clinical services of acceptable quality without sacrificing patient satisfaction. Advanced practice registered nurses (APRNs) have positioned themselves to serve an integral role in national health care reform. A successful transformation of the nation's health system will require utilization of all clinicians, including highly qualified APRNs, to provide cost- effective, accessible, patient-centered care. There is extensive, consistent evidence that nurse practitioners (NPs) provide care of equal or better quality at lower cost than comparable services provided by other qualified health professionals. However, current policies in many states prevent NPs from practicing within their full, legally defined scopes of practice. The Office of Technology Assessment's conclusions noted in 1981 that APRNs can be substituted for physicians in a significant portion of medical services with at least similar outcomes. Since then, numerous studies have supported that the care provided is equal to those provided by physicians for services within the overlapping scopes of licensed practice. This paper combines economic analysis with review of literature on health care reform initiatives to explore how the goals of healthcare reform can be accomplished by advanced nurse practitioners to provide their wide range of services directly to patients in a variety of clinical settings.

Assessing renewable energy portfolio futures with multiple perspectives: The case of the northwest US

Renewable energy has become a major driver for the federal and state governments. Many have received funds from recently announced programs. However there have been challenges in determining the optimum portfolio of energy alternatives. Multiple perspectives were operationalized through a prior assessment by the Office of Technology Assessment. Through additional literature review, a model was created to consider all factors and perspectives to be considered in developing a portfolio of renewable energy technologies. A limited demonstration with goal programming and scenarios was included. The case of the state of Oregon was used to demonstrate the approach.

Nurse Practitioners in Emergency Care

Nurse Practitioners in Emergency Care

TECH ASSESSMENT MAKES A COMEBACK

AFTER MORE THAN a decade of neglect, efforts to ramp up technology assessment—the practice of looking at the broad social implications of new science and technology—are under way in the U.S. Discussions are even starting to take place between the government and independent institutions on ways to integrate traditional models that incorporate expert technical opinions with emerging methods that consider the views of laypeople. Technology assessment has been lagging in the U.S. since the Republican-led Congress at the time shut down the Office of Technology Assessment in 1995. OTA advised Congress on complex science and technology policy issues for 23 years. Several attempts by Congress to resurrect OTA have failed. Meanwhile, science and technology have moved on at a breathtaking pace. To help fill the gap, the Government Accountability Office, which is the investigative arm of Congress, has been beefing up its technology assessment capabilities since late 2008. And the White House Office of Science ...

Bewertung von Innovationen in der klinischen Forschung: Stärken und Verbesserungspotenziale des Forschungsstandortes Deutschland

Clinical research is a central link in the development chain of new treatment methods; scientifically, it belongs between basic science and health services research. It spans from the first application of a new substance or device in humans to the main proofs of its efficacy and safety. Economically speaking, it absorbs almost half of the total expenditures for the research and development of a new drug and represents a significant factor in the labour market for researchers and study personnel. Also, through participation in clinical trials, patients gain early access to new treatment methods, while on the other hand they are placed at higher risk for undesired side effects. Politics have taken significant steps to strengthen clinical research, but the pharmaceutical industry continues to complain about competitive disadvantages. Despite internationally recognised and, to a large extent, legally codified guidelines there are still significant national differences in implementation. In addition, traditional practices in clinical research are challenged by novel, mainly biotechnological therapeutic methods for which our current knowledge base is rather limited and which therefore entail a higher risk for patients or trial participants. The following paper summarises a report for the Office of Technology Assessment at the German Federal Parliament (TAB). Based on current regulations, scientific literature and expert interviews, current challenges and solution strategies for clinical research will be analysed in terms of an international comparison.

Gerald L. Epstein, PhD: Director, Center for Science, Technology, and Security Policy, American Association for the Advancement of Science (AAAS)

Over his entire career, Gerald Epstein has toiled at the nexus of science, technology, and security. From 2003 to 2009, he was Senior Fellow for Science and Security at the Center for Strategic and International Studies Homeland Security Program, where he worked on reducing biological weapons threats, improving national preparedness, and easing potential tensions between the scientific research and national security communities. Epstein came to CSIS from the Institute for Defense Analyses. From 1996 to 2001, he served in the White House Office of Science and Technology Policy. And from 1983 to 1989, and again from 1991 until its demise in 1995, Epstein worked at the Congressional Office of Technology Assessment, where he directed a study on the proliferation of weapons of mass destruction, alongside research on other global security topics. A recognized expert in biological risk reduction, Epstein was actually trained as a physicist, having received SB degrees in physics and electrical engineering from MIT, and a PhD in physics from the University of California at Berkeley. How, then, did he come to study the evolving threat from bioterrorism? "What compelled me about bioterrorism was that it was a stellar example of a topic that would lead to a train wreck between the scientific community and the security community unless they figured out how to work together," he said. "The distance between a laboratory and a very large consequence event is a lot shorter in biology than in any other field. I got into bioterrorism to help make sure that the security community doesn't get so scared of the science that it shuts it down, and that the science community isn't so oblivious of security concerns that it pays no attention to them." Epstein spoke on November 6, 2009, with contributing writer Madeline Drexler, author of Emerging Epidemics: The Menace of New Infections (Penguin, 2009), an updated version of an earlier volume. Drexler holds a visiting appointment at the Harvard School of Public Health and is a senior fellow at Brandeis University's Schuster Institute for Investigative Journalism.

Science, Policy, and the U.S. Congress

Scientists often misunderstand the role science plays and should play in policy making. Those misconceptions are captured well in the debate over whether Congress should recreate an Office of Technology Assessment (OTA).

Un mécanisme de prospective technologique en prospective

The growth of consumer and environmentalist movements in recent years has shown that technological innovation is not always beneficial. Growing public pressure for better assessments of the consequences of technological projects has lead to the development of the concept of "Technology Assessment" which has been defined as "taking a purposeful look at the consequences of technological change". The concept of "Technology Assessment" originated in the U.S.A. in the early 1960's. In 1972 the Office of Technology Assessment (OTA) was formed as an aid to Congress. However since the Canadian political system differs significantly from that in the U.S.A. a different mechanism for Technology Assessment is needed in Canada. The present paper describes such a mechanism.

Office of Technology Assessment health program

The U.S. Congressional Office of Technology Assessment (OTA) established a health program in 1975. During the next few years, OTA's health program published a series of reports dealing with different aspects of health technology assessment (HTA) in some depth. The key report in this series concerned the efficacy and safety of health technology, which in many ways played a ground-breaking role. It pointed out the pervasive lack of accessible information on efficacy and safety, despite more-than-adequate methods of assessment. It also pointed to many problems that resulted from this lack, and the limited use of such information in clinical practice and policy making. It promoted synthesis of existing literature as a practical method of assessment. Other key reports developed other aspects of HTA, including cost-effectiveness. These reports are generally considered to have shaped the field of HTA at least into the 1990s. OTA also pioneered the use of HTA in determining what preventive services to cover in public healthcare programs.

What is technology assessment?

Technology is generally defined as "science or knowledge applied to a definite purpose." Technology assessment has been defined as a form of policy research that examines short- and long-term consequences (for example, societal, economic, ethical, legal) of the application of technology. The goal of technology assessment was said to be to provide policy makers with information on policy alternatives. Health technology assessment (HTA) grew out of this field and was developed in the U.S. Office of Technology Assessment (OTA). However, the OTA was closed in 1995. The links between technology assessment and health technology assessment were more-or-less lost after the dissolution of OTA, and few workers in the field of HTA seem familiar with the roots of the field in the more general and social-oriented technology assessment.

Restart the Congressional Office of Technology Assessment

Restart the Congressional Office of Technology Assessment