Debating Modern Medical Technologies
The Politics of Safety, Effectiveness, and Patient Access
by Karen J. Maschke and Michael K. Gusmano
September 2018, 215pp, 6 1/8x9 1/4
1 volume, Praeger

Hardcover: 978-1-4408-6189-5
$55, £43, 48€, A76
eBook Available: 978-1-4408-6190-1
Please contact your preferred eBook vendor for pricing.

Expensive new drugs can eliminate the Hepatitis C virus in infected patients, but insurance companies will not always cover treatment for patients who have not yet suffered liver damage.

This book analyzes policy fights about what counts as good evidence of safety and effectiveness when it comes to new health care technologies in the United States and what political decisions mean for patients and doctors.

Medical technologies often promise to extend and improve quality of life but come with many questions: Are they safe and effective? Are they worth the cost? When should they be allowed on the market, and when should Medicare, Medicaid, and private insurance companies be required to pay for drugs, devices, and diagnostic tests? Using case studies of disputes about the value of mammography screening; genetic testing for disease risk; brain imaging technologies to detect biomarkers associated with Alzheimer’s disease; cell-based therapies; and new, expensive drugs, Maschke and Gusmano illustrate how scientific disagreements about what counts as good evidence of safety and effectiveness are often swept up in partisan fights over health care reform and battles among insurance and health care companies, physicians, and patient advocates.

Debating Modern Medical Technologies: The Politics of Safety, Effectiveness, and Patient Access reveals stakeholders’ differing values and interests regarding patient choice, physician autonomy, risk assessment, government intervention in medicine and technology assessment, and scientific innovation as a driver of national and global economies. It will help readers to understand the nature and complexity of past and current policy disagreements and their effects on patients.


  • Helps readers to understand the political, economic, and ideological dimensions of disputes about health technology assessment and the implications of various policy approaches for patients and the health care system
  • Includes discussion of disputes related to hot topics such as stem cell therapies, mammography screening, genomic tests, breast cancer drugs, and Hepatitis C medications
  • Discusses interest group pressure on government from large pharmaceutical companies and medical device manufacturers
  • Connects to current political rhetoric about speeding up the availability of technology
Karen J. Maschke, PhD, is research scholar at the Hastings Center. She has a PhD in political science from Johns Hopkins University and a master's degree in bioethics from Case Western Reserve University. Prior to joining the Hastings Center, she was a college professor teaching a wide range of courses related to American government and politics, law and society, and constitutional law. Dr. Maschke has published three previous books, including (as coeditor) The Use of Performance-Enhancing Technologies in Sports: Ethical, Conceptual, and Scientific Issues. She is currently editor of IRB: Ethics & Human Research.

Michael K. Gusmano, PhD, is associate professor of health systems and policy at the Rutgers University School of Public Health, research scholar at the Hastings Center, and visiting fellow at the Rockefeller Institute of Government, SUNY. He has a PhD from the University of Maryland at College Park and was a post-doctoral fellow in the Robert Wood Johnson Foundation Scholars in Health Policy Program at Yale University. He has published four previous books and is currently an associate editor for the Journal of Aging and Social Policy and Health Economics, Policy and Law.


"Questions about the accessibility, value, and safety of expensive medical technologies loom large in the national conversation about the future of health reform in the United States. What medical technologies can we afford, how should we assess their clinical effectiveness, and who should possess the authority to make these important decisions? In their thoughtful and engaging book Debating Modern Medical Technologies, Karen J. Maschke and Michael K. Gusmano demonstrate that debates about the evidentiary standards for market entry and patient access to medical technologies are shaped not only by conflicts over science and data but also by disputes among interest groups, political ideologies, and partisan differences on the role of government. Their analysis artfully weaves together insights from political science, public policy, and science and technology studies in telling us how medical evidence disputes play out in a variety of regulatory and payer settings. The book is timely, compelling, and beautifully written. A must-read for students of health policy."—Eric M. Patashnik, Julis-Rabinowitz Professor of Public Policy and Political Science, Brown University, and Coauthor, Unhealthy Politics: The Battle over Evidence- Based Medicine

"Although medical technology is fundamental to the quality of care and its cost, it is too often studied in silos that separate its scientific and political dimensions. This excellent book by Maschke and Gusmano brings these dimensions together, much to the enlightenment of scholars of science, politics, and policy, by means of superbly researched case studies through which pass a rich array of technologies, evaluators, interest groups, advocates, bureaucrats, and political leaders. The book is a gold mine for all serious students—and practitioners—of health care policy."—Lawrence D. Brown, Professor of Health Policy, Department of Health Policy and Management, Columbia University, Mailman School of Public Health

"Debating Modern Medical Technologies illustrates how political science scholarship can truly contribute to the 'public good.' In lucid, accessible prose, Karen J. Maschke and Michael K. Gusmano analyze the decision-making process in five different cases of the adoption of and payment for medical technology in the United States—decisions that directly affect both the cost and quality of health care. They clearly explain the complicated debates about the risks and benefits of these technologies/medications, including the value of different types of scientific 'evidence,' and draw on insights about policy framing, political ideology, and the interests and activities of professional, industry, and consumer groups to examine the reasons for the decisions of government agencies and private insurers. This book should be required reading for every journalist writing about health policy, every student studying it, and every congressional and executive branch staffer/public official involved in making it."—Alice Sardell, Queens College, CUNY, and Author of Insuring Children’s Health: Contentious Politics and Public Policy

"Debating Modern Medical Technologies is a timely and important book. As medical expertise and populism collide in the 'right to try movement' and unprecedented deregulation upends historic norms, stakeholders need an unbiased account of how decisions about medical technology are actually made. Drawing upon their deep knowledge of health policy, Maschke and Gusmano brilliantly explain the mix of scientific, economic, and political forces that make medical progress possible and accessible. Their collaboration has resulted in serious scholarship in the public interest."—Joseph J. Fins, MD, MACP, FRCP, Weill Cornell Medical College and Yale Law School and author of Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness
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