Functional Area Problems, Opportunities, and Constraints 47 



Therefore, if substantial progress is to be made in the 

 coming years in combating drug and substance abuse 

 problems, increased research efforts into the causative 

 factors will be needed. Much has already been learned in 

 that area, and much is currently being studied. Major 

 efforts are now under way concerned with cigarette smok- 

 ing; those efforts should further our understanding of the 

 physiological and psychological causes and basic mecha- 

 nisms of nicotine dependence and withdrawal and should, 

 therefore, increase the effectiveness of treatment of that 

 public health problem. Studies also are ongoing or 

 planned to understand better both the physiological and 

 the psychological consequences of marijuana use in ado- 

 lescents. Research on genetic predispositions and other 

 biomedical factors appears to offer the first prospects for 

 advancing knowledge of the causes of alcoholism 

 (HEALTH). However, much additional research will be 

 needed before ultimate solutions to addiction problems 

 will emerge (HEALTH; SSRC-2). 



INCREASING EFFORTS TO TRANSLATE BASIC 

 BEHAVIORAL RESEARCH FINDINGS INTO BIOMEDICAL 

 PRACTICE 



The general problem of transferring basic scientific find- 

 ings into practical use is discussed elsewhere in this re- 

 port. However, there are some problems particular to 

 behavioral approaches to the treatment of addictive be- 

 haviors that should be highlighted here, since the incor- 

 poration of behavioral treatments into practice has been at 

 a slower pace than has been the acceptance of innovative 

 biomedical advances. One reason for the slow pace of 

 incorporation of behavioral approaches may be a lack of 

 convincing evaluation data to document the effectiveness 

 of the various innovative approaches. A second may be a 

 simple lack of systematic communication between be- 

 havioral and biomedical scientists. Therefore, there is a 

 need to determine more conclusively exactly which be- 

 havioral approaches are effective and which are not and, 

 then, a need to improve the processes by which such 

 information is disseminated to both health practitioners 

 and the general public (SSRC-2). 



FOSTERING THE DEVELOPMENT AND 

 ASSESSMENT OF HEALTH CARE 

 TECHNOLOGIES 



As the size and significance of the Federal research effort 

 have expanded, there has been increased concern about 

 obtaining the greatest possible return from government- 

 sponsored research. Of the $6.9 billion spent on health 

 research in 1979, 62 percent, or $4. 3 billion, was spent by 

 Federal agencies, and, of that amount, approximately 80 

 percent was provided by the Department of Health and 

 Human Services (HHS).'' Recognizing that research and 

 development frequently provide results that are useful 



beyond the original intent, there is a growing effort in 

 Federal agencies to seek spinoff applications, to assess the 

 relative benefits and costs of new technologies, and to 

 disseminate technology created with Federal funding for 

 use by others (ASTR-II). 



A variety of problems and constraints associated with 

 the use of new health technologies will have to be consid- 

 ered during the 1980s. For example, it obviously is impos- 

 sible to implement all new technologies. Therefore, 

 choices among the many opportunities and among various 

 alternatives for achieving the same goal will have to be 

 made. Questions must be asked about the costs, as well as 

 the benefits, of those new technologies. Although many 

 new technologies are cost-effective, others may not be. In 

 addition, the high costs of certain technologies, such as 

 the new scanning technologies, raise questions as to how 

 those technologies might best be dispersed to serve the 

 broadest possible range of patients. Finally, there may 

 prove to be a need, in some cases, to control the rate of 

 adoption of emerging technologies as their benefits and 

 costs are carefully assessed. Decisions on those issues, 

 like most policy decisions, are, of course, frequently 

 based on more than scientific grounds (see Section I-E). 



Prior to 1977, there was no formal mechanism at the 

 Federal level for coordinating and conducting assess- 

 ments of new or existing health care technologies, with the 

 exception of the Food and Drug Administration's (FDA) 

 programs related to pharmaceuticals. However, the as- 

 sessment and dissemination of medical technology have 

 accelerated rapidly in the last few years. For example, the 

 Office of Medical Applications of Research (OMAR) was 

 established in the National Institutes of Health (NIH) in 

 1977. OMAR, with the support of the National Library of 

 Medicine (NLM), now serves as the focal point of a 

 Federal-level strategy to assess the efficacy and safety of 

 new health technologies and to aid the transfer of the 

 results of those assessments to both practitioners and the 

 general public (HEALTH: ASTR-III). 



As an example of what has been done to achieve agree- 

 ment about the efficacy of a new or emerging technology, 

 OMAR emphasizes a process that involves the identifica- 

 tion and selection of a broad range of health experts 

 invited to participate in working groups. Broad and open 

 participation is encouraged in the conduct of such assess- 

 ments. Results from the assessments are then passed to the 

 medical and scientific communities and to health planning 

 and health delivery organizations (HEALTH). However, 

 in spite of those programs and the progress made to date, 

 several problems remain surrounding the development of 

 strategies for transferring basic research knowledge into 

 practice or technological development most effectively 

 and, then, for assessing those new technologies. Science 

 and technology efforts can be useful in both regards. 



