Disquiet over rising costs has come to dominate discussions of the health-care system. A major cause of the cost spiral, in the view of many policy makers, is the excessive and inefficient use of innovations such as CAT scanners and coronary-artery surgery. Consequently, Congress has recently voted to establish a Center for National Health Care Technology with a mandate to define the safety, efficacy, efficiency and cost-effectiveness of medical procedures.1,2 This center, by formulating and disseminating standards for such procedures, is expected to influence decisions made by both physicians and government and thus to affect favorably both the quality and . . .