Among the developments contributing to the technification crisis:

The growth of medical subspecialists. We are overwhelmed by information. Unable to interpret it ourselves, we have become dependent on subspecialists who are often hemmed into narrow diagnostic spaces, ordering more and more studies. If the patient's general physician holds up his hand, he may be told that he is placing his patient at risk.

The growth of medical insurance. Although "third-party payers," including Medicare, have begun to limit reimbursement, they encourage us to generate measurable items of medical service -- tests and procedures -- by rewarding us more generously for them than for examining the patient.

Growth of physician supply. Twenty years ago there was said to be a physician shortage. A program of federal subsidies has since brought forth a surplus, particularly in high-population areas. Where competition is keen, doctors are hardly going to withhold state-of-the-art technology.

Legitimization of medical advertising. The Federal Trade Commission and the courts have legitimized advertising by physicians. Since it is difficult for doctors to distinguish themselves from one another by their skills, our advertisements will tend to highlight gadgets and gimmicks.

The growth of television. As a major determinant of public awareness of "what's out there in medicine," TV draws attention to the visually dramatic, the breakthrough achieved through new devices.

The growth of medical litigation. Rising patient expectations are increasingly backed up by the threat of a malpractice suit. Given that threat, how hard will physicians try to convince patients that the "latest advances" they've heard about will not help them?