Reply by Chester Smith [9/11 was not Guerilla Warfare: Comments on "Efficiency of Guerilla/Terrorist Warfare" by Chester L. Smith]

| 27 course” that Callahan describes. But the collision is indirect: by pushing up costs of health care, the LVAD (and other expensive technologies) will make it even harder to extend health insurance to all Americans. Other countries take a different approach. England restricts consumption of high-tech medical services by, in effect, rationing medical care (except for those with the ability to pay for private care). But these countries are also facing the prospect of unsustainable medical costs. Can even wealthy societies afford the splendid technology of modern medicine? The LVAD is truly a splendid technology, a product of the artificial heart program developed without the hoopla that accompanied the artificial heart. But it creates a dilemma that will also arise with other artificial organs that may be developed in the future: the treatment costs are very high, there are many potential users, and the availability of the devices (unlike those of organs for transplant) is essentially unlimited. To paraphrase Callahan’s question: at what point does a new medical technology become too much of a good thing?