The machine is a classic American dream: big, expensive, and constantly going out of date. It is also the center of a passionate and uniquely American controversy. To many, the development of computerized tomography (CT) is the greatest diagnostic advance since the discovery of the x-ray.1 For others, the rapid purchase and unprecedented demand for these costly and complicated machines symbolizes what's wrong with the practice of medicine in this country.2 The case report by Heath et al in this issue (p 628) illustrates the dilemma.
The young man described by Heath et al had a malignant, relentlessly progressive form of regional enteritis. From first diagnosis at age 15, his disease led to numerous hospitalizations, three major surgical procedures, and death from an overwhelming infection before he became 21. For most of these six years, his care followed a traditional, accepted course. Where his case differed from the