Interface between technology, clinical, human and social ... · PDF fileSociology contribution...
Transcript of Interface between technology, clinical, human and social ... · PDF fileSociology contribution...
Sociology contribution to understanding the (no)diffusion
of a medical innovation
Philippe Gorry, University of Bordeaux
Interface between technology, clinical, human and social science and public health: Case study interventional radiology
A question
What are the barriers
to (medical) innovation’s diffusion (today) ?
Theory of innovation diffusion (Rogers, 1962) Innovation itself
Adopters
Communication channel
Time
Social system
Sociology of science (Merton, 1973) Importance of interactions between sociocultural structures and science
The triple helix model (Etzkowitz, 2008) University-industry-government interaction
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A subject
The case of interventional radiology (IR) Definition: Invasive medical procedures with thee aim of diagnoisis and/or
treatment of a disease performed under image guidance (X-ray, CT, MRI)
- Born with pioneering work of Charles Dotter Dotter C, Judkins M (1964). "Transluminal treatment of arteriosclerotic
obstruction. Description of a new technic and a preliminary report of its applications" , Circulation 30 (5): 654–70
- Invention of angioplasty and catheter-delivered stent
- Using ultrasound and MRI give rise to new approaches such as lithotripsy or high-intensity focused ultrasound (HIFU)
- Used in cancer since the mid-90s
Today many conditions that once required surgery could be treated nonsurgically by interventional radiologists but they are not. Why ?
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A team
A multidisciplinary team Health sociologist :
- Beatrice Jacques, PhD Asso. Prof. (Project leader)
- Sonja Purgues, Research assistant
Sociologist of science :
- Pascal Ragouet, PhD Prof.
- Leo Mignot, PhD student
Economist of innovation :
- Philippe Gorry, MD-PhD Asso. Prof.
- Emlie Bisbau, Master student
Health lawyer :
- Marine Aulois-Griot, PharmD-PhD, Prof.
Interventional radiologist :
- Jean Palussiere, MD
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A project Supported by a grant from INCa 2013-2015
3 axes of research
The history of the technology
- Catachresis innovation
- Incremental practice-embedded innovation
- Academic boundary problem
Strategies of legitimation & valorisation of the IR
- Education infancy
- Reconfiguration in the speciality & between specialities
- The problem of scientific legitimacy
The recognition by the public
- The experiment of the technique
- Ignorance of general public: a problem of communication
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A method
Litterature reviews
Scientometric, patent mapping & competitive intelligence study
Law & health public policy analysis Standart, MA & Health Technology Assessment
Field observations (weeks) In interventional radiology department (Bordeaux, Marseille, Strasbourg,
Montreal)
Semi-directed interviews (n>60) Researcher & Engineer
Physician (radiologist & other medical specialist; senior & junior)
Radiology tech & nurse
Hospital administrative
Health public agency representative
Entrepreneur (Start-up, SMEs & global companies)
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Some results
Axe #1 The invention of IR by Charles Dotter
Innovation by catachresis (Allamel-Raffin, 2005) - From Ancient Greek κατάχρησις (katákhrēsis, “misuse (of a word)”)
- Instrument « hijacking » from its original purpose to a new one
- An example of « sleeping beauty »
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Pub. by Dotter Pub.citing "Dotter" in Ti/abs/keyword Citations of all Dotter pub. Citations main Dotter paper
Glorification
✝ Mesh introduction
Controversy Diffusion
Some results
Axe #1: The history of the technology Incremental practice-embedded innovation
- with interleaving between independent lines of innovation:
tools (catherer, radiofrequency, HIFU,…)
medical imaging (US, Tomo, MRI)
Image guidance system
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1971
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y = 0,0371x + 1,625 R² = 0,8216
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Relatioship between CT innovation & microprocessor puissance
Some results
Axe #1: The history of the technology Disciplinary/professionals boundary problem
- Interrelationship between researcher, engineer & physician
A market-pull dynamic – the physician as prescriber of usefullness
Example: EDAP-TMS, INSERM & Lyon University hospital ->Ablaterm
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5- Production scientifique & technologique des acteurs des HIFU
Rôle d’interface des chercheurs-inventeurs en recherche translationnelle
Source : EDAP-TMS
Projet de recherche initié en 1989 grâce à la collaboration à Lyon de 3 partenaires (INSERM, HCL & EDAP-
TMS); homologué en Europe depuis 2000, après 10 ans de R&D.
Some results
Axe #2 Strategies of legitimation & valorisation of IR
Education infancy
- Non-institutionalized training: prevalence of companionship
"Those who have it in hand surgery and leaving not much room to rest."
"If the fact of forming radiologists bothers those joysticks in hand".
"we have failed, thereby, ensure the renewal of the generations of correct way"
"There are certain university towns where the teachers of Radiology did not play their role to both enhance this aspect and to attract young people to this aspect".
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Some results
Axe #2 Strategies of legitimation & valorisation of IR
Reconfiguration in the speciality & between specialities
- Intra-disciplinary configuration
The radiologist in the future: change management
Organization of the health care system
Health Economy
Impact of health technology evaluation
ROE
Pricing
- Inter-disciplinary configuration
Betweeen diagnostic & therapeutic: In competition with surgery
Boundary-work & professional space
Legacy: Visualize but do nottry to fix ».
Turf wars : IR v mini-invasive surgery
Fighting for the medical activity (access to the patient)
Statu quo : the patient for the surgerons, the instrument for the radiologists
Does IR is a speciality? : Clinician or hired-gun.
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Some results
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Axe #2 Strategies of legitimation & valorisation of IR
The problem of scientific legitimacy:
- Role of heath technology assessment by agencies (HAS, NICE, …) in the
social construction of the medical innovation value
Are the medical imaging techniques a scientific topic of HTA? How long between
innovation & evaluation? HTA brake or accelerator of diffusion innovation ?
Some results
Axe #2 Strategies of legitimation & valorisation of IR
Legal & normative framework
- 3 dimensions
Medical device :
declaration of conformity (CE marking)
Pricing
Protection against ionizing radiation
Dosimetry reporting in medical record Art. R. 1333-66
- An incompleteness of IR recognition in the Public Health Act
Recognition of IR procedure in cardiology and neurology
with minimal HR requirement & training
decree n° 2007-366 et 2007-367
decree n° 2009-409 et 2009-410
but NOT in oncology
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Some results
Axe #3 The recognition by the public
The experiment of the technique
- How the patient was informed of IR potential use ?
- Degree of satisfaction & understanding
- Regional disparities and inequalities of access to IR
Ignorance of general public: a problem of communication
Undergoing work
- Interview with advocacy patient group
- Patients survey
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In conclusion
Sociology of science
Beside catachresis & sleeping-beauty
A specific case of 2 parallel trends of innovation
Health sociology
IR a case of innovation diffusion embedded in professional
organization boundaries & relying on health care organization
Economy of innovation
The usefulness of the medical innovation is not determines anymore by the individual or the physician as prescriber but by the society through HTA agencies
Public Health law
Role of the legal framework in the institutionalization of new medical procedure
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Contacts Philippe Gorry, MD-PhD, Asso. Prof. Trained in medical genetic, has been past-funding director of the
technology transfer office of Bordeaux’s university, and is currently CFO of the university incubator. He is a research associate in the Dpt. of Economics. working on innovation in the pharma-biotech sector, and served as an expert for OECD, WIPO, ERC…. He is teaching mainly technology forecasting and clinical competitive intelligence at the School of Pharmacy & Faculty of Economics.
Contacts Adresse: GREThA - UMR CNRS 5113
Dpt of Humanities & Social Sciences
University of Bordeaux
Avenue Leon Duguit 33608 Pessac – France
Tel. / FAX: +33 5 56 84 25 75 /+33 5 56 84 86 47
Maill: [email protected]
Web: http://www.linkedin.com/in/philippegorry
http://gretha.u-bordeaux4.fr/fr/members/gorry-philippe
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