On Technical Innovation

We've raised the issue of the impact of innovation on health in a number of different ways, perhaps most expressly in discussing the McKeown Thesis.  Something that irritates me in health policy discourse is the widely-held assumption that the worth of technical innovation is of paramount value.  Under this narrative, any activities or initiatives which could undermine the pursuit of such innovation is immediately suspect.

However, such an argument is, to my mind, entirely question-begging.  The social value of technical innovation cannot fairly be assumed, because the actual notion of an ethical dilemma means expressly that whatever choice is made, something of value is lost.  Trying to assess the extent of the value of such innovation is a fundamental part of the inquiry in thinking about particular policy choices that might require just such a trade-off.

Given the McKeown Thesis, as well as a plethora of evidence suggesting that technical innovation is

• not a prime determinant of population health
• is a prime determinant of health care expenditures;
• and even contributes to disparities

the social worth of such innovation remains, to my mind, an open question.  The movement for translational science and medicine itself underscores the notion that in the majority of health care scenarios, we have all the innovation we need and then some to effectively treat the illness sufferer.  The problem is the gap between the evidence and the practices, not a problem in lacking the techniques to ameliorate illness.

Maggie Mahar over at the indispensable Health Beat Blog brings word of a new report produced by the Center for Studying Health System Change that addresses the role of technical innovation in driving costs:

The culprit behind long-term health care inflation, the study reveals, is not a “who” but a what: “advancing medical technologies” combined with low productivity.  Yes, that’s right: while improved technology has boosted efficiency in other sectors of the economy, when it comes to healthcare, technological advances are associated with lower productivity.

[ . . . ]

But one thinks of ongoing technological advances as one of the great virtues of U.S. healthcare: how can we regret the high cost of that technology?

The answer: some of the treatments are valuable, some are not. As [report author Paul] Ginsburg notes, “Advancing technology may have a particularly large impact on spending in the United States because of few requirements that effectiveness be demonstrated before technologies are used broadly.” 

Moreover, much of our technology is overpriced. The U.S. pays significantly more than other nations for precisely the same products and services. Finally, and most importantly, we often use the technology on a broad swathe of patients when only a few, who fit a very specific profile, actually benefit from it.

Indeed.  It is important to note that, as always when discussing public health policy here on MH Blog, I am discussing notions of relative priority.  That is, no one is suggesting that we abandon all pursuit of technical innovation in favor of other policy initiatives.  The question is how we allocate resources to support innovation in concert with other policy initiatives.

The point I have been pushing here is that far too many simply assume the high value of technical innovation in producing health, when the value of that innovation in producing health is an open question with legitimate grounds for challenge.

Thoughts?   

The answer: some of the treatments are valuable, some are not. As [report author Paul] Ginsburg notes, “Advancing technology may have a particularly large impact on spending in the United States because of few requirements that effectiveness be demonstrated before technologies are used broadly.” 

Moreover, much of our technology is overpriced. The U.S. pays significantly more than other nations for precisely the same products and services. Finally, and most importantly, we often use the technology on a broad swathe of patients when only a few, who fit a very specific profile, actually benefit from it.

Comments

[Patrick S. O'Donnell]

I absolutely agree with the proposition that "far too many simply assume the high value of technical innovation in producing health, when the value of that innovation in producing health is an open question with legitimate grounds for challenge." There does indeed appear to be a slavish (i.e., uncritical) capitulation to new technologies in health care, commensurate with a lack of familiarity with the literature on the philosophy of technology or simply critical theories of (modern/high-) technology (e.g.: Albert Borgmann, Jacques Ellul, Andrew Feenberg, Alvin Goulner, Donna Haraway, Martin Heidegger, Don Ihde, Ivan Illich, Lewis Mumford, Arnold Pacey, David Rothenberg, and Langdon Winner). Interestingly, new technologies often seem exempt from the kinds of cost/benefit analyses so popular elsewhere in public policy and administrative settings.

Of course a critical theory of technology is not necessarily "technophobic" nor does belief in the significance of same make one a "luddite" (as someone reflexively opposed to technological change or progess; although this is not an accurate description of the Luddites themselves, as E.P. Thompson, among others, makes clear).

And is anyone aware of a decent study of the marketing strategies and techniques of the purveyors of these new medical technologies on par with that recently made of the pharmaceutical industry?

[Daniel S. Goldberg]

Patrick,

And is anyone aware of a decent study of the marketing strategies and techniques of the purveyors of these new medical technologies on par with that recently made of the pharmaceutical industry?

That's a good question, and I'm honestly not sure. I believe there is some literature on marketing strategies related to medical devices, but not sure about other types of technologies.

[Dr. Rick Lippin]

In addition to outright greed of and aggressive marketing by bio-technology companies the psychology of why we accept these technologies without critical review has to do with the immature hope that technology will "beat" not only all diseases but death itself.

If we as a young nation ever overcome our irrational and obsessional fear of death we will have taken a important step toward both individual and cultural maturity.

Dr Rick Lippin
Southampton,Pa