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

2

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 ?

3

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

4

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

-

5

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)

6

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 »

7

0

50

100

150

200

250

300

0

2

4

6

8

10

12

14

16

19

48

19

50

19

52

19

54

19

56

19

58

19

60

19

62

19

64

19

66

19

68

19

70

19

72

19

74

19

76

19

78

19

80

19

82

19

84

19

86

19

88

19

90

19

92

19

94

19

96

19

98

20

00

20

02

20

04

20

06

20

08

20

10

20

12

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

8

1971

2000

1982

1993

y = 0,0371x + 1,625 R² = 0,8216

2

2,1

2,2

2,3

2,4

2,5

2,6

2,7

10 12 14 16 18 20 22 24

Med

cial

imag

ing

pat

ents

nu

mb

er

Transistor count

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

9

Bai

40; 1 Blanc

Chapelon

Chen

18; 0

Crum

18; 0 20; 2

0; 29

Fink

24; 0

Gelet

Crowe 26; 0 25; 1 26; 0

Li

27; 0

Madersbacher

Makin

0; 28 0; 28

Sanghvi

Barthe 21; 0

Tanter 0; 24 1; 22

Vaezy

Vaska Vitek

Wang

Wu

2; 20

21; 1

Zhu

0

10

20

30

40

50

60

70

80

90

0 5 10 15 20 25 30 35 40 45

No

mb

re d

e p

ub

licat

ion

s

Nombre de brevets

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".

10

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.

11

Some results

12

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

13

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

14

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

15

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: philippe.gorry@u-bordeaux.fr

Web: http://www.linkedin.com/in/philippegorry

http://gretha.u-bordeaux4.fr/fr/members/gorry-philippe

16