Social Recognition of a Medical Innovation: the case of Interventional Radiology in Oncology
Résumé
Numerous scholars have contributed to the question of innovation diffusion and the barriers to this process; stressing the role of adopters, the sociocultural structures and science interactions, or the inter-relationship between university-enterprise and government. Despite burgeoning medical innovations, there are increasing concerns that these innovations are not used fast enough. An interesting case is the interventional radiology (IR), whilst this mini-invasive medical procedure to treat disease under image guidance was born in the 60s, its recognition in medicine, especially in oncology, only occurred later and remains incomplete according to the physicians. Beyond the hype and hopes, the social and economic barriers could be explored in 3 directions: interactions between science, medicine and industry, strategies of legitimation, and the recognition by the public. To address these 3 dimensions, a multidisciplinary research team has been gathered bringing sociologist with a health and scientific background, economists in innovation, health lawyers and a medical referent.
We used qualitative and quantitative methods such as literature reviews, scientometrics and patent mapping, public health law and policies analysis, field observations (n=4 hospitals in France, and Canada) and semi-directed interviews (n=144) of the different stakeholders (researchers, engineers, radiologists and other medical specialists, x-ray technicians, nurses, hospital administrations, health public agencies’, firms and patients’ representatives).
The results show that the birth of the IR suffered of delayed recognition and was dependent from the concatenation of several lines of innovation. Its development was the result of incremental innovations embodied in practice emphasizing the role of the physician and its interrelationship with researcher and engineer. Thus, the IR has led to internal reconfigurations of the radiology specialty, and challenged professional organization boundaries and health care organizations. This, along with the absence of health technology assessment, has led to the incompleteness of institutional recognition in the public health system. Finally, patients who have benefited from IR show positive but distinct experiences that prevent them from taking a proactive role in publicizing and recognizing IR.
In conclusion, medical progress is not only a matter of financial support for academic research or start-up, but above all, a question of new health organisation involving changes in practice, workplace, external relations and economic model, supported by evolving legal framework.