Technological innovation in medicine: A critical view

Abstract

Technology innovation is any change with the objective of improving clinical practice. Many technology innovations only have the wish of improving clinical care, lacking the evidence of its impact on process and outcomes. For example, in the seventies of the XX century, physicians insisted that newborns and babies must sleep down to decrease the incidence of cot death. In practice, the consequence was the opposite. For example, in Holland, the incidence increased from 5 to 120 cot deaths, per 100,000 inhabitants. This effect was only overcome after a campaign of «back to sleep». Most technology innovation aims to increase the quality of clinical care. This usually implies to increase cost, because more is done to solve the same problem, with poor net gains. Sometimes, better quality is not followed by better health outcomes. More quality is not directly equivalent to more health. What we need is «the best quality with the minimum quantity, as near the patient as possible». For example, about tetanus vaccination, perhaps the best schedule is the British one. As usual until 14 years and only a new shot in whole life, around 50-60 years. In another example, fever is a symptom that most time merits to do nothing, which is not the usual behaviour of professionals and patients. We do not know the benefits of treating fever. A last example, work in health teams, in health centres in primary care. This organization has no clear advantages over solo practice. When considering technology innovations, systematic doubts will help. What is important is their impact on health outcomes.