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New Surgical Technology: Adoption or Diffusion? Essay

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This article raised an interesting subject: surgeons and patients seeking improved treatment often forget that a new technique is not necessarily a better one. Human body with its health problems remains the same but the surgical technology is always moving towards progress. People develop new surgical tools and new surgical procedures constantly. However, do we carefully test all these new tools and procedures before using them on people? And how? On humans? On animals first perhaps? Is it ethical? How do we know that new tools and procedures are better than the existing ones? Too many questions…

New surgical technology promises improved patient care and, therefore, surgeons may hurry to adopt it despite little evidence or their advantage over existing procedures.

Surgical procedures that are later found to be ineffective waste resources and endanger lives. Anything new must be carefully tested and proved in fact to be better. Therefore, the key to this problem is a cautious and total understanding from the surgeons and the patients of why such new procedures come to be offered as treatment.

Let’s look in detail how this new medical technology gets adopted in the US. It may come in the form of:

* a drug
* a device
* a procedure
* a technique
* a process of care

For the surgical technology in particular, new things come in the form of a new procedure that uses existing devices or drugs, or an existing procedure that uses new devices. Before adopting any new technology, people should seriously consider the following factors: * Will this new technology improve the quality of clinical care? * If found successful, will the inventor promote its rapid adoption? * How widely this new technology will be distributed?

* Will it pass all known and potential barriers for adoption, (financing, marketing, etc.)? * Is it compatible with the existing technologies and operating rooms? From all of these questions the main factor is always the same: the new technology MUST improve the quality of clinical care for patients. If this precondition is not satisfied, the technology should be abandoned: even a logical and scientifically positive attitude is no substitute for proof in practice. There were cases where surgical technology that was quickly adopted without evidence of its relative benefit, was abandoned after careful examination. For example: In 1964, Dr. Smith reported that injecting the enzyme chymopapain into an intervertebral disc relieved pain caused by herniation of the lumbar disc.

In 1989, the American Medical Association’s diagnostic and therapeutic technology assessment group questioned the effectiveness of the procedure and raised concerns about its safety. Their evaluation showed that, compared with placebo or no treatment, chymopapain was effective in only selected patients. In addition, when it was used by less experienced surgeons some patients had serious complications, including allergic reaction and even damage to the spinal cord. I feel positive about innovation in all fields especially when people can improve the quality of life by repairing and healing the human body. However, before adopting any new technology in the operating room, it should be offered to patients for a trial period. Also surgeons shall carefully watch and study this procedure being done numerous times, and if it can be supported by the already existing equipment and the existing operating rooms.

Do we ask the patient about the convenience or improvement by the new procedure or equipment? Of course! He is the one on the operating table putting his life in the hands of the surgeon. Surgeons always like the new technology if it can be easily and quickly understood, and added to their existing practice without waste of time. If the input to their practice is great, surgeons will invest more time and effort and disregard disruption of their routine day to expand the competitive advantage that a new technology offers. What I learned from this article is the use of new surgical technology has the potential to provide patients with the best possible care.

On the other hand, if the new procedure or instrument were not carefully tested and approved, it ruined surgeon’s reputation, wasted resources, and caused harm to patients. Surgeons and institutions must not adopt a new technology without solid evidence of its efficiency and superiority over existing ones. In reality, quite a few innovations in medical technology were often adopted without enough evidence and testing and this was wrong. No matter how good the surgeon’s skill and ability to perform a procedure, it is wrong, if the procedure should not be done in the first place and may potentially harm the patient.

Source: Article from BMJ : British Medical Journal 2006 January 14; 332(7533): 112-114. Editorial by Gabbay and Walley and pp 107, 109.
Contributors and sources: CBW is senior adviser for the Health Technology Center and senior fellow at the Institute for the Future in California. ————————————————-

References: McCulloch P, Taylor I, Sasako M, Lovett B Griffin D. Randomised trials in surgery: problems and possible solutions. BMJ 2002; 324: 1448-51. [PMC free article] [PubMed].

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