Medical Innovations: Their Diffusion, Adoption, and Critical Interrogation (original) (raw)

The 1950s and 1960s were a 'golden age' of medical progress: an era of high expectations, widespread faith, and life-saving innovations. In the 1970s, as it gradually became clear that medicine's technological advance also contributed to the rising costs of health care, policy makers began to question the ways in which new technologies diffused. Sociologists soon found that professional and institutional interests, the search for competitive advantage, and processes of 'institutional isomorphism' played major roles. By the end of the millennium, as a result of growing patient (and 'health care consumer') activism, and of globalization, the context in which new technologies were developed, introduced, and used had become politicized, and technologies had become more heterogeneous. The patient perspective offered a new vantage point from which to study medical technology in use, and one which fitted many sociologists' normative and methodological commitments. Many recent sociological studies highlight failures, contradictions, and the (often concealed) interests involved in the promotion of new drugs and other medical technologies. However, resources for studies aligned with dominant interests, perspectives, and claims are more readily available. Perspectives on medical progress In 1966, James Coleman and colleagues published a study of the diffusion and adoption of a new antibiotic, tetracycline, by physicians in four small American towns (Coleman et al. 1966). Although unusual in focusing on a drug, the study fitted in an established tradition of diffusion research. As in much of the work summarized in Everett M. Rogers' The Diffusion of Innovations (Rogers 1962), data from this study fitted on an S-curve. The authors' suggestion was that 'early adopters' influenced their colleagues, so that innovations spread rather like infectious diseases. They had little to say about why or how the drug had been developed, or about its consequences either for medical practice or for the patients prescribed it. Such questions were rarely posed in the 1960s. This was an era of unquestioning enthusiasm for medical advance, and of virtually limitless expectations. In the 1970s, this began to change, and sociologists were among those who began to pose new, and often critical, questions regarding medicine and medical progress (Fox 1973, 10). In the subsequent four decades, sociologists' questions have continued to evolve: a result of developments internal to the discipline but also, I believe, of the social, political, and economic changes to which medical technology has also responded. Specifically, I shall suggest, innovation in medical technology today tracks a growing variety of health-related concerns. The increasingly heterogeneous configurations of 'stakeholders' involved with it as a result has led to multiplication of the perspectives from which sociological analyses can be conducted. One factor in the more critical attitude to medical advance that arose in the mid-1970s was economic. The costs of health care were rising inexorably, and it appeared that technological innovation was partly responsible (see e.g. Wagner and Zubkoff 1982). Policymakers wanted to know what was going on, and what could and should be done. Researchers responded