Cascade Effects of Medical Technology

Abstract

Key Words technology, adverse effects, quality-of-care, diagnostic tests s Abstract Cascade effect refers to a process that proceeds in stepwise fashion from an initiating event to a seemingly inevitable conclusion. With regard to medical technology, the term refers to a chain of events initiated by an unnecessary test, an unexpected result, or patient or physician anxiety, which results in ill-advised tests or treatments that may cause avoidable adverse effects and/or morbidity. Examples include discovery of endocrine incidentalomas on head and body scans; irrelevant abnormalities on spinal imaging; tampering with random fluctuations in clinical measures; and unwanted aggressive care at the end of life. Common triggers include failing to understand the likelihood of false-positive results; errors in data interpretation; overestimating benefits or underestimating risks; and low tolerance of ambiguity. Excess capacity and perverse financial incentives may contribute to cascade effects as well. Preventing cascade effects may require better education of physicians and patients; research on the natural history of mild diagnostic abnormalities; achieving optimal capacity in health care systems; and awareness that more is not the same as better. CASCADE EFFECTS OF MEDICAL TECHNOLOGYHealth professionals and laypersons alike tend to equate new medical technology with better-quality health care, assuming that newer is better. Much of the scientific literature on diffusion of innovations focuses on the anticipated beneficial effects of new technology and methods to ensure its rapid adoption (53). However, many new medical technologies are introduced and disseminated with only modest evaluation of efficacy, optimal indications, or impact on practice. Unfortunately, their use in routine care sometimes proves futile or even harmful. The adverse effects and consequences of new technology are often unanticipated (53). One of these is the cascade effect.The term cascade effect, in reference to medical technology, was apparently coined by Mold & Stein in a 1986 article in the New England Journal of Medicine (44). In biology, the term cascade refers to a process that proceeds in stepwise fashion from an initiating event to a seemingly inevitable conclusion. A molecular example is the blood clotting cascade, typically initiated by a cut in the skin. The

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