Scientific evidence and the abandonment of medical technology: A study of eight drugs

Abstract

INTRODUCTIONIn the study to be described, we examine the declining use, over time of eight technologies, all pharmaceuticals, by a professional group, practitioners of medicine. For the sake of argument, we begin by assuming that the abandonment of these drugs might appropriately be viewed as a reverse of the process of adoption -the "acceptance" of a piece of "negative" information, first by "opinion leaders" and then others whom they influence. We will, however, offer empirical evidence that causes us to seriously doubt the validity of that assumption. We discuss the possible significance of our observations and suggest some directions for further study. A common thread that runs through much of the adoption research is a concept of contagion or spread, borrowed from the biology of epidemics, and an S-shaped curve that describes it (see Rankings of Periods Used in Test of S-Shaped CurveOSAGE lEVZL TI»Z -4-relatlng the change over time (t) If the "coefficient of innovation" (a) is set to 0, the logistic model remains, with the "coefficient of imitation" (b) equivalent to theThe Bass model and the other variants of the traditional logistic function offered to explain innovation-adoption about which we are aware still have S-shaped graphical representations. In our review of the literature, we were unable to identify any research that systematically -5-consldered whether the abandonment of technology could appropriately be described by an analytic model of one of these forms or another form.

The When and Why of Abandonment: The Role of Organizational Differences In Medical Technology Life Cycles

“…Third, to the extent that our individual-level analysis reveals that decision makers known for significant agency conform to the norms of their organizations, our work underscores the importance of organizational mission, which dominates individual preferences. Finally, our results offer a plausible explanation for mixed findings reported in studies of organizational abandonment (Burns and Wholey 1993, Finkelstein and Gilbert 1985, Greer 1981, Howard and Shen 2012; i.e., the divergent results may be a function of underlying heterogeneity in triggers for technology abandonment and organizational type.…”

“…Second, abandonment may be triggered by the release of new information questioning efficacy of the technology. These instances represent a delegitimation of the technology, rather than a response to a superior alternative (Finkelstein and Gilbert 1985, Greve 1995, Howard and Shen 2012, Kennedy 2011.…”

“…However, the second trigger is also a driver of abandonment of medical treatments due to both safety and comparative effectiveness concerns. For example, episiotomies have seen a significant decline in utilization after information about both their health effects and costs was revealed (Howard and Shen 2012; much like pharmaceutical drugs being discontinued when information on their efficacy is released; Finkelstein and Gilbert 1985)). Disturbingly, this is not always the case.…”

“…In such instances, the preferred choice would be to adopt the new technology, because failure to stay at the cutting edge of practice may place the organization at a competitive disadvantage (Tripsas 2009). Alternatively, new information about the efficacy of an incumbent technology may be discovered, thereby necessitating its abandonment (Finkelstein and Gilbert 1985). In this instance, the rate of abandonment need not be the "twin" because abandonment will be unrelated to the adoption of an alternative technology.…”

The Impact of Clinical Trials on the Use of Medications for Acute Myocardial Infarction

“…One review4 of the published lit¬ erature found that only two of 25 studies reviewed were able to demonstrate a de¬ tectable change in clinical practice based on publication of the results of an RCT. 5,6 A recent study found the publica¬ tion of large RCTs on the treatment of acute myocardial infarction (AMI) to be associated with measurable changes in clinical practice.7 However, this study was performed within the context of a large RCT (the Survival and Ventricular En¬ largement [SAVE] Trial8). The study sub¬ jects were a highly select group represent¬ ing less than 10% of patients with AMI who met eligibility requirements and had sur¬ vived the acute hospitalization for at least 72 hours,9 thereby raising questions con¬ cerning generalizability to broader com¬ munity settings.…”