How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments

Abstract

Medical specialists play a pivotal role in health innovation evaluation and policy making. Their influence derives not only from their expertise, but also from their social status and the power of their professional organisations. Little is known, however, about how medical specialists determine what makes a health innovation desirable and why. Our qualitative study investigated the views of 28 medical specialists and experts from Quebec and Ontario (Canada) on three controversial innovations: electroconvulsive therapy, prostate-specific antigen screening and prenatal screening for Down's syndrome. Our findings indicate that the scientific, clinical and social arguments of medical specialists combine to create a relatively consistent narrative for each innovation. Our comparative analysis suggests that these narratives bring about a 'soft' resolution to controversies, which relies on a more or less tacit understanding of the social desirability of innovations and which sets the stage for their routinisation. Such an unpacking of medical specialists' arguments both for and against new technologies is needed because such arguments may easily be considered authoritative and because there are few forums for debating the social desirability of innovations not generally deemed to be highly controversial.

Women’s and health professionals’ preferences for prenatal tests for Down syndrome: a discrete choice experiment to contrast noninvasive prenatal diagnosis with current invasive tests

“…37,38 Ideally, the implementation of NIPD will take all stakeholder views into consideration. Furthermore, health professionals must recognize that their views about prenatal tests may differ from those of the women with whom they discuss testing.…”

Public viewpoints on new non-invasive prenatal genetic tests

“…This study set out to investigate public viewpoints of NIPD amongst those often selected in study samples, but also amongst those who are not (men, the child-free, older/younger individuals, those with little experience of genetic disorders or disabilities). There is no doubt that medical and scientific experts are powerful actors in framing the social desirability of a given innovation (Lehoux, Denis et al 2010). However, it is the wider societal group who set the backdrop for the acceptance or resistance of new and emerging technologies such as NIPD.…”

The Sociology of Medical Screening: Past, Present and Future

“…Many of these debates are very heated, with frequent claims and counter-claims made to support particular positions and interests. It almost goes without saying that the kinds of evidence that particular groups draw upon and cite in support of their positions and demands can vary enormously, with a common juxtaposition being discernible between personal experience or understanding of a disease on the one hand and epidemiological study and technical principles on the other (see for example, Barker and Galardi 2011, Armstrong and Murphy 2008, Armstrong et al Page 16 of 26 2010, Wieser 2010, Lehoux et al 2010. Developing a rigorous and focused sociology of screening will help to invigorate and inform these debates, in particular by affording deeper recognition of the social and ethical implications of screening, and contribute to the evidence-base on which policy and practice is founded.…”