3. A subject
The case of interventional radiology (IR)
§ Definition: Invasive medical procedures with thee aim of diagnoisis and/or
treatment of a disease performed under image guidance (X-ray, CT, MRI)
- Born with pioneering work of Charles Dotter
Dotter C, Judkins M (1964). "Transluminal treatment of arteriosclerotic
obstruction. Description of a new technic and a preliminary report of its
applications" , Circulation 30 (5): 654–70
- Invention of angioplasty and catheter-delivered stent
- Using ultrasound and MRI give rise to new approaches such as lithotripsy or
high-intensity focused ultrasound (HIFU)
- Used in cancer since the mid-90s
§ Today many conditions that once required surgery could be treated
nonsurgically by interventional radiologists but they are not. Why ?
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4. A team
A multidisciplinary team
§ Health sociologist :
- Beatrice Jacques, PhD Asso. Prof. (Project leader)
- Sonja Purgues, Research assistant
§ Sociologist of science :
- Pascal Ragouet, PhD Prof.
- Leo Mignot, PhD student
§ Economist of innovation :
- Philippe Gorry, MD-PhD Asso. Prof.
- Emlie Bisbau, Master student
§ Health lawyer :
- Marine Aulois-Griot, PharmD-PhD, Prof.
§ Interventional radiologist :
- Jean Palussiere, MD
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5. A project
Supported by a grant from INCa 2013-2015
3 axes of research
§ The history of the technology
- Catachresis innovation
- Incremental practice-embedded innovation
- Academic boundary problem
§ Strategies of legitimation & valorisation of the IR
- Education infancy
- Reconfiguration in the speciality & between specialities
- The problem of scientific legitimacy
§ The recognition by the public
- The experiment of the technique
- Ignorance of general public: a problem of communication
-
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6. A method
Litterature reviews
Scientometric, patent mapping & competitive intelligence study
Law & health public policy analysis
§ Standart, MA & Health Technology Assessment
Field observations (weeks)
§ In interventional radiology department (Bordeaux, Marseille, Strasbourg,
Montreal)
Semi-directed interviews (n>60)
§ Researcher & Engineer
§ Physician (radiologist & other medical specialist; senior & junior)
§ Radiology tech & nurse
§ Hospital administrative
§ Health public agency representative
§ Entrepreneur (Start-up, SMEs & global companies)
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7. Some results
Axe #1 The invention of IR by Charles Dotter
§ Innovation by catachresis (Allamel-Raffin, 2005)
- From Ancient Greek κατάχρησις (katákhrēsis, “misuse (of a word)”)
- Instrument « hijacking » from its original purpose to a new one
- An example of « sleeping beauty »
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1948
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Pub. by Dotter Pub.citing "Dotter" in Ti/abs/keyword Citations of all Dotter pub. Citations main Dotter paper
Glorification
✝ Mesh introduction
Controversy Diffusion
8. Some results
Axe #1: The history of the technology
§ Incremental practice-embedded innovation
- with interleaving between independent lines of innovation:
tools (catherer, radiofrequency, HIFU,…)
medical imaging (US, Tomo, MRI)
Image guidance system
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1971
2000
1982
1993
y = 0,0371x + 1,625
R² = 0,82164
2
2,1
2,2
2,3
2,4
2,5
2,6
2,7
10 12 14 16 18 20 22 24
Medcial imaging patents number
Transistor count
Relatioship between CT innovation
& microprocessor puissance
10. Some results
Axe #2 Strategies of legitimation & valorisation of IR
§ Education infancy
- Non-institutionalized training: prevalence of companionship
"Those who have it in hand surgery and leaving not much room to rest."
"If the fact of forming radiologists bothers those joysticks in hand".
"we have failed, thereby, ensure the renewal of the generations of correct way"
"There are certain university towns where the teachers of Radiology did not play their
role to both enhance this aspect and to attract young people to this aspect".
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11. Some results
Axe #2 Strategies of legitimation & valorisation of IR
§ Reconfiguration in the speciality & between specialities
- Intra-disciplinary configuration
The radiologist in the future: change management
Organization of the health care system
Health Economy
Impact of health technology evaluation
ROE
Pricing
- Inter-disciplinary configuration
Betweeen diagnostic & therapeutic: In competition with surgery
Boundary-work & professional space
Legacy: Visualize but do nottry to fix ».
Turf wars : IR v mini-invasive surgery
Fighting for the medical activity (access to the patient)
Statu quo : the patient for the surgerons, the instrument for the radiologists
Does IR is a speciality? : Clinician or hired-gun.
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12. Some results
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Axe #2 Strategies of legitimation & valorisation of IR
§ The problem of scientific legitimacy:
- Role of heath technology assessment by agencies (HAS, NICE, …) in the
social construction of the medical innovation value
Are the medical imaging techniques a scientific topic of HTA? How long between
innovation & evaluation? HTA brake or accelerator of diffusion innovation ?
13. Some results
Axe #2 Strategies of legitimation & valorisation of IR
§ Legal & normative framework
- 3 dimensions
Medical device :
declaration of conformity (CE marking)
Pricing
Protection against ionizing radiation
Dosimetry reporting in medical record Art. R. 1333-66
- An incompleteness of IR recognition in the Public Health Act
Recognition of IR procedure in cardiology and neurology
with minimal HR requirement & training
decree n° 2007-366 et 2007-367
decree n° 2009-409 et 2009-410
but NOT in oncology
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14. Some results
Axe #3 The recognition by the public
§ The experiment of the technique
- How the patient was informed of IR potential use ?
- Degree of satisfaction & understanding
- Regional disparities and inequalities of access to IR
§ Ignorance of general public: a problem of communication
§ Undergoing work
- Interview with advocacy patient group
- Patients survey
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15. In conclusion
Sociology of science
§ Beside catachresis & sleeping-beauty
§ A specific case of 2 parallel trends of innovation
Health sociology
§ IR a case of innovation diffusion embedded in professional
organization boundaries & relying on health care organization
Economy of innovation
§ The usefulness of the medical innovation is not determines anymore by
the individual or the physician as prescriber but by the society through
HTA agencies
Public Health law
§ Role of the legal framework in the institutionalization of new medical
procedure
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16. Contacts
Philippe Gorry, MD-PhD, Asso. Prof.
§ Trained in medical genetic, has been past-funding director of the
technology transfer office of Bordeaux’s university, and is currently CFO of
the university incubator. He is a research associate in the Dpt. of
Economics. working on innovation in the pharma-biotech sector, and
served as an expert for OECD, WIPO, ERC…. He is teaching mainly
technology forecasting and clinical competitive intelligence at the School
of Pharmacy & Faculty of Economics.
Contacts
§ Adresse: GREThA - UMR CNRS 5113
Dpt of Humanities & Social Sciences
University of Bordeaux
Avenue Leon Duguit 33608 Pessac – France
§ Tel. / FAX: +33 5 56 84 25 75 /+33 5 56 84 86 47
§ Maill: philippe.gorry@u-bordeaux.fr
§ Web: http://www.linkedin.com/in/philippegorry
http://gretha.u-bordeaux4.fr/fr/members/gorry-philippe
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