This page is a summary of Leff and Finucane, 2008
OVERVIEW
Excerpted from Leff and Finucane, 2008:
- Gizmo idolatry refers to the general implicit conviction that a more technological approach is intrinsically better than one that is less technological unless, or perhaps even if, there is strong evidence to the contrary.
- A particular technology may be a gizmo in one clinical context and not in anotheru
- Seven overlapping categories of incentives encourage clinicians and patients to favor the use of gizmos
INCENTIVES FOR GIZMO IDOLATRY
- Common sense appeal (face validity)
- e.g. drug-eluting stents
- Human love of bells and whistles
- e.g. nebulisers vs MDI for asthma; IV fluid vs ORS for gastroenteritis
- Exploits versus uneventful diligence
- e.g. the allure of surgery – e.g. for low back pain, when simple measures are just as effective
- Gizmo Utilization as Proof of Competence
- e.g. the mantle of expertise from being first or ‘cutting edge’
- Gizmo as Source of Objective, Quantifiable Information
- e.g. pre-operative tests, even though they don’t improve outcomes; MRI for vague neurological complaints
- Proof Against Negligence
- belief that use of technology presents a higher standard and more defensible level of care
- Channeling Money
- business models created around gizmos, e.g. prostate irradiation therapy techniques
HARMS FROM GIZMO IDOLATRY
- early adoption alters perception of expertise and may delay proper evaluation (e.g. pulmonary artery catheter use)
- manipulation of practitioners to perform well reimbursed gizmo-based procedures instead of low-tech equally or more effective measures
- adopting expensive gizmos makes healthcare less affordable for the patient and the health care system
- early adoption may be difficult to ‘unlearn’ or reverse (see Unlearning)
PERPETUATING FACTORS
- Fee-for-service rather than value-based funding (rewards the use of procedures, often with fancier gizmos, rather that outcomes aligned with patient values)
- Publication bias (less likely to publish negative studies, such as those showing lack of benefit from new technologies)
- Confirmation bias, cherry picking, logic chopping fallacy (selective appreciation of the evidence base, including excessive nitpicking of counter evidence)
- Golden hammer fallacy (suggestion of the gizmo as the solution to every problem that needs a solution)
- Thought leaders and personality cults (need to remain “cutting edge” to maintain status, have existing networks where they exert influence)
- Social media (rapid and widespread dissemination of ideas regardless of value)
- Industry influence and advertising (on journals, funding agencies, clinicians, and the public)
WHAT TO DO?
- recognition and education of gizmo idolatry
- promote critical thinking
- tort reform (in the USA especially, to limit legal liability from poor outcomes resulting when ‘cutting edge’ technology not used)
- promote health care organisational structures that foster effective care delivery
- detailed strategies to improve the quality of patient-physician decisions regarding treatments in which patient preference should play a role
- promotion of more conservative practice styles
- establishment of Comprehensive Centers for Medical Excellence to implement these changes
References and Links
Journal articles
- Leff B, Finucane TE. Gizmo idolatry. JAMA. 2008 Apr 16;299(15):1830-2. [PMID 18413879]
FOAM and web resources
- MedEdStuffnNonsense — Episode 6: Gizmo Idolatry and Ping (2019)
SMILE
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