Gizmo Idolatry

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

Journal articles

Leff B, Finucane TE. Gizmo idolatry. JAMA. 2008 Apr 16;299(15):1830-2. [PMID 18413879]

FOAM and web resources

The machine that goes “ping” – Monty Python

SMILE

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