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

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)