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Home | LITFL | SMILE2 | Gizmo Idolatry

Gizmo Idolatry

by Dr Chris Nickson, last update June 23, 2019

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)
The machine that goes “ping” – Monty Python
MIME 700 2

SMILE

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…more SMILE2

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About Dr Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | INTENSIVE| SMACC

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