A sociology of medical innovation: deep brain stimulation and the treatment of children with dystonia

Abstract

This project explores the dynamics of medical innovation using the development of deep brain stimulation therapy in paediatric neurology as a case study. Ethnographic research was conducted with a multidisciplinary clinical team developing a novel clinical service that uses deep brain stimulation (DBS) to treat children and young people with movement disorders. Interviews and observations were carried out to identify key challenges encountered by team members, and to explore the way in which team members attempt to manage these challenges in day-to-day clinical practice. Four key challenges were identified: coordinating multidisciplinary teamwork, identifying suitable candidates for deep brain stimulation; managing the expectations of patients and families; and measuring clinical outcomes. By exploring the strategies used by team members to overcome these challenges, this thesis develops the Complex Model of Medical Innovation which challenges prevalent, linear ‘bench-to-bedside’ understandings of innovation. While scientific ‘discovery’ is one source of medical innovation, new therapies in medicine also emerge from technology transfer (the transfer of technology from one sector into another) and clinicians’ learning-in-practice (the ability of clinician to learn ‘on the spot’). Importantly, this thesis demonstrates that technology transfer, learning-in-practice, and medical innovation in general are shaped by various socio-political trends. The activities of the multidisciplinary team and their novel DBS service, for example, have been shaped by the evidence based medicine movement, commercial interests, and a movement that promotes multidisciplinary approaches to paediatric service provision. A consequence of these influences is that the team subjects their patients to a broad clinical gaze. Adopting the Complex Model of Medical Innovation has important consequences: First, it draws attention to the innovative activities of clinicians, activities that may be worth disseminating in other contexts. Second, it highlights the role of existing social and material factors in shaping the development of new clinical services. The social impact of new technologies will be influenced by these contextual factors and cannot be attributed to the technology alone.