Biases and imperatives in handling medical technology

Abstract

Objectives

For a long time key actors in health care have conceived of medical technology as a rational science-based means to obtain specific human goals, such as reducing suffering and increasing health. However, this appears paradoxical as medical technologies are handled in ways that appear non-rational by the standards of the field itself, e.g., by implementing non-efficient technologies and by not abandoning harmful or low-value technologies. The objective of this article is to investigate this apparent paradox. How can it be explained? Accordingly, the research question is: What biases and imperatives are involved in the handling of medical technology that counter and hamper what is conceived of as rational handling of such technology in medicine and health care? Methods

Kahneman's framework of System 1 and 2 modes of thinking from cognitive psychology is applied and combined with Mazarr's analysis of imperatives in order to study and develop a typology of irrational implementation of technology. Examples from health care are found by targeted searches in PubMed. Results

Health policy on technology assessment and implementation is based on measures, such as safety, effectiveness, and efficiency. Nevertheless, a range of technologies are implemented and used without obtaining such goals. This can be explained by, a range of affective biases, such as the Identifiability Effect, Affective Forecasting, and Impact bias, as well as cognitive biases, such as the Focusing Illusion, Prominence Effect, Status Quo Bias, Endowment Effect, Availability Heuristics, Anchoring Effect and others. Various imperatives also contribute to this, such as Positive feedback loops, Imperative of Action, Technology Placebo Effect, Imperative of Knowledge, the Boys and Toys Effect and others. Examples illustrate how all of these effects can distort rational technology implementation and policy. Conclusion

We need to include biases and imperatives in our theories and our strategies to handle medical technologies. Believing and acting as if we implement and use technology in health care as external means to our internal goals may be treacherous. Understanding technology indeed includes understanding of ourselves.