New medical technologies and clinical practice: a survey of lymphocyte subset monitoring.
BACKGROUND
Since its inception in the early 1980s, lymphocyte subset (LS) monitoring of transplant patients has been a controversial technique. The clinical literature is replete with contradictory claims concerning its usefulness. No systematic information is however available on clinicians' attitudes towards the new technology.


METHODS
We carried out a mail survey of the members of The Transplantation Society concerning the availability, use, value, and critical assessment of LS monitoring.


RESULTS
Results show that LS monitoring technology is available in most clinical settings surveyed and is regularly used by about half of the respondents associated with a clinical transplant program. About half of the users obtain diagnostically relevant measurements (T4/T8 ratios), as opposed to measurements related to OKT3 anti-rejection therapy. While claiming that LS measurement is a useful tool, respondents attribute a low average score to the diagnostic value of the technique; about 2/3 believe that its absence would not affect their clinical judgment. Finally, 25% of the respondents send blood for LS measurements although they do not believe the technique is useful.


CONCLUSIONS
The results suggest that research instruments which generate clinical interest may develop clinical-diagnostic routines despite a lack of consensus concerning their usefulness. More importantly, these routines avoid a critical assessment of key notions such as "immune monitoring" which tend to blur the distinction between research and therapy.
Cambrosio
A
A
Department of Social Studies of Medicine, McGill University, Montreal, Quebec, Canada.
Guttmann
R D
RD
Keating
P
P
D001291:Attitude of Health Personnel; D003625:Data Collection; D006801:Humans; D016131:Lymphocyte Subsets / Q000276:immunology; D015166:Monitoring, Immunologic / Q000379:methods* / Q000706:statistics & numerical data; D013673:Technology Assessment, Biomedical; D014181:Transplantation Immunology