The medical ecoculture at work: the case of the metal-on-metal hip.
The United States has the most expensive, technologically intensive system of medical care in the world, but not the most effective. Reforming health care will require understanding the interactions among the many individuals and institutions that collectively constitute the health-care ecoculture, an ecosystem with a major human component. Because technology is a key driver of health-care costs and a critical component of the patient's experience of American medicine, it is fruitful to consider an example of a particular technology: why it was embraced, who benefited from its use, and the response of the ecoculture when a critical flaw in the technology emerged. The case of the introduction, diffusion, and withdrawal of metal-on-metal hip prostheses will be discussed from the perspective of patients, physicians, device manufacturers, regulators, and the legal system. Each of these groups responded to external stimuli by adaptation in an attempt to maximize its own interests. Interactions between the groups served as a further mechanism of maintaining the status quo within medicine. A single change, such as modification of the payment system or incentivizing patients, is thus unlikely to be effective in transforming health care; instead, a multi-pronged approach, along with reforms outside medicine, will likely be necessary.
Muriel R
MR
Gillick
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics / Q000941:ethics / Q000295:instrumentation*; D016265:Conflict of Interest; D018795:Device Approval; D004059:Diffusion of Innovation; D018166:Health Care Reform; D019981:Health Care Sector / Q000191:economics / Q000941:ethics; D006622:Hip Prosthesis / Q000009:adverse effects / Q000191:economics / Q000941:ethics; D006801:Humans; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects / Q000191:economics / Q000941:ethics; D061214:Patient Safety; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D057053:Safety-Based Medical Device Withdrawals; D016896:Treatment Outcome; D014481:United States