gizmo idolatry

excerpt from:
Gizmo Idolatry by Bruce Leff & Thomas E. Finucane
JAMA 2008; 299(15): 1830-1832

It seems that "gizmo idolatry" now exists in the practice of medicine...In this article, gizmo is used to refer to a mechanical device or procedure for which the clinical benefit in a specific clinical context is not clearly established, and 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. The credulous acceptance and rapid diffusion of frontal lobotomies in the 1930s and 1940s led to great harm, and to a Nobel Prize for Egas Moniz in 1949 “for his discovery of the therapeutic value of leucotomy in certain psychoses.”1 ....

[snip]

Seven overlapping categories of incentives may encourage clinicians and patients to favor the use of gizmos.


Common Sense Appeal

Many gizmos make so much sense, in the absence of evidence or even the presence of evidence to the contrary, that their value or utility is persuasive prima facie.


Human Love of Bells and Whistles

Increasing the technological complexity of treatment appears to increase the significance of an illness and the appeal of an intervention.


Exploits vs. Uneventful Diligence

In The Theory of the Leisure Class, Veblen10 noted that in early societies, the upper leisure class performed high-prestige hunting and military exploits, while the lower classes performed menial work, such as agriculture, child-rearing, and cooking, which was arguably more important to survival of the society. Vestiges of this construct persist in medicine where surgical exploits are valued more highly than uneventful diligence or watchful waiting of primary care. Recovery
from backache can be transformed into a patient’s exploit if magnetic resonance imaging is obtained, and even more so if this leads to surgery. [ed.: this one is likely to be overblown for patients, at least. See: Personality: What Makes You the Way You Are by Daniel Nettle]


Gizmo Utilization as Proof of Competence

The cutting edge or first on the block use of a gizmo can bestow on the physician a mantle of expertise, competence, and preeminence. [SMART Boards!]


Gizmo as Source of Quantifiable, Objective Information

Gizmos are used to provide objective, quantifiable information, often used to rule out a diagnosis. For patients who are frail and face the risk of surgery, technological preoperative testing shows that the patient received a thorough evaluation, although this testing does not produce better outcomes than a thorough clinical examination, assessment of functional capacity, and basic laboratory testing.11 [Data-driven instruction!]


Proof Against Negligence

The risk of malpractice litigation depends heavily on a physician’s communication skills,12 but a totemic belief persists that gizmo deployment reduces the risk of litigation.....the death of a very thin, demented, bedfast nursing home resident with pressure sores may be less likely to lead to litigation if that patient died with dietary supplementation being infused through a percutaneous endoscopic gastrostomy as he or she lay on a specialized bed. [irrelevant to schools]


Channeling Money

Business models, having more to do with money than health care, are created around gizmos. A prostate irradiation therapy known as intensity-modulated radiation therapy is being marketed with great potential to enhance practice revenue for urologists, who reportedly are reimbursed at $47 000 per patient treated.15 Thousands of physicians have purchased, are using, and bill profitably for a handheld device that checks patients for nerve disease.16 Although evidence
of benefit to the patient is uncertain, profits to practitioners and corporate vendors for successful gizmos such as these can be substantial.17 [vendors!]

Offhand, I would say the Partnership for 21st Century Skills has an advanced case of gizmo idolatry.