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Published in: Medicine, Health Care and Philosophy 1/2012

01-02-2012 | Scientific Contribution

How do medical device manufacturers’ websites frame the value of health innovation? An empirical ethics analysis of five Canadian innovations

Authors: P. Lehoux, M. Hivon, B. Williams-Jones, F. A. Miller, D. R. Urbach

Published in: Medicine, Health Care and Philosophy | Issue 1/2012

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Abstract

While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate “value proposition” of their innovation and seek to respond to what they consider the key expectations of their customers. Our analysis shows that the manufacturers’ framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians’ and patients’ expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others.
Footnotes
1
Our intent is not to promote specific corporate activities and products. We thus use numbers to refer to each innovation instead of repeating the names of either the manufacturers or their product. Because we quote directly from the corporate websites, both manufacturers and products are easily identifiable. We here mention brand names once, so readers who may wish to, can obtain additional information.
 
2
By the time we had completed our analysis of the five websites, three of the five SMEs had been sold to larger companies. Four websites still exist, but their content has changed; there is no longer any website for Innovation 5.
 
3
All downloadable documents, including videos, brochures, press releases, peer-reviewed publications and annual reports, were also indexed and downloaded but these will be analysed in a separate paper.
 
4
A detailed table containing the verbatim website content is available upon request.
 
5
Medical device R&D processes are increasingly seeking ways to increase interactions with users so as to better address “human factors,” which provide greater insights into the context in which an innovation is used and into its users’ needs, expectations and constraints (Vicente 2004). For instance, Nelson (1995, p. 1535), a physician working in the medical device industry, argues that it is by “working closely with physicians” that the medical device industry can design technologies that “save physicians time” and “improve the quality of life for patients”.
 
6
As one would expect, some of the arguments that we retrieved from the websites describe both the problem and the solution. For instance, when a website states that “reducing complication rates” is valuable, the implication is that complication rates are currently too high.
 
7
Here, two arguments invoking scientific authority are brought to the fore: 1) “There’s little data to show which manoeuvre is more effective at alleviating shoulder dystocia without injury;” and 2) “Existing guidelines recommend consideration of elective caesarean when estimated foetal weight is greater than 5,000 g, or over 4,500 g in the presence of maternal diabetes. … However, the average foetal weight of babies experiencing shoulder dystocia with injury is around 4,000 g”.
 
8
As suggested by one reviewer, substantial ethical issues may reside in the tensions between the four categories we analyzed. Although space precludes us from exploring these tensions, we certainly recognize that such tensions could be the source of significant ethical debates. For instance, tensions between the clinical and the structural dimensions of an innovation may raise concerns about the appropriate roles and responsibilities of individual physicians and those of an organized, publicly funded health care system.
 
9
Whether manufacturers’ rhetoric regarding costs and risks reduction is convincing or not to a policymaking audience remains an open question. The real promises of innovations might simply be disregarded due to perceived uncritical marketing or even unsubstantiated hype (Brown 2003; Williams-Jones and Corrigan 2003).
 
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Metadata
Title
How do medical device manufacturers’ websites frame the value of health innovation? An empirical ethics analysis of five Canadian innovations
Authors
P. Lehoux
M. Hivon
B. Williams-Jones
F. A. Miller
D. R. Urbach
Publication date
01-02-2012
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 1/2012
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-011-9312-5

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