Innovation Versus Exnovation
Sometimes, we need to go backwards to go forwards in medicine
Innovation drives translational science forwards – but what happens after an innovation has been adopted? Sometimes, advancing medical practice means taking note of new evidence and moving in the opposite direction, according to Kimon Bekelis, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, New Hampshire, USA – and first author of a recent study on the importance of de-adoption – also known as exnovation (1).
“The process by which innovations enter everyday use has been studied extensively in many disciplines. But the process by which physicians scale back the use of medical practice has received much less attention”, says Bekelis.
Understanding the process of de-adoption – why medical practices fall out of favor – is important when it comes to ensuring that low-value treatments, such as those that have little effect or those that are prohibitively expensive, are reduced in everyday practice, explains Bekelis.
Using carotid revascularization – a surgical procedure that has become controversial (2) – as an example, Bekelis and his colleagues looked into the factors that caused a decline in its use. They found that more experienced surgeons were likely to scale back their use of the procedure more quickly – but, on the other hand, surgeons who used the procedure more often were more likely to keep using it. “Reliance on some procedures for financial reasons might deter physicians and organizations from integrating new evidence into clinical practice,” adds Bekelis.
Next, the authors plan to find out whether their findings can be applied to other procedures and settings – and they believe that more should be done to ensure that interventions that are not supported by strong evidence are more quickly scaled back in the clinic. “Specialty societies should more aggressively disseminate practice guidelines, and national registries should aid in quality control and benchmarking,” says Bekelis.
- K Bekelis et al., “De-adoption and exnovation in the use of carotid revascularization: retrospective cohort study”, BMJ, 359, j4695 (2017). PMID: 29074624.
- EA Halm et al., “Has evidence changed practice? Appropriateness of carotid endarterectomy after the clinical trials”, Neurology, 68, 187–194 (2007). PMID: 17224571.
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