Medical innovation and the sustainability of health systems: A historical perspective on technological change in health
Bibliographic record
Abstract
New medical technology challenges the sustainability of healthcare systems in several countries. Drawing on secondary sources of data, the aim of this article is to generate a better understanding of the historical Research & Development dynamics that have contributed to shape today’s medical innovation ecosystem. We describe key technological achievements along three historical periods – the 1950s, the 1980s and the 2000s – and situate them within their broader political, social, cultural and economic contexts. Our analyses bring forward self-reinforcing dynamics between technology, medical specialization, individualization of disease and the concentration of resources in academic teaching centres. We argue that the way medical innovation has been financed, designed and commercialized since the 1950s has engendered path dependency, which exacerbates the sustainability challenges healthcare systems are now facing. We conclude on the need for innovation design principles that could protect the sustainability of healthcare systems.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.003 | 0.016 |
| Scholarly communication | 0.006 | 0.008 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".