Path creation by public agencies — The case of desirable futures of genomics

https://doi.org/10.1016/j.techfore.2015.06.038Get rights and content

Highlights

  • We studied a path creation scenario exercise by public agencies.

  • Public agencies need to position themselves vis-à-vis emerging technologies.

  • Public agencies can use mindful deviation to anticipate emerging technologies.

  • We studied the repercussions of genomics for accessibility of health care.

  • The article combined a retrospective and prospective method.

Abstract

Public agencies are central actors in the emergence of technologies. They use their cognitive resources and instruments (regulation, public procurement) to deal with new technologies, against the backdrop of institutional frames and particular responsibilities in serving the ‘public good’. How these public agencies anticipate emerging sociotechnical futures has so far remained underexplored. This article aims to explore public agencies' anticipatory role as a ‘knowledgeable actor’. A conceptual model is proposed that builds on path creation and mindful deviation literature. This conceptualization is explored for the case of genomics in health care insurance in the Netherlands by making an innovative link between a retrospective study on the integration of genomics in public health insurance with prospective scenarios of possible futures for genomics and insurance. Our findings show that policy agents enter anticipatory exercises in a tentative way, carefully drafting next steps, taking into account current boundaries, positions and historical institutional contexts. Their ‘local’ approach to emerging technologies can, however, influence ‘global’ technological and institutional developments. In this context, path creation scenarios can contribute to anticipatory governance that serves societal interests by early-stage identification of moments of potential intervention.

Introduction

A wide range of uncertainties regarding their further development and social effects commonly surrounds emerging and breakthrough technological innovations. Therefore there are apparent reasons for prospecting emerging innovations, e.g., companies might want to prepare for future opportunities and public agencies have a need for anticipation on societal impacts of new technologies. Yet, new technologies always emerge in the context of socio-institutionally and historically preconfigured selection environments. On the one hand, the variety in development paths of technologies is augmented by changes in this selection environment, which has been recognized in CTA (Robinson, 2009) and transition literature (Geels and Schot, 2007). At the same time, the selection environment restricts variety; possibilities are bounded by historical contingencies, such as the economic environment, technological paradigms and regimes, and institutions. In anticipating and steering the pathways of technological innovation, it is therefore crucial to recognize the implications of historical socio-technical developments. Analytically, this might imply a need for linking retrospective studies of technological development, uncovering the non-linear innovation journeys, with prospective studies. Such prospective perspective should take into account restrictions laid out by historical contingencies but also leave room for flexibility in defining different pathways into the future and in perceiving the selection environment as prone to change.

While literature on anticipating technological change and its social consequences promotes sensitivity to the institutional and historical circumstances that shape innovation journeys, less explicit attention is given to the role of public agencies in shaping innovation pathways. Of course there are public organizations whose dedicated task is to conduct technology assessment. In this article we focus on public agencies that have a role as regulators, purchasers and/or users of new technologies in a particular policy domain, such as healthcare. They are often explicitly assigned the task to consider collective interests and social implications of new technologies in terms of the public good, like maintaining quality, affordability and accessibility of medical care, but conducting technology assessments normally falls outside their remit and capabilities.

The socio-technical character of emerging technologies and the large role of public institutions in defining domains of application thus suggest that intervention by these institutions towards the public goals they are supposed to serve should be possible. In this regard, it is assumed that public agencies are central to anticipatory governance of new technologies that have the potential to serve public goals. This paper therefore proposes how public agencies can explore sociotechnical futures, taking developments in incorporating genomics in health care insurance as a case.

Conceptually, we build on path creation literature that suggests that proactive stakeholders should “meaningfully navigate a flow of events even as they constitute them” (Garud and Karnoe, 2001, p. 2). These actors investigate possible ways forward without losing sight of existing structures and boundaries, thereby pursuing ‘mindful deviation’. This article aims to add to current literature by studying path creation and mindful deviation (e.g., Djelic and Quack, 2007, Garud and Karnoe, 2001) focusing on public bodies, anticipating the development and consequences of emerging technologies. Most literature on anticipation of future technologies by public agencies has focused on policy making and policy instruments (Borrás and Edquist, 2013) or public agencies participating in wider consultation. Instead we focus on public agencies as central figures in path creation and explore to what extent these actors use their cognitive resources and instruments (regulation, public procurement) to deal with new technologies, against the backdrop of institutional frames and particular responsibilities in serving the ‘public good’. At the same time, public agencies are not operating in isolation. We therefore also consider the role of public institutions in their wider social and historical context, addressing questions about how historically developed configurations facilitate and restrict actions by public institutions to influence innovation, and how interventions by specific organizations can be scaled up to wider technological regimes. To this end, we conceptualized and operationalized mindful deviation in such a way to include the co-evolution of historical contingencies, the selection environment and technology development as proposed by Robinson (2009), explicitly linking past and future development of technology as recently suggested by Breukers et al. (2014).

We explore the role of public institutions in anticipating emerging sociotechnical futures for the case of genomics in health care insurance in the Netherlands. Human genome research is considered to be laying the foundations for the future of medicine. Increasing insight into the structure and functions of human DNA as well as interactions with lifestyle and environmental influences are supposed to contribute to a radically improved understanding of the mechanisms of disease (Malik and Khan, 2010, Nightingale and Martin, 2004, PriceWaterhouseCoopers, 2005, Royal Society, 2005). Among the medical benefits expected to emerge from human genome research are an improved understanding of the course of diseases, the development of predictive and preventive approaches in health care and better tailored development and prescription of drugs (Ashley et al., 2010, Belsky et al., 2013, Khatri et al., 2012). Despite these potential benefits to health care, questions and concerns are still surrounding this kind of research. Part of these concerns relate to the predictive capacities of genetic information and its potential misuse leading to the exclusion of genetically predisposed individuals from various social goods and services (Macdonald, 2003, Mc Gleenan et al., 1999, Nelkin and Tancredi, 1994). A pressing question for public organizations developing health care policies is thus how to produce advances in medical technologies that are socially productive and reflect societal underlying values, such as solidarity.

Section two develops a framework for analyzing path creation concentrating on the co-evolution of technology and socio-institutional boundaries, taking public agencies and their tasks and desirable socio-technical futures as the focal point of study, at the same time positioning these organizations in a wider environment. This framework is useful for making an explicit case for investigating possibilities for public policy intervention in the emergence of new technologies in future scenarios. The third section elaborates how to identify possibilities for public policy intervention by describing the methodological approaches to the studies of contemporary health care governance and future scenarios. One of these studies investigates the recent integration of genetic technologies in health care in the Netherlands and elsewhere. On the basis of that study, section four describes a number of potential intervention moments where public authorities have influenced the trajectory of emerging genetic technologies into health care. The second study comprises a scenario exercise with policy makers at the Dutch Health Care Insurance Board (College voor Zorgverzekeringen, hereafter CVZ), aimed at identifying likely and desirable futures for genomics in health care. Section five describes these scenarios more fully and maps the moments of intervention onto the scenarios, indicating mindful deviation and opening up room for intervention to promote the interests of widely accessible and affordable health care. In the concluding section, we address the value and limitations of our combined retrospective and prospective approach to study path creation activities by public agencies.

Section snippets

Theoretical framework

The emergence of a new technology is perceived as a co-evolution of technological dimensions and socio-institutional embedding (cf. Nelson and Winter, 1982). Following the literature on constructive technology assessment (CTA), the co-evolution of technology and society can be made more reflexive by stimulating deliberative interactions between design, development, implementation and use phases (Rip et al., 1995). Recently, CTA scholars conceptualized the emergence of new technologies as a path

Methods

As was introduced in the previous sections, future technology paths can be regarded as emerging from historical contingencies and guided by future visions. A way to study path creation is to connect a retrospective and a prospective focus and regard these perspectives as interrelated. In analyzing how specific moments in which public authorities (may) intervene in the incorporation of genomic technologies in medicine relate to the realization of visions incorporated in future scenarios, we

Retrospective perspective: incorporating genomics in Dutch health care distribution

This section provides a retrospective analysis of the ‘moments’ where public institutions intervened to shape the application of genetic technologies in health care in the Netherlands — moments that were both shaped by existing visions of how to incorporate genetics in health care, and continued to shape subsequent visions (Brown and Michael, 2003). It describes the co-evolution of genetic technologies with medical practice and health care delivery, in the particular institutional framework of

Prospective perspective: scenarios of socio-technical interaction in genetic medicine

Taking the historical developments and related moments as a starting point, prospective scenarios are created that provide insights into the mindful deviation involved in devising scenarios that mark emerging, desirable innovation pathways. Two of such scenarios are presented below.

Discussion and conclusions

Path creation literature envisages co-evolution between technology and society based on a careful tinkering of technological and societal characteristics rather than ‘chance events’. These incremental steps or mindful deviation build on existing technological paradigms, economic and social institutions, and so on. In other words, deviation departs from existing technological paths and selection environments. This article contributes to current technological forecasting literature by 1) focusing

Acknowledgments

The authors want to thank all participants of the workshops and interviews. We are also grateful to the reviewers and Douglas Robinson for his valuable comments.

Wouter Boon is an assistant professor in Innovation Studies at Utrecht University. His research focuses on user involvement, public–private partnerships and regulation in relation to emerging technologies.

References (53)

  • N.N. Malik et al.

    Personalized medicine: potential impact on the biopharmaceutical industry

    Drug Discov. Today

    (2010)
  • P. Nightingale et al.

    The myth of the biotech revolution

    Trends Biotechnol.

    (2004)
  • D.K.R. Robinson

    Co-evolutionary scenarios: an application to prospecting futures of the responsible development of nanotechnology

    Technol. Forecast. Soc. Chang.

    (2009)
  • D.K.R. Robinson et al.

    Multi-path mapping for alignment strategies in emerging science and technologies

    Technol. Forecast. Soc. Chang.

    (2008)
  • A. Roelofsen et al.

    Exploring the future of ecological genomics: integrating CTA with vision assessment

    Technol. Forecast. Soc. Chang.

    (2008)
  • H. Van Lente et al.

    Comparing technological hype cycles: towards a theory

    Technol. Forecast. Soc. Chang.

    (2013)
  • R.O. Van Merkerk et al.

    Tracing emerging irreversibilities in emerging technologies: the case of nanotubes

    Technol. Forecast. Soc. Chang.

    (2005)
  • P.W. Van Notten et al.

    An updated scenario typology

    Futures

    (2003)
  • G. Wright et al.

    Scenario methodology: new developments in theory and practice

    Technol. Forecast. Soc. Chang.

    (2013)
  • E. Aarden

    Politics of Provision. The Co-production of Genetic Technologies and Health Care Arrangements in Germany, the Netherlands and the United Kingdom

    (2010)
  • E. Aarden et al.

    Solidarity in practices of provision: distributing access to genetic technologies in health care in Germany, the Netherlands and the United Kingdom

    New Genet. Soc.

    (2010)
  • W.B. Arthur

    Positive feedbacks in the economy

    Sci. Am.

    (1990)
  • D. Barben et al.

    Anticipatory governance of nanotechnology: foresight, engagement, and integration

  • D.W. Belsky et al.

    Genetics in population health science: strategies and opportunities

    Am. J. Public Health

    (2013)
  • N. Brown et al.

    A sociology of expectations: retrospecting prospects and prospecting retrospects

    Technol. Anal. Strateg. Manag.

    (2003)
  • W.M. Cohen et al.

    Absorptive capacity: a new perspective on learning and innovation

    Adm. Sci. Q.

    (1990)
  • Cited by (7)

    • Conceptualizing market formation for transformative policy

      2022, Environmental Innovation and Societal Transitions
      Citation Excerpt :

      This empowerment of individuals tied in with using direct-to-consumer predisposition tests for common diseases without clinical oversight [DemandArt]. At the same time, our interviews and workshops revealed that clinicians might still be involved considering that the outcomes of genetic tests would lead consumers to general practitioner's offices for explanation, treatment or consolation, increasing the burden on healthcare systems (Boon et al., 2015). A new ‘workflow’ arose in which customers received test kits delivered to their homes, which they should return by mail, after which communication took place mostly online [NewUse].

    • Agency and actors in regional industrial path development. A framework and longitudinal analysis

      2020, Geoforum
      Citation Excerpt :

      They can play a powerful role in framing regional policy issues through careful storytelling and mobilising legitimacy and resources for new regional initiatives, drawing on both regional and extra-regional resources (Isaksen and Trippl, 2017). Public policy actors can act as risk-takers when they support new regional initiatives and push new agendas forward against opposition from other actors in the regions (Boon et al., 2015; Holmen and Fosse, 2017; Miörner and Trippl, 2017). Similarly, other accounts have highlighted that regional policy agents support and facilitate the development of new regional industrial paths by promoting new ideas in front of regional and national decision-makers and prioritising them for political support (Dawley, 2014; Dawley et al., 2015).

    • What to expect from assisted reproductive technologies? Experts' forecasts for the next two decades

      2019, Technological Forecasting and Social Change
      Citation Excerpt :

      ART is already subject to greater regulations compared with other medical sectors (Brigham et al., 2013), and emerging social and ethical issues pose growing challenges (Johnson, 2014). Establishing appropriate regulatory policies requires better understanding and anticipation of the innovation trajectories of ART (Boon et al., 2015). This work broadly focuses on the diffusion of ART as an innovation.

    • Governance through expectations: Examining the long-term policy relevance of smart meters in the United Kingdom

      2019, Futures
      Citation Excerpt :

      Further, they are said to be constitutive ‘in attracting the interest of necessary allies (such as innovation networks and regulatory actors, users, etc.) and defining roles and in building mutually binding obligations and agendas’ (Borup et al., 2006: 289). Past research within this literature has mainly concentrated on studying ‘expectations among researchers, industry actors, or media discourses’ (Budde & Konrad, 2015: 7) and associated with emerging technologies (Bakker, Van Lente, & Meeus, 2011; Boon, Aarden, & Broerse, 2015; Kirkels, 2015; Van Merkerk & Van Lente, 2005), rather than being interested in their role within discourses in policy documents.1 Budde and Konrad (2015) have argued that such neglect of policy discourses is peculiar, considering that many innovation activities intend to influence policymaking.

    • Prospective scenarios: A literature review on the Scopus database

      2018, Futures
      Citation Excerpt :

      In the results, several prospective scenarios are proposed in order to better understand this relationship. Blois and Souza (2008), Boon, Aarden, and Broerse (2015), Chakareski (2012), Chakareski (2013), De Díaz, Lobo, and Geraldino (2013), Gregório and Velez Lapão (2012) and Hirschinger, Spickermann, Hartmann, Gracht, and Darkow (2015) address the use of prospective scenarios for strategic analysis in different sectors. Blois and Souza (2008), for example, intend to propose a form of systemic analysis of the footwear sector that integrates the Prospective Scenario approach to the System Dynamics.

    View all citing articles on Scopus

    Wouter Boon is an assistant professor in Innovation Studies at Utrecht University. His research focuses on user involvement, public–private partnerships and regulation in relation to emerging technologies.

    Erik Aarden is a post-doc at the Department of Science and Technology Studies of the University of Vienna, Austria. His research interests include the emergence of new research infrastructures in the biomedical sciences and their implications for public policy and social justice. He previously held positions at Maastricht University, the Program on Science, Technology and Society at Harvard University and the VDI Chair for Futures Studies at RWTH Aachen University.

    Jacqueline Broerse is a professor in innovation and communication in health and life sciences at Athena Institute, VU University Amsterdam. Her research is focused on methodology development for realizing a science-society dialogue in new and emerging innovations in the health and life sciences, in particular biotechnology, genomics and neurosciences.

    View full text