Co-evolution of physical and social technologies in clinical practice: The case of HIV treatments

Abstract

In this paper, we investigate the interplay of clinical knowledge and technological capabilities in the recent development of HIV/AIDS treatments and offer qualitative and quantitative evidence from the empirical setting of Italian practice. The study contributes to the literature on the co-evolution of physical and social technologies in medical innovation by showing how professional guidelines, systematic evaluative research and local coordination mechanisms contribute actively to the resolution of the uncertainty that surrounds technological advances, while leaving room for largely discretional therapeutic choices. The resulting variety in implementation strategies improves health outcomes, but may reduce productive efficiency.