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MANAGING KNOWLEDGE FOR INNOVATION 185

Whilst the brachytherapy technique had been around for some time,
Medico had recently developed a new technology that allowed much
more accurate seed implantation (using a new product comprising a
suture ‘preloaded’ with seeds that could be implanted under ultrasound
visioning). This had significantly improved clinical effectiveness. Clinical
trials data over a ten-year period were showing that long-term survival
rates were as good with this new treatment as with prostatectomy, and
that adverse side effects, often associated with the surgery for prostate
cancer (incontinence and impotence) were greatly reduced, making
brachytherapy a viable form of treatment for some kinds of patients.
This was not just an innovation in technology, however. Brachytherapy
also entailed significant innovation in the way in which treatment was to
be delivered to patients. Traditionally prostate cancer had been treated
with prostatectomy (surgery delivered by a consultant urologist) often
followed later by radiotherapy. In contrast, delivering brachytherapy
meant combining surgical skills (for implantation) with radiotherapy (for
dosage). This represented a radical departure from established medical
practice, requiring consultant urologists and radiologists, as well as nurses
and physicians, to be involved in all stages of treatment decision and
delivery.
A major challenge that Medico faced was to get different professional
groups to work together and overcome resistance. As the Project Manager
put it, ‘Urologists deal with prostate cancer. Radiation oncologists deal
with radioactive materials. One of the barriers has always been that the
urologists can’t offer brachytherapy by themselves, as compared with
surgery, and so there is always going to need to be a team of physicians,
radiation oncologists and urologist working together’. Yet the involvement
and expertise of these professionals was essential, both to design the
treatment and also to demonstrate and ‘prove’ it to the rest of the medical
community. Consultant urologists, in particular, were very powerful and
busy professionals, who often had little time for commercial ventures.
As one Medico Sales Manager complained, ‘Medical consultants don’t
even look up when you enter the room’. Significantly, because it relied
so centrally on radiotherapy knowledge as well as knowledge of surgery,
the new treatment threatened to shift primary authority for patient
treatment decisions away from the consultant urologists (traditionally
the most powerful group) towards radiation oncologists, which further
increased resistance. The Scientific Marketing Manager commented
wryly: ‘there is quite a lot of resistance from urologists to the method
because it is a method that directly competes with prostatectomy which
is what they do . . . There is definitely a financial preference to them to do
prostatectomies, although we are changing that. Also they are trained
as surgeons and it is difficult for them to embrace a multidisciplinary
approach when they have been used to being in charge of everything.

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