Navigating foresight in a sea of expectations: lessons from the sociology of expectations

Men's sociotechnical imaginaries of artificial intelligence for prostate cancer diagnostics - A focus group study

Artificial intelligence (AI) is increasingly used for diagnostic purposes in cancer care. Prostate cancer is one of the most prevalent cancers affecting men worldwide, but current diagnostic approaches have limitations in terms of specificity and sensitivity. Using AI to interpret MR images in prostate cancer diagnostics shows promising results, but raises questions about implementation, user acceptance, trust, and doctor-patient communication. Drawing on approaches from the sociology of expectations and theories about sociotechnical imaginaries, we explore men's expectations of artificial intelligence for prostate cancer diagnostics. We conducted ten focus groups with 48 men aged 54-85 in Norway with various experiences of prostate cancer diagnostics. Five groups of men had been treated for prostate cancer, one group was on active surveillance, two groups had been through prostate cancer diagnostics without having a diagnosis, and two groups of men had no experience with prostate cancer diagnostics or treatment. Data was subject to reflexive thematic analysis. Our analysis suggests that men's expectations of AI for prostate cancer diagnostics come from two perspectives: Technology-centered expectations that build on their conceptions of AI's form and agency, and human-centered expectations of AI that build on their perceptions of patient-professional relationships and decision-making processes. These two perspectives are intertwined in three imaginaries of AI: The tool imaginary, the advanced machine imaginary, and the intelligence imaginary - each carrying distinct expectations and ideas of technologies and humans' role in decision-making processes. These expectations are multifaceted and simultaneously optimistic and pessimistic; while AI is expected to improve the accuracy of cancer diagnoses and facilitate more personalized medicine, AI is also expected to threaten interpersonal and communicational relationships between patients and healthcare professionals, and the maintenance of trust in these relationships. This emphasizes how AI cannot be implemented without caution about maintaining human healthcare relationships.

Fair and equitable AI in biomedical research and healthcare: Social science perspectives

Artificial intelligence (AI) offers opportunities but also challenges for biomedical research and healthcare. This position paper shares the results of the international conference "Fair medicine and AI" (online 3-5 March 2021). Scholars from science and technology studies (STS), gender studies, and ethics of science and technology formulated opportunities, challenges, and research and development desiderata for AI in healthcare. AI systems and solutions, which are being rapidly developed and applied, may have undesirable and unintended consequences including the risk of perpetuating health inequalities for marginalized groups. Socially robust development and implications of AI in healthcare require urgent investigation. There is a particular dearth of studies in human-AI interaction and how this may best be configured to dependably deliver safe, effective and equitable healthcare. To address these challenges, we need to establish diverse and interdisciplinary teams equipped to develop and apply medical AI in a fair, accountable and transparent manner. We formulate the importance of including social science perspectives in the development of intersectionally beneficent and equitable AI for biomedical research and healthcare, in part by strengthening AI health evaluation.

The UK COVID-19 contact tracing app as both an emerging technology and public health intervention: The need to consider promissory discourses

The UK's National Health Service (NHS) COVID-19 contact tracing app was announced to the British public on 12th April 2020. The UK government endorsed the app as a public health intervention that would improve public health, protect the NHS and 'save lives'. On 5th May 2020 the technology was released for trial on the Isle of Wight. However, the trial was halted in June 2020, reportedly due to technological issues. The app was later remodelled and launched to the public in September 2020. The rapid development, trial and discontinuation of the app over a short period of a few months meant that the mobilisation and effect of the discourses associated with the app could be traced relatively easily. In this paper we aimed to explore how these discourses were constructed in the media, and their effect on actors - in particular, those who developed and those who trialled the app. Promissory discourses were prevalent, the trajectory of which aligned with theories developed in the sociology of expectations. We describe this trajectory, and then interpret its implications in terms of infectious disease public health practices and responsibilities.

Synchronous remote fine-tuning and follow-up within aural rehabilitation: a randomised controlled trial

OBJECTIVE

The objective of the study was to evaluate the effect of including synchronous remote fine-tuning and follow-up as a part of the aural rehabilitation process.

DESIGN

A randomised controlled trial (RCT).

STUDY SAMPLE

Experienced hearing aid users who were due for renewed aural rehabilitation were randomised to either an intervention group (n = 46) or a control group (n = 49). Both groups underwent all stages of the conventional renewed aural rehabilitation process within our clinics, but the intervention group was also offered remote follow-up visits, including an opportunity for synchronous remote fine-tuning of hearing aids. The Hearing Handicap Inventory for the Elderly/Adults (HHIE/A), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the International Outcome Intervention for Hearing Aid Users (IOI-HA) were used as outcome measures.

RESULTS

Both groups improved in self-rated hearing difficulties and hearing aid benefits measured with HHIE/A and APHAB. No significant differences were found between the intervention and the control group.

CONCLUSION

Including synchronous remote follow-up and fine-tuning as a part of an aural rehabilitation process may effectively complement clinical visits. Additionally, the synchronous remote follow-up has the potential to further develop person-centred care by enabling hearing aid users to identify individual needs directly in an everyday environment.

Expectations and attitudes towards medical artificial intelligence: A qualitative study in the field of stroke

INTRODUCTION

Artificial intelligence (AI) has the potential to transform clinical decision-making as we know it. Powered by sophisticated machine learning algorithms, clinical decision support systems (CDSS) can generate unprecedented amounts of predictive information about individuals' health. Yet, despite the potential of these systems to promote proactive decision-making and improve health outcomes, their utility and impact remain poorly understood due to their still rare application in clinical practice. Taking the example of AI-powered CDSS in stroke medicine as a case in point, this paper provides a nuanced account of stroke survivors', family members', and healthcare professionals' expectations and attitudes towards medical AI.

METHODS

We followed a qualitative research design informed by the sociology of expectations, which recognizes the generative role of individuals' expectations in shaping scientific and technological change. Semi-structured interviews were conducted with stroke survivors, family members, and healthcare professionals specialized in stroke based in Germany and Switzerland. Data was analyzed using a combination of inductive and deductive thematic analysis.

RESULTS

Based on the participants' deliberations, we identified four presumed roles that medical AI could play in stroke medicine, including an administrative, assistive, advisory, and autonomous role AI. While most participants held positive attitudes towards medical AI and its potential to increase accuracy, speed, and efficiency in medical decision making, they also cautioned that it is not a stand-alone solution and may even lead to new problems. Participants particularly emphasized the importance of relational aspects and raised questions regarding the impact of AI on roles and responsibilities and patients' rights to information and decision-making. These findings shed light on the potential impact of medical AI on professional identities, role perceptions, and the doctor-patient relationship.

CONCLUSION

Our findings highlight the need for a more differentiated approach to identifying and tackling pertinent ethical and legal issues in the context of medical AI. We advocate for stakeholder and public involvement in the development of AI and AI governance to ensure that medical AI offers solutions to the most pressing challenges patients and clinicians face in clinical care.

Professional expectations and patient expectations concerning the development of Artificial Intelligence (AI) for the early diagnosis of Pulmonary Hypertension (PH)

The expectations of professionals working on the development of healthcare Artificial Intelligence (AI) technologies and the patients who will be affected by them have received limited attention. This paper reports on a Foresight Workshop with professionals involved with pulmonary hypertension (PH) and a Focus Group with members of a PH patient group, to discuss expectations of AI development and implementation. We show that while professionals and patients had similar expectations of AI, with respect to the priority of early diagnosis; data risks of privacy and reuse; and responsibility, other expectations differed. One important point of difference was in the attitude toward using AI to point up other potential health problems (in addition to PH). A second difference was in the expectations regarding how much clinical professionals should know about the role of AI in diagnosis. These findings allow us to better prepare for the future by providing a frank appraisal of the complexities of AI development with foresight, and the anxieties of key stakeholders.

Epistemic virtues and data-driven dreams: On sameness and difference in the epistemic cultures of data science and psychiatry

Data science and psychiatry have diverse epistemic cultures that come together in data-driven initiatives (e.g., big data, machine learning). The literature on these initiatives seems to either downplay or overemphasize epistemic differences between the fields. In this paper, we study the convergence and divergence of the epistemic cultures of data science and psychiatry. This approach is more likely to capture where and how the cultures differ and gives insights into how practitioners from both fields find ways to work together despite their differences. We introduce the notions of "epistemic virtues" to focus on epistemic differences ethnographically, and "trading zones" to concentrate on how differences are negotiated. This leads us to the following research question: how are epistemic differences negotiated by data science and psychiatry practitioners in a hospital-based data-driven initiative? Our results are based on an ethnographic study in which we observed a Dutch psychiatric hospital department developing prediction models of patient outcomes based on machine learning techniques (September 2017 - February 2018). Many epistemic virtues needed to be negotiated, such as completeness or selectivity in data inclusion. These differences were traded locally and temporarily, stimulated by shared epistemic virtues (such as a systematic approach), boundary objects and socialization processes. Trading became difficult when virtues were too diverse, differences were enlarged by storytelling and parties did not have the time or capacity to learn about the other. In the discussion, we argue that our combined theoretical framework offers a fresh way to study how cooperation between diverse practitioners goes and where it can be improved. We make a call for bringing epistemic differences into the open as this makes a grounded discussion possible about the added value of data-driven initiatives and the role they can play in healthcare.

Exploring interpretations of blockchain's value in healthcare: a multi-stakeholder approach

Purpose

Drawing broadly from the technology frame (Davidson, 2002) and organizing vision perspectives (Swanson and Ramiller, 1997) which consider the business value of information technology as resulting from actors' efforts to make sense of new technology, the study applies Ojala's (2016) business model framework to examine how different sets of actors understand the value of blockchain within the healthcare sector.

Design/methodology/approach

To include the perspective of different sets of actors, the research combines a systematic literature review to capture academic research, semi-structured interviews with blockchain experts, with an analysis of blockchain healthcare vendors.

Findings

The study finds a high degree of congruence between the perspective of different actors, with key sources of blockchain value concentrated around value proposition, particularly enhancing privacy and security; value capture, specifically cost savings, and value network, mostly enhancing data accessibility and reducing intermediation. Value delivery is the least emphasized value creation mechanism and concerns primarily improvements in supply chain transparency. Minor variations between actors' interpretations of value exist, mostly around the contribution of blockchain to support the value proposition and include the provision of social value, the creation of trust, supporting automation and improving employment.

Originality/value

Recognizing that the value of new technology is as much the result of actors' interpretations, as the objective outcome of its deployment, this study takes a multi-stakeholder perspective to examine blockchain's business value and highlights new aspects of value associated with blockchain deployments. The findings include a value outcome framework that allows systematic comparisons between blockchain implementations across contexts.

Is tomorrow’s car appealing today? Ethical issues and user attitudes beyond automation

The literature on ethics and user attitudes towards AVs discusses user concerns in relation to automation; however, we show that there are additional relevant issues at stake. To assess adolescents’ attitudes regarding the ‘car of the future’ as presented by car manufacturers, we conducted two studies with over 400 participants altogether. We used a mixed methods approach in which we combined qualitative and quantitative methods. In the first study, our respondents appeared to be more concerned about other aspects of AVs than automation. Instead, their most commonly raised concerns were the extensive use of AI, recommender systems, and related issues of autonomy, invasiveness and personal privacy. The second study confirmed that several AV impacts were negatively perceived. The responses were, however, ambivalent. This confirms previous research on AV attitudes. On one hand, the AV features were perceived as useful, while on the other hand, their impacts were negatively assessed. We followed theoretical insights form futures studies and responsible research and innovation, which helped to identify that there are additional user concerns than what has been previously discussed in the literature on public attitudes and ethics of AVs, as well what has been envisioned by car manufactures.

The Value of a Valuation Perspective for Theorizing about Social Change and Climate Change: A Study on Carbon Pricing in China

This study combines three purposes: to advance a valuation perspective for theorizing about social change and climate change; to contribute to the general debate on pricing as the dominant policy to meet climate mitigation goals; to improve our understanding of potential decarbonization processes in China. We apply a valuation perspective to an in-depth case study of an emerging carbon market in Hubei Province in Central China. The study builds on original data collected during field trips to Hubei (2014, 2015) and additional documents covering recent developments in the Chinese carbon market. It shows how putting a price on carbon in China emerges as the outcome of a long-term cultural and institutional process in which China’s high-carbon growth model is increasingly contested. We emphasize the work that was required before a carbon price could emerge as a market price, and focus on the uncertainty that needed to be overcome in the complex multilevel Chinese system. We suggest that China’s introduction of low-carbon policies are a side effect of other political, economic and social pressures, and that it is largely facilitated because such policies are consistent with many other changes that are occurring simultaneously both in the Chinese context and globally.

Ordering theories: Typologies and conceptual frameworks for sociotechnical change

What theories or concepts are most useful at explaining socio technical change? How can - or cannot - these be integrated? To provide an answer, this study presents the results from 35 semi-structured research interviews with social science experts who also shared more than two hundred articles, reports and books on the topic of the acceptance, adoption, use, or diffusion of technology. This material led to the identification of 96 theories and conceptual approaches spanning 22 identified disciplines. The article begins by explaining its research terms and methods before honing in on a combination of fourteen theories deemed most relevant and useful by the material. These are: Sociotechnical Transitions, Social Practice Theory, Discourse Theory, Domestication Theory, Large Technical Systems, Social Construction of Technology, Sociotechnical Imaginaries, Actor-Network Theory, Social Justice Theory, Sociology of Expectations, Sustainable Development, Values Beliefs Norms Theory, Lifestyle Theory, and the Unified Theory of Acceptance and Use of Technology. It then positions these theories in terms of two distinct typologies. Theories can be placed into five general categories of being centered on agency, structure, meaning, relations or norms. They can also be classified based on their assumptions and goals rooted in functionalism, interpretivism, humanism or conflict. The article lays out tips for research methodology before concluding with insights about technology itself, analytical processes associated with technology, and the framing and communication of results. An interdisciplinary theoretical and conceptual inventory has much to offer students, analysts and scholars wanting to study technological change and society.

Representing scale: What should be special about the heritage of mass science?

This symposium marks the achievement of a transformation in the history of science. Whereas in the 1960s, the study of modern developments was marginal to the field, it has now become a key part of the discipline's central concerns. The contrast between this conference and a 1960 symposium is illuminating. The paper reflects on the tensions over the future direction of the discipline expressed at the 1974 semi-centenary conference of the History of Science Society. Today, genomics with its vast demand for resources and its challenges to traditional boundaries is not untypical of a wide range of scientific activities. Its study can serve as a pioneering case study interesting for itself and important for a wider understanding of science. Papers at this meeting show the implications for the understanding of methods, appropriate targets of study, the interpretation of images and the preservation of archives.

Scrutinizing the epigenetics revolution

Epigenetics is one of the most rapidly expanding fields in the life sciences. Its rise is frequently framed as a revolutionary turn that heralds a new epoch both for gene-based epistemology and for the wider discourse on life that pervades knowledge-intensive societies of the molecular age. The fundamentals of this revolution remain however to be scrutinized, and indeed the very contours of what counts as 'epigenetic' are often blurred. This is reflected also in the mounting discourse on the societal implications of epigenetics, in which vast expectations coexist with significant uncertainty about what aspects of this science are most relevant for politics or policy alike. This is therefore a suitable time to reflect on the directions that social theory could most productively take in the scrutiny of this revolution. Here we take this opportunity in both its scholarly and normative dimension, that is, proposing a roadmap for social theorizing on epigenetics that does not shy away from, and indeed hopefully guides, the framing of its most socially relevant outputs. To this end, we start with an epistemological reappraisal of epigenetic discourse that valorizes the blurring of meanings as a critical asset for the field and privileged analytical entry point. We then propose three paths of investigation. The first looks at the structuring elements of controversies and visions around epigenetics. The second probes the mutual constitution between the epigenetic reordering of living phenomena and the normative settlements that orient individual and collective responsibilities. The third highlights the material import of epigenetics and the molecularization of culture that it mediates. We suggest that these complementary strands provide both an epistemically and socially self-reflective framework to advance the study of epigenetics as a molecular juncture between nature and nurture and thus as the new critical frontier in the social studies of the life sciences.

Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands

This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users.