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Knowledge Networks in Oncology: Weavers of Medical Innovation

Final Report Summary - KNOWMI (Knowledge Networks in Oncology: Weavers of Medical Innovation)

The project analysed medical innovation processes, and focuses on two areas of Oncology: Breast cancer (BC) and Colorectal cancer (CC). It pursued two broad objectives:
1. Clarifying important conceptual aspects and exploring new ones in relation to the organisational and institutional, other than scientific, aspects of knowledge generation and diffusion. This speaks directly to policy questions concerning the governance mechanisms that are most effective for medical innovation.
2. Developing tools to study how interactions across scientific and clinical realms emerge and change in medical research. The main effort in this direction has been the perfecting of methods for the visualisation of research networks and the elaboration of specific indexes to measure the degree of diversity observed in structures of inter-organisational collaboration. Using bibliometric data (Source: ISI Web of Science and PubMed) the analysis focused on (a) individual articles; and (b) scientific journals; and institutions.

The juxtaposition of bibliometric study and historical records analysis uncovers patterns of medical-clinical discovery that differ substantially from past observations. Five main results stand out:
(a) For what concerns research areas (from article topic and journal title) the studies highlight sustained entry and rapid expansion of new fields, slightly higher in CC compared to BC. This contrasts with the traditional view of paradigm-led science.
(b) Divergent dynamics of search emerge across both fields, more in CC than in BC. The implication is that in the former new hypotheses generated from established paradigms lead to stronger diversification and sub-specialisation. This contrasts with BC where divergence is a more exceptional occurrence.
(c) In both areas basic scientific discoveries are followed by a spur of diversification in the organisational matrix. Novelty coming from direct clinical experience acts, however, as a selection mechanism with significant reduction of organisational diversity.
(d) Each area of Oncology carries specific forms of complementarities: BC features a more diversified knowledge base and cross-disciplinary competence building while CC has relatively more intense cross-national collaborations.
(e) BC research remains geographically concentrated in Anglo-Saxon countries as opposed to CC which tends to attract contributors from a broader group of countries.

The matters addressed in this research are policy relevant, especially for what concerns the mismatch between the level of research efforts and the outcomes of such efforts as ultimately experienced by patients. High-mortality diseases like cancer call upon clearer understanding of the institutional mechanisms that deliver higher benefits to patients by facilitating the integration between the laboratory and the clinic.

The research carried out for KNOW-MI can be considered the first step of a longer trajectory in search of improved understanding on the mechanisms that stimulate the diffusion of new ideas, new professional standards and new technologies in the field of medicine. The applicability of its results need not be restricted to the areas of Oncology explored in our empirical analysis. As a matter of fact, the extent of the novelty of this research is better appreciated when considering that the results span different areas of interest at the interface between innovation economics, management studies and policy analysis.