Making Meaning in Medical Devices – A Historical View

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This post is the second in an occasional series, building up a historical picture of the everyday cyborg.

During my time with the Everyday Cyborgs project, I have catalogued historical newspaper articles that have used the term ‘medical device’, in order to chart its development in British popular media since 1945. Here are a few reflections on what I have observed as I have trawled through the British Newspaper Archive. It has become apparent to me during the research that the term’s meaning has undergone subtle shifts over time in light of broader social, legal, and economic developments. The term’s clearest meaning of course is as a catch all for the many different kinds of apparatus used in medical treatment: hearing aids, computers, walking sticks and drugs are all referred to as medical devices in the articles I have worked on. During the early years of the NHS, ‘medical device’ was only used a handful of times in British newspapers mainly in reports on technology exhibitions designed for specialist audiences. I suspect the seldom use of medical device between 1945 and 1960 was because journalists and copy editors opted to name individual devices such as pacemakers or hearing aids instead of using the term, either because they thought the general public would be unfamiliar with it, or because  the category of ‘medical device’ was not yet in common usage. 

How ‘medical devices’ took shape in the UK and Irish press

More and more job listings and news stories employed the term from the mid-1960s onwards, indicating a gradually expanding health technology sector accompanying the expansion of health services in the United Kingdom and Ireland. The second half of the eighties saw a huge rise, with newspapers from the three years between 1986 – 1989 having more articles using ‘medical device’ than the two decades leading up to them combined. Excitement accompanied stories reporting on medical teleconference devices that held potentials for treatments to be administered in the home, increasing the convenience of healthcare services. The development of existing devices such as pacemakers was reported with optimism, and reporting on new technologies – such as functional electrical stimulation – now finding application in physiotherapy, promising to help the disabled walk again. Job listings in these new high tech industries advertised in local newspapers give some initial indication of expansions in the sector, with the job listings being concentrated in specific geographical regions. This was mainly confined to the private sector, with many of the companies based in the USA. Stories from the articles that I have encountered talk about how new, clean, and safe jobs in burgeoning hi-tech industries held the potential to revitalise areas with high unemployment, including the place that I myself grew up in, post-industrial Deeside on the Welsh borders, along with rural areas that had seen little growth in their agricultural sectors. 

While there are reasons to treat the geography of these newspaper reports with care, from the archive items that I have investigated, the new opportunities created by medical device manufacturing were particularly pronounced in South and West Ireland. The period from the late eighties to the year 2000 saw a dramatic increase in job listings published in local dailies such as the Gorey Guardian, the Sligo Champion and the Dublin Evening Herald, which suggests that the country was establishing itself as a leading European base for the high-tech medical devices sector, particularly when it came to hosting US commercial interests. The national newspapers the Irish Independent and Sunday Tribune ran stories of efforts made by the national Independent Development Agency and figures in government to tout business. Large US companies such as cardiovascular product manufacturer C.R. Bard were eager to set up European operations, and many chose Ireland as their base. The country successfully used its position within the EEC and EU to expand the sector, with newspaper stories proudly reporting on the valiant efforts of figures such as Business and Enterprise ministers Richard Bruton and Mary Harney to ‘steal’ jobs away from European rivals. This was done through incentives including tax breaks, and building facilities such as the Galway Technology Park.  

A handful of stories discuss the cultural connections to the diaspora in the USA, proudly announcing how prominent Irish born business people had chosen to establish operations in Ireland over the UK and mainland Europe. It is difficult to assess how decisive these connections in fact were, but it is clear from press coverage that high tech industries were viewed as offering more than economic expansion and new jobs. They held much prestige, and gave potential for Ireland to develop a future specialism that would help to define the future of Irish industry and its place within the globalised economyNewspaper profiles of local captains of industry extolled these virtues, and give a sense of the real pride and achievement felt in attracting a high tech sector that brought well paid jobs manufacturing products that would help to save lives and improve standards of living.  

Accidents, scandals, and governance

But the coverage of medical devices was not all positive. The safety of increasingly ubiquitous medical devices also features increasingly often in news stories, as do mentions of the links between medical services and private commerce. This seems to have increased the negative press surrounding certain medical devices. A 1990 BBC World in Action episode warned of faults in the Bjork-Shiley artificial heart valve, a medical device that was at the centre of a major legal battle involving its parent company Pfizer. 

Björk–Shiley heart valve – Image property of the Smithsonian

Towards the mid-nineties public concern increased as developments unfolded surrounding faulty medical devices attracted publicity, often running as headline articles with special investigations into Harley street plastic surgeons cutting corners with cheap soy based silicone implants prone to leakages, and grisly tales of repurposed medical devices taken from the deceased. In November 1997 an Aberdeen newspaper ran the headline ‘No Glow Zone’ in response to a government warning to not use novelty condoms as a medical device that was prompted by fears over the AIDs epidemic and a moral panic over teenage pregnancies. Towards the end of the decade, potential malfunctions in medical devices were linked to mass hysteria surrounding the Y2K bug, indicating the extent to which medical devices had become incorproated into health services in the UK and Ireland.   

In 1998 a scandal surrounding faulty hip replacements manufactured by the US multinational 3M led to calls from doctors to better regulate the industry by introducing national registers of approved medical devicesA group of researchers based in Harlow Wood Orthopaedic Hospital found that design flaws in the company’s capital model hip replacement shortened its life from twenty years to two. This lead to thousands of patients requiring replacements, and the Government’s then Medical Devices Agency (today merged into the MHRA) projected the cost to be up to £10,000 a patient, leading to questions on legal and moral responsibility being raised within the increasingly lucrative medical technology sector. Medical judgement was questioned in one notable case of local authorities in Staffordshire wanting to phase out apnoea monitors designed to prevent cot death because they claimed the devices did not work: the charity and service user representation group the National Cot Death Society claimed that they had saved lives and pressed service providers to continue to offer them to mothers through the NHS. 

Jobs in these industries also began to receive negative press: in 1999 the Sunday Tribune reported on a European Union judgment that the legality of Boston Scientific’s operations in Ireland had broken the law. Local newspapers ran cautionary stories about a local unskilled labour force frozen out of well-paid high tech jobs, with many companies offering generous salaries and benefits to attract skilled workers from further afield instead of investing in training. Seemingly in response to these concerns and towards the end of the nineties, Irish higher education institutes ran adverts in the major Irish dailies to publicise newly established bespoke courses in mechanical engineering designed for those hoping to enter the medical devices sector.  

The newspaper stories that I have examined have provided clues as to the history of medical devices, an understudied area in the history of medicine. The patterns of usage in these archives gestures towards broader cultural, social, legal, and technological changes. As the term became increasingly familiar within the public sphere, new meanings became linked to the promises of these new technologies, and the risks posed by them. From the stories that I have analysed it is clear that by the turn of the millennium, the term had developed sophisticated and complex cultural connotations. With this in mind, the research that I have conducted so far suggests that medical devices function as boundary objects between medical, legal, and broader social discourses. 

Written by: Kevin Matthew Jones


Funding: Work on this was generously supported by a Wellcome Trust Investigator Award in Humanities and Social Sciences 2019-2024 (Grant No: 212507/Z/18/Z) and a Quality-related Research Grant from Research England.