More than technology alone.

Traditionally, developments in the labon-a-chip community have been technology-pushed, mainly guided by analytical chemists, micro-machinists and material scientists, rather than demand-pulled. Applications such as LabChip from Caliper (Fig. 1) and i-STAT from Abbott Point of Care (Fig. 2) can now be found on the market, solving practical problems for users. However, the field is still lacking the promised breakthroughs and this trend will continue as long as we keep using a purely technologicallydriven approach. We therefore claim that for the long-term survival of this field a demand-pulled and market-driven approach is of the utmost importance. This article is framed around the medical applications of lab-on-a-chip technologies in the Netherlands; however, the results go beyond the Dutch context and are relevant to other countries experiencing similar technological changes. Lab-on-a-chip scientists working on medical applications must consider diverse aspects such as user-friendliness, industrial collaboration, social acceptance, health care insurance, and various stakeholder interests in evaluating their research. All these interrelated issues make this already multifaceted area of technological innovation even more complex, but how should we deal with this? Part of the answer might lie in the hands of social scientists working in Innovation Studies. Since the 1970s an approach known as Technology Assessment (TA) has been developed in an attempt to deal with such complexities. In its origins, TA was merely an inward-looking discipline aiming to predict the course of technological advances and functioning as a warning mechanism, thus striving to forecast potential harmful effects. Due to the unpredictable nature of innovations, this linear approach (as in the famous Chicago World Fair’s (1933) slogan: ‘‘science finds, industry applies, man conforms’’) turned out not to be very useful or reliable. Instead, an evolutionary model was proven to be more suitable. This view is characterized by feedback and feed-forward linkages among all relevant stakeholders involved in the different stages of development and use of new technologies. In brief, innovation is not a relay race in which the baton is passed from the scientist, via industry, to the end-user. It is much more like a jigsaw puzzle, where the pieces change while trying to fit them together. Thus, TA became a process that not only includes scientists and traditional stakeholders in technology development, but also gives a voice to previously underexposed stakeholders that bring other relevant questions into the discussion. Complexity increases when we realize that the various stakeholders are subject to change in their own environments, such as public regulation leading to health care competition. Also, cultural differences in technology and markets between geographical regions are important issues to consider when applying the technology globally. In other words, it is more than technology alone that makes or breaks innovative applications. Another important issue to consider is the so-called ‘Collingridge dilemma’ which states that technologies become more difficult to influence over time owing to investments and structures already in place, while at its early stages opportunities to steer are richest, but hard to find. Adapted approaches of TA, such as Constructive TA, attempt to actively enrich technological developments while they are still on the drawing board;{ involving all relevant stakeholders’ wishes and needs. Thanks to this wide variety of standpoints, Constructive TA allows for a more constructive assessment of opportunities for promising technological applications and it creates room to anticipate futures under different scenarios. Over the past year, a Constructive TA project has been conducted for medical applications of lab-on-a-chip technology in the Netherlands. A wide diversity of stakeholders were invited to debate the future of the technology and identify promising applications. The discussions included economic, political and sociocultural aspects, and potentially successful medical applications were also debated. Before we continue to discuss the possible added value of Constructive TA we will give three examples that illustrate cases where the technology failed to develop as foreseen: (1) In the early 1990s, authors such as Manz et al., Harrison et al., and Verpoorte et al., 2,3,6 had already touched upon the promise of mTAS devices for use outside the laboratory. For medical devices this was soon linked up with the ability to measure (bio)chemical substances when and wherever needed, a process known as Point-of-Care testing. However, very few of these applications are on the market or in use today. This gives rise to the question: What are the chances of developing and facilitating the application of these technologies such that they can have an improving impact on our everyday lives? (2) General practitioners often see patients with symptoms ranging from fever to the early stages of a heart attack.