Friday, May 14, 2010

Limits of Medical Innovation

Innovate or die. The phase, popular in Silicon Valley in the nineteen nineties, has since become a mantra throughout the business world…The real questions is how do we keep the good parts of innovation without being stuck with the bad.

James Surowiecki, “ Financial Innovation: Too Clever by Half,” The New Yorker, May 17, 2010

The real problem with cheap eyeglasses in the developing world isn’t making cheap lenses, it’s testing eyes and writing accurate prescriptions for people with little of no access to medical care – a matter of politics and economics rather than technology. The world’s most urgent need, he has come to believe, is not some miraculous-seeming scientific break through but for a vast, unprecedented transformation of human behavior.

David Owen, “The Annals of Design: The Inventor’s Dilemma,” a portrait of Saul Griffith, inventor extraordinaire, The New Yorker, May 17, 2010

We just don’t know what happens in vivo. That’s why drug development is still so hard and so expensive, because the human body is such a black box. We are totally shooting in the dark. You have to have good science, sure. But once you shoot the drug in humans you go home and pray.

Lan Bo Chen, Scientist at Synta Pharmaceutical Corp., Annals of Innovation, The Treatment, The Difficulties of Making A Cancer Drug, The New Yorker, May 17, 2010

This morning the May 17 issue of The New Yorker crossed my desk. It contains three extraordinary articles on innovation - one devoted to innovation of new energy sources and climate change, which so far have fizzled out, the second on Wall Street innovations, which have been disastrous for the U.S. and the world economies, and the third on the sporadically fruitful but usually inconsistent search for drugs that cure cancer.

I believe these three articles have lessons to teach about the limits of medical innovation.

The energy piece describes the work of Saul Griffith, a PhD graduate of M.I.T. Griffith developed a device to grind eyeglass lenses dirt cheap, an invention that failed on the market, and he is now working in Silicon Valley on wind-energy devices that produce enough power to ease the energy crisis. His invention no commercial takers yet.

The Wall Street article concerns the excessive financial innovations -C.D.O. Centralized Debt Obligations, A,B.S (Asset Based Securities), C.D.S.(Credit Default Swaps)- and other computerized and bundled financial derivatives which nobody, including myself, understand , but which everybody thinks make financial risk opaque and capable of destroying the world’s economies. Greed may be good but massive greed bundled and computerized, is unsustainable.

The piece by Malcolm Gladwell on cancer drug development is about the hits, misses, odds, and dashed hopes in the search for cancer drugs.

The lessons for health care innovations are three fold.

One, medical innovation has limits. They may represent technological breakthroughs but often prove ineffective once human markets and human behavior comes into play. An example of this is the Google-ization of medicine. You can talk all you want about Health 2.0 or Health 3.0 or the value of universal transparency in judging value, new electronic horizons of consumer-doctor communication, and deploying data to define who well doctors and hospital perform. But unless transformation of human behavior and expectations occur to accompany the technologies, not much fundamentally changes. If patients do not fill prescriptions or take their medicine as ordered, or cannot afford to take medications, outcomes of chronic disease may not improve, and catastrophic events may not be prevented.

Two, medical innovations have economic consequences.
It is sometimes said 70% of cost rises stem from medical innovations – new drugs for cancer, heart disease, diabetes, erectile dysfunction, or new niche diseases such as fibromyalgia, medical imaging CT, MRI, and PET scans; or restoration of life style function (stents, knee and hip replacements), and so on ad infinitum. It may be there is some massive innovation out there - an all-purpose magic pill with multiple ingredients for preventing diabetes and catastrophic cardiovascular disease, a cure-all for cancer , or a universal appetite suppressant without side-effects that eliminates obesity, the world’s number one health problem. But unless we find some way to achieve universal access through economic and political policies and transformations that alter normal human behavior, these and other innovations will have a limited effect.

Three, the human body remains a mysterious “black box,” and no two human bodies react the same. Even Juda Folkman’s beautifully elaborated theory about angiogenesis - curing cancers by cutting off the flow of blood vessels to tumors has had its ups and downs and inconsistencies.

Still, as I observed in my book Innovation-Driven Health Care (Jones and Bartlett, 2007), it is never too late to innovate - and in a complex adaptive society filled with complex adaptive human organisms. Maybe, just maybe, we can innovate our way out of the problems that beset us. There is always a better way after the bad ways have been exhausted.


R. Lee Heath said...

I find this commentary very interesting. I just want to add something more on a positive note. I would add just one quote to this. "Show me a man who is content and I will show you a failure.", Thomas Edison.

I think it is best to approach innovation with at least the idea that anything is possible, if you put your mind to it. Things can be made simpler rather than complicated. Certainly politics can make everything a lot more complicated. ;)

Roger Heath
inventor making possible the modern automatic heart defibrillator

Richard L. Reece, MD said...


Thank you. I agree we ought to purse the notion that anything is possible. The modern automatic defibrillator is an excellent example. So are things like portable ultrasound devices and portable devices for measuring cardiac and lung function is the office. The invention of such devices is called "disruptive innovations," meaning less sophisticated people can apply them at the site of their need. I prefer the phrase "chunking" because you can start small and build these devices into larger systems. said...

A lot of effective data for myself!

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