Innovation

It is rare for me to feel energized and inspired by a big medical school lecture... but yesterday was one of those days. 

Dr. David Brailer gave an excellent talk about innovation and entrepreneurship… and why they matter for health reform. 

Where we are now. 

“No other industry has an output that actually changes the human equation… that makes the human condition better.” 

• A child born today has >50% chance to living over 100. Over the past 100 years we’ve added 5 years to our life expectancy (in the past 30 years, we’ve added 1 extra year of life per year). 
• A lot of this increase in life expectancy is from living in a safer society – better public health, fewer homicides, fewer accidents. But a lot of this is also the result of innovation. Penicillin, Insulin, Antiretrovirals. These are the building blocks from which life expectancy grew. 
• Many inventions do not come out of laboratories, but rather they are concepts. The Framingham study (from which many cardiovascular and other treatments have stemmed), early cancer detection, evidence-based medicine. These are not treatments, but they make our treatments more effective. 
• As more and more companies suggest new products, he asks, “So what? What is this really going to contribute?” 

Health information technology.

“The great lifesaver of the 21st century will be health information technology.” 

• A patient needs to be able to go to the emergency room and have their medical records available right away – similar to how we can quickly get cash from an ATM.
• When a doctor uses a computer, they deliver better care (access to evidence-based medicine, health alerts, drug-dosing, drug-interactions, etc.) 
• The single largest growing item in federal budget is health information technology. We are living through this transition now. 
• Personal health records: Consumers thirst for being more involved in their care. They want to be more knowledgeable, more empowered. They want access to information. There is going to be a tremendous change in health literacy over time. 
• Where we are heading in terms of health information technology: 
• Telemedicine -- Getting specialists out to rural areas. 
• In-home monitoring -- Keeping a patient at home with an “electronic garden” rather than putting them into expensive skilled nursing facility. 
• Teleradiology. 
• "Autopilot" controls -- Just as planes have systems which don’t allow pilots to make unsafe maneuvers, this would similarly prevent physicians from cutting too close to vessels, etc. 
• Pharmacogenomics -- Looking at how genetic influences responses to drugs. 
• Data mining -- Sifting through clinical data to find powerful associations (this is how COX-2 inhibitors were taken off the market). 
• Real-time monitoring -- Of outbreaks, pandemics, etc. 

The culture of innovation. 

• We live in a “culture of health innovation.” 
• On one side, there are the inventors and entrepreneurs: 

“It is not usually that they have a new and different idea, but it is that they never give up on that idea. They push, break rules, frustrate conventions, risk careers, push push push. It’s not the discovery (though this happens as well), but it’s the hard work.” 

• On the other side, there is the more cautious, scientific discipline. The standards of conduct, inertia, status quo… all pushing back against ideas. 
• The purism and methodology of science lives in a messy and complicated real world, and it is the balance of these forces that creates our culture of innovation. 

How innovation happens. 

• Absolute persistence. Repeated failures, challenges, setbacks. This has been true for dialysis, organ transplant, the discovery of mRNA, the development of the CT scanner, etc.
• What IS innovation? It is when people work against norms and fears. It is relentlessness and not giving up. It is losing reputations. It is not working years, but working decades. 

Lessons from the arts: two types of geniuses (most innovators fall under category #2!). 

• One: The conceptual genius -- Picasso example. Picasso did his best work in his 20s. His earliest works are astronomically priced, while his works later in life are reasonable. His price curve goes down. As soon as he looked at the world, he knew. He painted each painting ONCE. He did not go back. 
• Two: The evolutionary genius -- Cezanne example. Cezanne did his best works in his late 50’s. His price curve goes up higher and higher. He went through iterative, exploratory processes. He repeated paintings, destroyed them, and painted them again 20 years later. It took him decades to evolve his style. He did not give up. 

What is holding back health reform. 

• The health system is protected. It is in the American psyche that we will find cures for diseases and live longer, healthier lives. People are scared that if we change policy too much, it will interfere with our system capable of discoveries and cures. 
• The health system is inertial. Current policy protects the status quo, even if it’s a bad status quo. For example, despite evidence on the dangers of tobacco, the federal government subsidized tobacco production until 2004. They subsidized the price per pack by more than half. Similar stories for getting insulin pumps, seatbelts, intensive care units into the system… the policy world is really hard to change. 

Protecting innovation.

• Americans have a depth of perseverance and relentlessness. No policy will change our culture of innovation. The innovation system works precisely because it goes against the status quo. 
• The question is: How can our health system encourage more innovation?