In medicine, too many disruptors disrupt disruption

Recently, I was dining with elite radiologists. In that uncomfortable silence between dessert and the check, I said, “radiology must shift the traditional paradigm by creating value streams using disruptive innovation to leverage population health to build strong ecosystems and a robust ectoplasm.”

I was experimenting if excreted verbiage hastens the check. Instead, it sparked a vigorous conversation about disruptive innovation, compelling me to drink more cognac.

In health care, no two words have been as mercilessly cheapened by overuse as “disruptive innovation.” This is a shame. Disruption is serious scholarship by Clayton Christenson who studies the diffusion of technology.

Christenson astutely observed that when the technology (disruptor) which renders its predecessor obsolete arrives, it is cheaper and (usually) of lower quality. It is by virtue of its lower quality it can be cheaper, and by virtue of its low cost it appeals to a neglected segment of the market.

Disruptors appeal to our moral sense of social justice. A start-up brings a giant corporation to its knees — how cool is that? It’s like David taking on Goliath (with a little help from venture capitalists).

Disruptive innovation is a historical analysis. History is analyzed when the dust has settled, and the facts have emerged. This sort of analysis concludes that if people hadn’t overreacted to a random archduke being shot by a social misfit, World War One might not have happened. History is written by those who can be bothered to write it.

Christenson’s sharp historical analysis about technology has morphed into a prediction industry. Consultants teach how to forecast disruptors, and survive disruption. It is Krav Maga on PowerPoint. This has robbed disruptive innovation of its key attributes: serendipity.

The problem with predicting disruption is that there are many more potential disruptors than actual disruptors. No good scholarship goes unpunished by policy makers, or capitalists. Combine eager prediction-merchants, bad predictions, venture capitalists, sun, sea and Silicon Valley, and third party payers: Suddenly there’s an epidemic of disruptors. Everyone wants a slice of the $3 trillion pie.

At various times, the following have been touted as disruptive innovations in health care: ultrasound on the iPhone, watches with ECGs, wearables, heat-sensing underpants, compassion, urine test for Alzheimer’s disease, natural language processing, and the lamentably boring, Watson. Too many disruptors disrupt disruption.

A physician, endowed with an MBA, once said with an earnest face, “Breaking vertical silos is the next disruptive innovation.” I asked, like a simpleton:“Do you mean talking to one other?”

All disruptors are the next disruptor. Like jam tomorrow and never jam today, disruptors live in a permanent future tense. The only disruptor living in the present participle is the electronic health record. It is disrupting my forbearance.

Where are the disruptions? The truthers blame a cabal of Luddite physicians for resisting disruption. One charming gentleman, irked by a piece of mine which teased futurists, tweeted menacingly, “This is why we need to disrupt physicians.” I wondered if, until then, he had held back the deadly disruptor. Whether he was going to unleash the disruptive technology only when he saw too much belligerence in a paternalistic physician. Whether I was the straw that broke his goodwill. “Time to put this lad in his place. Don’t spank him. Disrupt him.”

Vinod Khosla believes health care can be solved by Silicon Valley if pesky physicians get out of the way. Henry Ford never said, “These horses are getting too big for their hoofs. Get that internal combustion engine ready. Ahoy, equestrian disruption ahead. Horses! Out of the way.”

No one can stop disruption. If health care hasn’t been disrupted by Silicon Valley, it’s not because doctors are in the way. It is because innovation, with its present hype, is a load of cock and bull.

The space between innovation and policy has shrunk. Health care has red meat to devour. Silicon Valley knows this. It hypes and promises and is valued billions for hope and change. Oddly, a media which is constantly suspicious of physicians, and perhaps rightly so, starts believing in the tooth fairy once “disruptive innovation” is uttered.

Disruptive innovation is technology Darwinism — evolution at its finest. In health care, it is a fashion statement.
In my university days, the Ministry of Sound, a nightclub in London, was a great leveler. Around 1 a.m., after a few gins and loud music, every uncoordinated idiot was on the dance floor. The only requirement was locomotion, and the ability to lift off the floor when House of Pain shouted, “Jump, jump.”

All you need to enter Silicon Valley’s disruptive gang is a working lexicon of medicine, basic arithmetic, and a promise of an app that creates a value stream. The music is blasting. The industry is ginned with hope. Show payers the potential savings and they’ll ask, “How high should I jump, jump?”

Like a madman whose protests that he is not mad proves that he is mad — “Of course you’re going to deny being mad, you’re mad” — skepticism of disruption proves its efficacy. Of course, physicians are skeptical of disruptive innovation. It’s disruptive, innit. They wouldn’t be skeptical if they weren’t worried about their jobs.

Sorry dear, this is called peer review. It’s annoying, and I have a constant gripe with it. But it does a reasonable job of spotting total and utter BS.

Salk, the discoverer of polio’s vaccine, has helped poor kids in faraway lands we’ve not heard about, bend their arms and legs whenever they want to — useful skill if you want to play cricket in India and Pakistan. Thanks to Ms. Holmes’s disruptive technology, we can keep our arms bent so that blood can be drawn from our fingertip.

The Internet brought the world to your fingertips. Theranos brings the test for herpes simplex virus to your fingertips. Eons ago in villages in India, men were diagnosed with diabetes when they urinated on the walls and an unusually large colony of ants congregated. There was certainly room for improvement in diagnostics, then.

Imagine if, in the first episode of Star Trek, Captain Kirk, instead of saying “Beam me up, Scottie,” said “Check if I have herpes by pricking my finger tip, not the antecubital fossa, Scottie.” I don’t know about you, but I wouldn’t have bothered with episode two.

The depressing thing about Theranos is not that it may not deliver what it promised to deliver, but what it actually promised to deliver. The company is valued $10 billion dollars for saving you from a tourniquet around the elbow. How did our imagination for the future of mankind shrink to such marginal levels? How will we colonize another planet if we’re still obsessing about blood-letting?

The most disruptive innovation has been around for millennia. It is free to use and is of high quality. It is known as walking. But, we need a more expensive technology, the wearable, to enable this free technology. Perhaps, we need an even more expensive technology, such as close circuit TVs, to make us wear wearables, so that we walk more.

In other areas, disruptive innovation achieves the extraordinary by an effort that is ordinary. In health care, disruption is an extraordinary effort at achieving not even the ordinary.

Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad.  This article originally appeared in the Health Care Blog.

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