Disruptive Idiots From Silicon Valley

Disruptive Idiots From Silicon Valley

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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 healthcare, 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 (disrupter) 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.

Disrupters 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 disrupters, and survive disruption. It is Krav Maga on power point. This has robbed disruptive innovation of its key attribute – serendipity.

The problem with predicting disruption is that there are many more potential disrupters than actual disrupters. 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 disrupters. Everyone wants a slice of the $3 trillion pie.

At various times, the following have been touted as disruptive innovations in healthcare: ultrasound on the I-Phone, watches with ECGs, wearables, heat-sensing underpants, compassion, urine test for Alzheimer’s disease, natural language processing, and the lamentably boring, Watson. Too many disrupters 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 disrupters are the next disrupter. Like jam tomorrow and never jam today, disrupters live in a permanent future tense. The only disrupter 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 disrupter. 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 which broke his goodwill. “Time to put this lad in his place. Don’t spank him. Disrupt him.”

Vinod Khosla believes healthcare 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 healthcare 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. Healthcare 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 healthcare, it is a fashion statement.
In my university days, the Ministry of Sound, a nightclub in London, was a great leveler. Around 1 am, 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 mad man 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 healthcare, disruption is an extraordinary effort at achieving not even the ordinary.

 

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23 Comments on "Disruptive Idiots From Silicon Valley"


Member
Oct 25, 2015

This was an amusing and delicious read- though a bit of an unfair Theranos slug to focus on the finger prick. If it “works” I’m told by pathologist friends of mine that reducing the blood volume required for certain blood draws could have very significant clinical implications, especially for those who require frequent tests. Additionally, the consumer – driven lab tests, especially the angle they are advocating for in places like Arizona where patients can actually order their own tests, and more transparent and lower lab pricing could be quite disruptive for the business of medicine.

Member
William Palmer MD
Oct 24, 2015

Doctors getting together in an association with patients, to act as patients’ agents–a labor “union” of both docs and patients–demanding cheaper drugs, higher insurance actuarial values, instant and facile access of patient records, variable and patient-specific plan benefits, understandable hospital charges…with the overall goal of reducing information assymetry in patients….all this would disrupt to the level of a happy revolution. Hooray!

Member
Allan
Oct 23, 2015

I Like this statement because it is true and so many people don’t realize it.

“No one can stop disruption. If healthcare 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.”

Another great post.

Member
Oct 24, 2015

Thanks Allan.

Member
Oct 23, 2015

often said, when ‘everyone’s innovating’ is anyone really innovating?

Member
Oct 24, 2015

Thanks Gregg. You have crystallized my point nicely

Member
lawyerdoctor
Oct 22, 2015

Great piece as always, Dr. Jha.
In my university days we had “Just a little bit louder now, just a little bit louder now” –
but I am not such an old fart as to realize that you now “gotta get up to get down.”

Member
Oct 22, 2015

Thanks lawyerdoctor. I should mention that at 130 am they played the Dancing Queen, which tested the survival of the fittest.

Member
Oct 22, 2015

I think @RougeRad’s been hanging out in a dark room staring at screens too long. I told the careful THCB reader last week that Theranos’ tech even if it worked wasn’t that big an advance AND I said about 4 other things and in about a quarter the number of words. This is just a long vague ramble. I vote we replace it with video of @RogueRad on the dance floor from the Ministry of Sound–you know it exists somewhere!

Member
Oct 22, 2015

Sorry, wrong video (there are so many videos).

This one is a truer representation.

https://www.youtube.com/watch?v=BhS8ngubgTk

Member
Perry
Oct 22, 2015

Looks like a cross between Elvis and John Travolta, Bollywood style.

Member
Oct 22, 2015

Matthew, in my defense I never thought I was Patrick Swayze.

I think this might be the video you are looking for.

https://www.youtube.com/watch?v=4iMO41RIEeM

Member
Oct 22, 2015

“If only readers would be more careful!” weeps the misunderstood and under-appreciated wonk of innovation. But poets, not analysts, steal the hearts of readers.

Member
Oct 22, 2015

Poetic analysis, sir!

Member
Oct 22, 2015

Yeah. 🙂 Your THCB post put me onto the Theranos CusterFluck. I cited your money shot paragraph. Ms. Holmes is certainly dancing between the raindrops these days. She may single-handedly solve the CA drought.

Member
Perry
Oct 22, 2015

Clearly, doctors need to be more disruptive.
And isn’t “elite radiologist” an oxymoron (I’m married to one)?

Member
Oct 22, 2015

I know no other way of addressing MD-MBAs. I don’t believe “knighthood” is American tradition, otherwise I’d call them “sirs” and “ladies.”

Member
Oct 22, 2015

“Combine eager prediction-merchants, bad predictions, venture capitalists, sun, sea and Silicon Valley, and third party payers – suddenly there’s an epidemic of disrupters. Everyone wants a slice of the $3 trillion pie.”
__

A thing of beauty, that. 🙂
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“All disrupters are the next disrupter. Like jam tomorrow and never jam today, disrupters live in a permanent future tense.”

LOL.

My post on this riff was entitled “Free Beer Tomorrow,” a prologue to the Health 2.0 2015 Conference.

http://regionalextensioncenter.blogspot.com/2015/10/free-beer-tomorrow-transforming.html
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“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? ”
__

I’m reading a cool book at the moment, “Genomic Messages.” One of the co-authors (an MD) notes that a solid, probing physician’s FH (Familiy History) going back 3 generations is still as good as a genomic assay for evaluating heritable disease risk.

Member
Oct 22, 2015

Thanks, Bobby. Also for the book recommendation. I think the point, we all appreciate, is that there is so much innovation that’s incremental that gets touted for disruption.

I love free beer tomorrow. Better than jam tomorrow.

Member
Oct 22, 2015

Great post, Dr. Jha.
I have been railing against this idiocy for years, including Prof. Christensen’s own misguided attempts to prescribe the disruption of health care, based on Xerox and Southwest hindsight, so I am not going to launch into one of my customary tirades, except to say the following.
The most disruptive innovation in health care right now is the introduction of public fraud as a legitimate business model, initiated, incubated, encouraged and vigorously promoted by an irreversibly corrupt government.

Member
Civisisus
Nov 7, 2015

wow, look at that – a vague, cranky and pointless comment from Margalit. You don’t see that every 15 minutes.

“irreversibly corrupt”! “Everything is horrible now – not like it used to be!” “Get off my lawn!”

Get over yourself and your curdled notion that doctors are the center of anyone’s universe, outside of KevinMD

Member
Oct 22, 2015

Thanks Margalit. It’s not easy to predict disruptive technology, even outside healthcare. Steve Jobs thought the segway would disrupt the automobile. Now when I see people on a segway I wonder why don’t you just ride a bike.

Member
Oct 22, 2015

I want to hear more about Margalit’s public fraud. Other than that this whole post would be better replaced with video from @RogueRad’s time on the dance floor at the Ministry of Sound from some random night in the 1990s.