What does the Concorde Tell Us About Healthcare Technology in the 21st Century?

I am spending this month in the English Midlands in Stratford-on-Avon hard by the canal, the Bard’s town of quaint half-timbered Tudor pubs with “established 1482” on the plaques, and I am thinking about medical technology. I am here with Jenni to support her older brother as he goes through open-heart surgery and recovery. We have spent hours watching the ICU monitors.

The other night I watched a BBC documentary about the development of the Concorde, the supersonic aircraft. Beautiful plane, impressive technology for the time. Ridiculously expensive. Ultimately abandoned as not easily profitable and of limited use for a limited market.

The designers of the plane were quite proud of it, even as old men talking to the documentary cameras. They well should be, as it was a formidable technological achievement. One of the pilots talked about how many passengers would leave London at 10:30 am, arrive in New York at 9:30 am, conduct a day’s business, then ride the Concorde back to London in the evening, at $8,000 for round trip.

Here is the shocking take-away from the documentary. When they had finished the plane and were shopping it around, a number of countries complained about the noise, the sonic booms it would generate over every inch of its flight path. Eventually they sold zero planes, and the only airlines that put the Concorde into regular service were Air France and British Airways, the national carriers of the two countries that built it. That is not what is shocking. This is what is shocking: This was a surprise to them. The promoters and designers had apparently never considered that people might object to the noise. Never even thought about it.

Nor, it turns out, had they ever fully considered the cost/benefit ratio: Even at very high ticket prices, even at relatively full utilization, even when British Airways was given the planes for £1 each by the British government without having to shoulder any of the vast and deep more-than-decade-long development costs, the Concorde was hard to make a profit from. The crash of a Concorde in Paris in 2000, then 9/11 with its prolonged drop in air travel, spelled the beginning of the end. By 2003 both airlines had withdrawn the entire fleet from service and given up on the beautiful but flawed Concorde.

Think about that. Think about the fact that the poor business case for the Concorde was a surprise and shock to its planners and designers. “Build it and they will come,” they thought.

They had built the Concorde as a matter of national (and ultimately bi-national) pride, a proof that they could build the best, the greatest, the fastest, the most beautiful airplane ever. Neither the British nor French governments nor the designers had ever given serious thought to whether it would “pencil out,” nor whether the global context would even allow its deployment on multiple global routes.

The true wave of the future at the time the Concorde was deployed turned out not be sleek SSTs but 747s and Airbuses, less expensive ways to move large numbers of people reasonably fast, rather than ridiculously expensive ways to move a small number of very rich people faster.

Context matters. Context more than matters, it rules. Always. It makes no difference if your cool new technology is cool. Or amazing. Or beautiful. None. What makes a difference is: Does it solve a perceived problem for someone in your market at a price that “pencils out” for them? If it doesn’t, seriously, not fooling yourself with any prattle about what the customers and users “should” go for, go back to the drawing board and the modeling software. Work it over again and once more again until it does, or it will flame out in a fiery, expensive, destructive pile like the Concorde over Paris that summer day in 2000.

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8 replies »

  1. That is definitely one of the technologies I had in mind. A hugely expensive technology with no proven medical utility and even less any proven cost-effectiveness as a solution to a real problem.

  2. Wonderful essay, Joe! My Concorde nominee in medical technology: proton beam therapy. A $150 million hood ornament for wealthy health systems with too much money on their hands.

  3. The Concorde was pretty on the outside, but it had significant technical problems and it was an environmental disaster in the making. It was one of those governmental attempts to bring stuff they think are good to the market (I think they ended up selling each plane for a dollar or something like that). It was born as a niche product and it died that way too, because an airplane that can’t fly over land without busting windows and shattering walls below, while guzzling fossil fuels like there’s no tomorrow and ripping the protective ozone layer above, cannot possibly scale to anything useful for people.
    Sort of like health tech….. 🙂

  4. Enjoyed your thoughts, Joe. It’s worth noting that many innovators don’t capitalize on their work as they’re too focused on technical achievement than practicality for end users. Collectively, we should be working together to figure out parameters for utility instead of rushing to market.

    And yes, EMRs fit this description.

  5. A similar scenario occurred with the introduction of digital watches. Within two years, the employment of mechanical watch makers, virtually disappeared, especially in Switzerland. And so, our nation’s annual health spending ( as compared to all of the other 34 OECD nations) is the largest contributor to the annual Federal deficit.

    Amid the wrangling about healthcare reform, we have lost sight of its most efficient and effective therapeutic tool: “trust.” It becomes especially prominent when combined with responsive “medial TRIAGE” offered by each citizen’s Primary Physician. Our nation’s healthcare lacks this capability since there is no means to assure that equitably available, enhanced Primary Healthcare is offered to every citizen, community by community. None of this is rocket science.
    Slowly but surely, we need to reduce health spending from 18% of nation’s GDP to 13%, or less. For the last ten years, economic growth has been around 2% annually, and health spending has increased at about 4-5% annually (2-3% faster than economic growth). With future economic growth at 3-4% annually, reducing health spending growth would only require a reduction of 2-3% a year, an adjustment of more or less depending on economic growth.

    Remember the financial ROI (return on financial investment) for Social Capital is 3:1 (NOTE: the ROI for early childhood education is 7:1). Accept my current definition of SOCIAL CAPITAL as follows:

    .the spontaneously communicated attributes of Trust, Cooperation and
    .that become more prevalent for resolving the Social Dilemmas encountered
    .during each citizen’s participation in the civil life of their community
    .when CARING RELATIONSHIPS increasingly characterize
    .the enduring networks of the community’s citizens,
    .especially within the neighborhood network if each citizen’s Family.

    As a reminder, CARING RELATIONSHIP may be defined as follows:
    .a variably asymmetric interaction
    .between two persons who share a Beneficent intent
    .to enhance each other’s Autonomy by communicating
    .with Warmth, Non-critical Acceptance, Honesty and Empathy.