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At Little-Known Health Agency, DOGE Ends Dream ‘To Make A Difference’

By MICHAEL MILLENSON

Four days after emergency surgery and barely able to walk, Heather Sherman flew from Chicago to Washington for first-day-of-work onboarding at the Agency for Healthcare Research and Quality. Fourteen months later, Sherman suddenly became one of the thousands of federal employees summarily dismissed by a weekend email telling them they were “not fit for future employment.”

The trauma of that abrupt ending in mid-February — giving her just a few hours before all access was shut off — still lingers. “This was my dream job,” Sherman told me.

If Sherman were an air traffic controller or nuclear materials expert, her work keeping the public safe would be obvious. But as a mid-level employee with a technical role at a little-known agency in the mammoth Department of Health and Human Services, her curt dismissal and that of an undisclosed number of AHRQ colleagues prompted not even a ripple of news coverage.

Yet what a New York Times editorial decried as a “haphazard demolition campaign” by the Elon Musk-led Department of Government Efficiency, one that is undermining “the safety and welfare of the American people,” applies to agencies like AHRQ and low-profile jobs like Sherman’s just as much as to more high-profile positions.

In complex systems, of which healthcare is surely one, carelessness has consequences.

(Disclosure: I’ve known Sherman for years, and while I serve on AHRQ’s National Advisory Council, I have no inside information. All opinions are my own.)

For Sherman, with two master’s degrees and a Ph.D., the anodyne title of health scientist administrator masks a beyond-the-data devotion to patient safety. A 2023 report by the President’s Council of Advisors on Science and Technology declared patient safety “an urgent national public health issue.” In truth, the urgency is embraced mostly by a small number of individuals determined to drastically reduce the estimated 160,000 Americans perishing each year from preventable medical errors in hospitals.

That death toll is a conservative estimate by the Leapfrog Group. Food and Drug Administration administrator-designate Martin Makary has called medical error “the third-leading cause of death” and estimated a death toll of more than 250,000 Americans.

Saving Lives and Money

Even if the focus is only fiscal — leaving aside the human impact — medical care that causes unintended harm is inefficient and costs money. The potential savings are large: an in-depth examination of medical records by the HHS Office of the Inspector General found that a shocking one-quarter of Medicare patients suffer some level of harm during a hospital stay.

It’s that “inefficiency,” human as well as financial, that Sherman wanted to attack at AHRQ. She proposed an initiative enabling hospitals nationwide to collaborate within a legal framework that promotes candor by protecting their interactions from being discoverable in a malpractice lawsuit. That structure is known as a “patient safety organization,” established by Congress through bipartisan legislation in 2005. The process of ongoing collaboration is known as a “learning health system.”

Sherman recalls reaching out to everyone she knew whose organization was affiliated with a PSO and asking what they needed to meet today’s challenges. “The almost unanimous answer was, ‘We want a place to find solutions, a place to share solutions,’” Sherman said. “‘We want to know what to do.’”

“Any kind of systemic prevention of problems saves money,” she added.

To be effective, however, collaborative problem-solving on a large scale requires more than just setting up Zoom calls and sharing documents. It quickly gets technical; e.g., ensuring that all participants classify and report an adverse event in the same way.

“Classification is the key,” Sherman said. “It’s like a box of different-colored Lego pieces in different sizes. Each Lego is a data element. Everybody has to understand what it means in order to use it.”

Along with her technical expertise, Sherman also brought a determination to expand what information was collected and how it was used; for instance, by bringing in patient and family input. “The law was not meant to exclude reporting of problems by anyone who wasn’t a clinician,” Sherman said. She also planned to utilize qualitative data “to tell a story. You learn a lot more about the nuances of error in the qualitative data.”

To accomplish those ambitious goals, Sherman began seeking buy-in from AHRQ leadership while also planning a national kick-off conference for May. Then, awakening on Saturday morning, Feb. 15, and turning on the TV news, she heard a White House correspondent report that government departments were firing “probationary employees.” Soon afterwards, the dreaded email popped up in her inbox from the HHS personnel office.

“We all knew it was coming,” Sherman said. “We just didn’t know when.”

A Legal Loophole

“Probationary employee” has a different meaning for federal employees than for private-sector ones. In the private sector a probationary period might last a few months, but an employee can typically still be fired “at will” any time afterwards, barring protections related to union membership or illegal discrimination. In federal employment, in contrast, the probationary period before civil service job protections kick in can last one, two or even three years, depending on various factors, and the probationary period can start over even for long-time employees if they’re promoted or switch agencies. Sherman was hired on a two-year probationary period.

Even probationary employees, however, can be fired only for certain reasons. Hence the careful language of the DOGE-driven form letter signed by HHS Chief Human Capital Officer (Acting) Jeffery Anoka that informed Sherman she’d not met “the burden to demonstrate why it is in the public interest” for the government to finalize her appointment. It continued, “your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate.”

Excerpt from letter firing federal workers
Excerpt from letter sent to probationary federal employees

“I was very calm that day,” remembered Sherman. “The next day I was a mess.” Questions of what would happen to her work, as well as compensation for unused sick leave and time off, remain unresolved; senior AHRQ managers are also in the dark. “Nobody knows anything, and there’s no guidance,” she said. “I am disheartened and disappointed.”

At the Centers for Medicare & Medicaid Services, a senior manager named Jeff Grant pushed back hard in a letter to Anoka posted on LinkedIn after 82 employees in his group were told they were “not fit for continued employment.” Grant began by announcing he was immediately retiring after 41 years of federal service, emphasizing later that he had served with equal dedication both Republican and Democratic administrations. Grant went on to refute accusations of incompetence by saying the fired workers had not only passed a series of formal reviews with high marks, but the interview process, one in which he was personally involved, allowed CMS to select “truly the best of the best” out of hundreds of resumes.

Moreover, Grant pointedly noted, many of those fired at his Center for Consumer Information and Insurance Oversight were set to work on writing and implementing a new rule announced as a Trump administration priority. That rule, “is projected to save billions in program dollars,” he wrote, “which is the ultimate in government efficiency.”

A Plea For Public Service

On an even more personal note, an “open letter to America from career federal civil servants,” written anonymously to avoid retaliation, poignantly reminded the public, “We are your neighbors, friends and family. … Most of us heeded a call to serve because we love this country and what it represents as much as you and wanted to give back. The hard work we do, we do on your behalf.”

That declaration resonates with Sherman, who said she’s long yearned to work for AHRQ, a small-budget agency with the big-mission task of helping make U.S. medical care better and safer.

“I never wanted to leave AHRQ,” Sherman said. “I wanted to be in this department, in this job, for the rest of my life. I didn’t go into this profession to be rich. I went into this profession to make a difference in people’s lives.”

The “chainsaw” approach favored by Musk continues: the administration has ordered every federal agency to turn in a plan for even more drastic cuts by March 13. The impact of two federal juges’ orders reversing some probationary employee layoffs remains to be seen, particularly since they are being appealed. For Sherman, meanwhile, there are two poignant codas to her career situation. DOGE, the force behind her firing, has been criticized for acting with both joyful cruelty and dubious legal authority. As it happens, Sherman’s undergraduate major was in judicial morality and constitutional democracy.

Meanwhile, although Sherman almost immediately lost all job-related access, her last official day on the AHRQ payroll was March 14. This year, that’s the next-to-last day of Patient Safety Awareness Week.

Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor. This piece was previously in Forbes

How Routine Medical Care Fuels America’s Opioid Crisis

By MATT McCORD

When most Americans undergo surgery, they expect to recover quickly and return to their normal lives. Few realize that something as routine as a shoulder surgery, a hernia repair, or a mastectomy can mark the beginning of a life-altering opioid addiction. This often-overlooked connection between routine medical care and opioid dependence demands urgent attention.

How Physicians and Hospitals Sustain the Opioid Epidemic

For decades, the pharmaceutical industry has shaped medical education, ingraining the belief that opioids are the best first-line treatment for acute pain. As a result, American physicians prescribe opioids at dramatically higher rates than their counterparts in other countries. A recent study in Annals of Surgery found that after three common surgeries, 91% of U.S. patients were prescribed opioids, compared to just 5% of the global patients.

Hospitals and health systems have also played a significant role in perpetuating opioid dependence. Opioids have long been a convenient and cost-effective solution for acute pain management, readily available and inexpensive to administer. However, the financial incentives for hospitals extend far beyond the initial prescription. The short-term complications of opioid use—such as nausea, constipation, urinary retention, and hyperalgesia—require additional treatments, increasing hospital revenue. Long-term complications, including dependence, overdose, and addiction, further drive profitability through repeat admissions, extended care, and emergency visits. In effect, hospitals and health systems have become financially reliant on opioid-based care, benefiting from both the immediate and prolonged consequences of opioid prescribing.

A study from the University of Michigan/IBM Watson revealed that a single opioid prescription after elective surgery increased healthcare costs by an average of $5,680 per patient per year across all payer types, including Medicare, Medicaid, and commercial insurance. This widespread cost increase affects insurance premiums, employer healthcare spending, and state and federal budgets. Notably, this estimate does not even account for the long-term costs of addiction treatment, which can be 2-16X that cost per patient per year.

The Devastating Impact of Routine Opioid Prescriptions

Each year, over 60 million surgeries are performed in the U.S., leading to the prescription of 45 million new opioid prescriptions per year. But the real crisis lies in what happens next: nearly 10% of all surgical patients remain on opioids long after their recovery should be complete. That means 2-4 million Americans every year are still using opioids beyond 90 days post-surgery.

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Health Care in Abundance

By KIM BELLARD

A recent report from Moody’s Analytics, by chief economist Mark Zandi, had an eye-opening fact: the top 10% of earners in the U.S. – those who make $250,000 or more – now account for just shy (49.7%) of half of consumer spending. If that strikes you as unusual, you’re right. It is a record since at least 1989. Thirty years ago the comparable percentage was 36%.

“The finances of the well-to-do have never been better, their spending never stronger and the economy never more dependent on that group,” wrote Dr. Zandi. He added: “Wealthier households are financially more secure and thus more able and willing to spend their income. That is, they save less than they would otherwise.”

The rest of us are struggling to hold our own against inflation, not always successfully. It’s why companies like Costco and Walmart are trying to target upscale shoppers, while “value” oriented firms like Big Lots, Family Dollar, or Kohl’s are closing stores or even declaring bankruptcy.

This extreme bifurcation, of course, made me think of healthcare, where – as is famously known – half of all spending is attributable to only 5% of patients. In case you’d forgotten, in healthcare, half the population accounts for 97% of all spending, so the other half accounts for a measly 3%.

Now, you might say, neither of those is surprising: rich people spend more, and sicker people cost more. But somehow neither of those seems right to me.

I started thinking more about this after reading a recent New York Times op-ed from Ezra Klein. In it he makes the following assertion:

The answer to a politics ofscarcity is a politics of abundance, a politics that asks what it is that people really need and then organizes government to make sure there is enough of it.

Mr. Klein didn’t coin the phrase “politics of abundance,” but he and Derek Thompson did just write a book on the topic (Abundance) that discusses their thoughts at more length. I have not read the book, but I saw a quote from it that I quite liked: “What is scarce that should be abundant? What is hard to build that should be easy?”

And so we’re back to healthcare.

We seem to live in a country where healthcare is too scarce. A new analysis suggests that we have a looming shortage of hospital beds, and if you live in a rural area, it’s already here. If you believe the Association of American Medical Colleges, we have a looming physician shortage, and if you’re looking for primary care, it’s already here. We’re facing nursing storages, pharmacist shortages, nursing home worker shortages, home health worker shortages, to name a few. We even have shortages of many critical prescriptions, including some needed for cancer treatments.         

Despite all these shortages or would-be shortages, of course, we manage to spend way more than other countries on healthcare. One can only imagine how much we might be spending if there were no shortages. I take that back: I’m not sure I can imagine.   

In the category of things that are scarce that should be abundant, and/or things that are hard to build that should be easy, I’d probably put housing at the top but healthcare as a close second. The trouble is, when we pour more money into healthcare, as we are wont to do, we don’t seem to fill any of our many shortages, much less improve the quality of care or outcomes.

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We Cannot Let RFK Jr Lead Us Backwards in Health

By ARIEL FRISTOE

As the artistic director of Out of Hand Theater, an arts organization that promotes anti-racism, social activism and health equity, I believe the recent appointment of Robert F. Kennedy, Jr. (RFK) as Secretary to the Department of Health and Human Services is beyond concerning. RFK is not a doctor, nor is he a scientist, yet he has been very vocal about his vaccine skepticism and has promoted misinformation about vaccine safety. Now, along with the removal of scientific information and warnings from the Centers for Disease Control (CDC) website, RFK’s appointment could lead to major increases in preventable and serious illnesses, outbreaks and deaths.

COVID-19 and its various mutations are still very much part of our daily landscape. According to the World Health Organization (WHO), more than 7 million COVID-related deaths have been reported since 2020 worldwide, nearly 2 million deaths were recorded in 2020 alone. The first vaccines were developed and became available by November 2020 and reported deaths from the last 28 days is 3,872, which is a 98.7% decrease from the onset of the pandemic. Vaccines work and save lives!

Diseases like smallpox and the bubonic plague were wiped out because scientists developed vaccines. Currently, with the “anti-vax” rhetoric being embraced and misinformation being so commonplace, reports of measles went from 4 cases in 2023 to 285 in 2024. Nine of these cases required hospitalization. The affected individuals include six children under four years old, 16 individuals aged 5-17, and two adults over 18 – the numbers rise as the days go by with 124 cases in in Texas in 2025 alone. We cannot and should not be going backwards where medicine is concerned.

Health experts are concerned that increasing nonmedical vaccine exemptions among schoolchildren could lead to more frequent outbreaks. Declining vaccination rates are worrisome as measles can cause serious illness, including hospitalization and brain swelling. I am not a doctor nor a scientist, but I place my trust in the actual doctors and scientists who have the greater good in mind when developing medicines to combat and prevent diseases. Why does this matter to me? Through our Equitable Vaccines program, we use art, information and conversation to encourage vaccine confidence and educate the community about resources so that we can create a healthier community, and we’re proud to have helped deliver 650 vaccines across Georgia. A healthy community is a strong community – and to me, that is the most valuable commodity over what is imported and exported.

As a woman, as a mother, as a human, I worry about our health and our children’s future with RFK Jr leading the Department of Health and Human Services.  I implore that all of us contact our local and state representatives to express our concerns over RFK’s Department of Health and Human Services appointment. We cannot go backwards when we have the resources available to us to create a safe and healthy place for every citizen to thrive. We must prioritize our communities’ health and allow proven data to guide our most important decisions that impact those that are most precious to us.

Ariel Fristoe is the Artistic Director at Out of Hand Theater

What would a rational DOG(gi)E do(o)?

By MATTHEW HOLT

DOGE, or Doggie as Kara Swisher has been calling it, has gone from being a meme about Shiba Inus to a crypto scam to a group tearing the Federal government apart.So I thought I would use the title of this piece to make a joke. Like Musk’s humor it’s puerile and not funny. What’s also not funny is what Musk’s team has done to small government agencies, like USAID & CFPB that really help people, not to mention the irrational firing of thousands of government employees that appear to be screwing up the NIH, the National Parks, the FAA and much more. But it’s all got me thinking, what in health care should an effort to quickly rationalize government spending do?

Now I’m not proposing that there’s anything OK with the way Musk and his team have been blundering around the Federal government, telling lies about what it does and indiscriminately firing the people who have the most important responsibilities and then desperately trying to get them to come back. This has been pure ignorance theater, and it would be hilarious if it wasn’t so damaging. Equally importantly the places DOG(gi)E has started are stupid because they don’t spend much money. But the government spends a lot on health care –between two and three trillion dollars, depending on how you count it.

So if you wanted to save some money and potentially change the system, what would you do? First you’d take a deep breath and get some real data, and improve your understanding about what is actually happening. There are some areas in health care where the issues are well understood and the data is clear and there are others where it’s less obvious.

Let’s start with a relatively small one–spending on Federal Employees health benefits. Chris Deacon’s Linkedin posts are a constant source of fun and games, and she has been highlighting screwups in the FEHBP administration for a long time. Essentially the government via the OPM pays lots of different insurance companies to manage Federal employees’ health care. There is very poor oversight of what happens in those programs and when the OPM’s OIG points that out, not much happens. The plans (including Horizon Blues in NJ and BCBSNC and many others) have been caught being sloppy or fraudulent but not much has happened. All DOG(gi)E needs to do is read the report on the audits, or look at what GOA said about $1bn being spent on ineligible members in 2022 and apply their recommendations.

Next let’s get into something that requires a little more investigation. In America we buy (and sell) drugs in a mind-bogglingly complex way.

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Goodbye, American Science

By KIM BELLARD

Many people don’t realize it, but a hundred years ago America was something of a scientific backwater. Oh, sure, we had the occasional Nobel laureate, but the center of science was in Europe, particularly Germany. Then in the early 1930’s the Nazis decided that “purity” – of political ideas, of blood – was more important than truth, making life uncomfortable at best and deadly at worst for their scientists. So hundreds of them fled, many of them ending up in the U.S. And – voila! – American science came of age and hasn’t looked back.

Until now. Now, I fear we’re going to suffer what Germany did, a brain drain that will bode well for some other country’s scientific fortunes.

Once of the first chilling announcements from the Trump Administration was that it was freezing NIH grants in order to ensure they were in compliance with Trump’s executive order banning DEI-related efforts. That froze some $1.5b in grant funding.

Piling on, the Administration announced that NIH grants would limit indirect costs to 15%. Sounds reasonable, you might say, but the vast machinery of U.S. biomedical research uses these “indirect” costs to fund the infrastructure that makes the research possible. Numerous state Attorney Generals immediately filed a lawsuit to block the cuts, claiming:

This research funding covers expenses that facilitate critical components of biomedical research, such as lab, faculty, infrastructure and utility costs. Without it, lifesaving and life-extending research, including clinical trials, would be significantly compromised. These cuts would have a devastating impact on universities around the country, many of which are at the forefront of groundbreaking research efforts – while also training future generations of researchers and innovators.

Oh, and on top of all this, as many as 1,500 NIH employees are in line to be laid-off.  

Katie Witkiewitz, a professor at the University of New Mexico, lamented to The New York Times: “The N.I.H. just seems to be frozen. The people on the ground doing the work of the science are going to be the first to go, and that devastation may happen with just a delay of funding.”

Universities are similarly frozen, not sure when or how much money they can expect. The University of Pittsburgh has paused all Ph.D. admission, until it can better understand its funding future. One has to suspect it won’t be the only such program to do so, and we may never know how many would-be Ph.D. students will simply decide a future in U.S. science is too bleak to risk.

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How hard is it to prove you have coverage?

A friend of mine who wants to stay anonymous (for now at any rate) had a crazy waste of time proving that he was eligibile for a medication on his plan. I thought his story might trigger a few of you! And yes Optum is of course part of United HealthGroup–Matthew Holt

Here is the ridiculous situation I had with filling a prescription through COBRA a few weeks back.

I spent 33 minutes on the phone on January 8th, 2025 before I finally navigated the maze that is American healthcare to the extent that a medication that has been prescribed for me by my doctor regularly for several years could be delivered to her office in time for my next appointment. OK, there is a need to verify health insurance coverage, but one might expect this to be a simple matter of checking eligibility->coverage->currency-with-premiums, and something that can be done asynchronously. Not so. Optum needed to verify the “paid-through date.” I pointed out that I’d already made four attempts to resolve this situation since December 19th, including on the last occasion by providing details of my COBRA policy to the Optum agent so that she could follow up with them to verify whatever it is they needed to verify. Apparently she hadn’t bothered, so here we were again.

What was required to resolve this in the end was literally a four-way conference call, which of course is absolutely ridiculous in the Information Age. With the primary Optum agent on the line, I conferenced in the COBRA hotline, but the automated voice confirming my “paid-through date” was not good enough for her to be able to vouch for me. I needed to get a human agent on the line. Meanwhile, the primary Optum agent conferenced in someone from their payments division. With all four of us on the phone, I did the introductions, then the second Optum agent asked the COBRA agent to repeat the paid-through date, give his name and a confirmation number, and that was enough information for the Optum payments person. The primary agent and I twiddled our thumbs on the line for another 5-10 minutes until the payments agent came back online to tell us that she had completed her work–at least for the coverage part.

But wait. There’s more. Now I needed to confirm my consent to the terms and conditions, which the agent had to read out to me in full, taking several minutes of her reading the small print, before I confirmed that I accepted. The final stage was for me to wait on hold again while she set up overnight delivery and then reconfirmed my appointment with my doctor. In the end, this was successful, but it cost me nearly 35 minutes in a process that is absolutely unnecessary.

Delay, Deny, Defend were the words inscribed on Luigi Mangione’s bullets. This was his point. They haven’t gotten the memo.

No More ‘Dabbling’: It’s Time to Embrace Value-Based Care

By ALEX AZAR

Presidential transitions are always a time of great change, but few leaders have ushered in a shift as sweeping as the rewiring of one-seventh of the U.S. economy. President Trump has the opportunity to do just that by doubling down on the health transformation achievements of his first term.
 
A key to success is continuing the shift from a fee-for-service (FFS) healthcare model to value-based care (VBC). The current FFS model continues to deliver higher costs and greater utilization of healthcare resources—but not better outcomes for patients. By contrast, a VBC model ties provider payments to quality patient care that incorporates prevention and coordination. 
 
As a country, we’ve been dabbling with value-based models for decades. Now, the time has come to rip off the proverbial Band-Aid and embrace system-wide changes. 
 
We actually have more evidence than most people realize in favor of alternative care delivery and payment models. 
 
Significant positive changes have already occurred in the primary care space through programs like the Medicare Shared Savings Program (MSSP).

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Patients Are NPCs

By KIM BELLARD

I found a new way to think about patients in an opinion piece by Ezra Klein: they’re NPCs. For those of you unfamiliar with gaming, NPCs are those characters in video games that aren’t controlled by live players; they’re part of the game, serving as background for the actions the actual players take.

Not a very flattering metaphor.

Mr. Klein’s article is neither about healthcare nor gaming, but about politics: The Republican Party’s NPC Problem — and Ours. Conservatives, Mr. Klein explains, accused liberals of being NPCs — passive, conformists, deferential – whereas they were the live players, willing to take chances and make things happen. He goes on to explain why this is not at all accurate, especially in the Congress, but this paragraph is what really struck me:

It’s a genuine failure of Democrats that they didn’t put more energy into making the government faster and better when they were in charge. How did the Biden administration pass $42 billion for broadband in 2021 and have basically nothing to show for it by November of 2024? How did it get $7.5 billion for electric vehicle chargers but build only a few hundred chargers by the end of the term?

i.e., Democrats had some good ideas, took action to try to make them happen, but failed in the delivery. Good intentions matter, but are necessary, not sufficient.

Marc J. Dunkelman makes a similar argument in The Atlantic: How Progressives Broke the Government (an adoption of his new book Why Nothing Works: Who Killed Progress–And How to Bring It Back). Here are a couple of the relevant passages, aimed at the Progressive movement:

Progressives are so fearful of establishment abuse that reformers tend to prefer to tighten rather than loosen their grip on authority. The movement discounts whatever good the government might do in service of ensuring that it won’t do bad. And that’s driven well-intentioned reformers to insert so many checks into the system that government has been rendered incompetent.

At present, progressives are too inclined to cut public authority off at the knees. And that’s why they so often feel like they can’t win for losing. Their cultural aversion to power renders government incompetent, and incompetent government undermines progressivism’s political appeal.

America can’t build housing. We can’t deploy high-speed rail. We’re struggling to harness the promise of clean energy. And because government has failed in all these realms—because confidence in public authority has waned through the years—progressives have found it difficult to make a case for themselves.

What does any of this have to do with healthcare, much less NPCs? It’s this: we talk a good game about health care, especially Democrats, but we consistently fail to deliver. Pick your poll: Americans are critical of the healthcare system in general, of the quality of care, and especially its costs.  Americans hate Big Pharma, we hate health insurers, and our trust in doctors and hospitals has plummeted, especially since COVID.

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Disruption For the Sake of Disruption Is Not Innovation

By MIKE MAGEE

“The technological leaps of the 1900s — microelectronics, antibiotics, chemotherapy, liquid-fueled rockets, Earth-observing satellites, lasers, LED lights, disease-resistant seeds and so forth — derived from science. But these technologies also spent years being improved, tweaked, recombined and modified to make them achieve the scale and impact necessary for innovations.”    Jon Gertner, author of “The Idea Factory.”

The Idea Factory is a history of Bell Labs, spanning six decades from 1920 to 1980. Published a decade ago, the author deliberately focused on the story inside the story. As he laid out his intent, Jon Gertner wrote “…when the drive to invent has become a mantra, Bell Labs offered us a way to enrich our understanding of the challenges and solutions to technological innovation. Here, after all, was where the foundational ideas on the management of innovation were born.”

One of the scholars Gertner likes to reference is Clayton Christensen. As a professor at Harvard Business School, he coined the term “disruptive innovation.” The Economist magazine loved him, labeling him in 2020 “the most influential management thinker of his time.”

A process thinker, Christensen deconstructed innovation, exploring “how waves of technological change can follow predictable patterns.” Others have come along and followed in his steps.

  1. Identify a technologic advance with a potential functional market niche.
  2. Promote its appeal as a “must have” to users.
  3. Drop the cost.
  4. Surreptitiously push aside or disadvantage competitors.
  5. Manage surprises.

Medical innovations often illustrate all five steps, albeit not necessarily in that order. Consider the X-ray. Its discovery is attributed to Friedrich Rontgen (Roentgen), a mechanical engineering chair of Physics at the University of Wurzburg. It was in a lab at his university that he was exploring the properties of electrically generated cathode rays in 1896.

He created a glass tube with an aluminum window at one end. He attached electrodes to a spark coil inside the vacuum tube and generated an electrostatic charge. On the outside of the window opening he placed a barium painted piece of cardboard to detect what he believed to be “invisible rays.” With the charge, he noted a “faint shimmering” on the cardboard. In the next run, he put a lead sheet behind the window and noted that it had blocked the ray-induced shimmering.

Not knowing what to call the rays, he designated them with an “X” – and thus the term “X-ray.” Two weeks later, he convinced his wife to place her hand in the line of fire, and the cardboard behind. The resultant first X-ray image (of her hand) led her to exclaim dramatically, “I have seen my death.” A week later, the image was published under the title “Ueber eine neue Art von Strahlen” (On A New Kind of Rays).

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