Saving Lives by Stripping the Power of Doctors
Clayton M. Christensen is a professor of business administration at the Harvard Business School. He is the bestselling author of five books, including his seminal work, The Innovator's Dilemma, which received the Global Business Book Award for the best business book of the year, and most recently, The Innovator's Prescription, which examines how to fix our healthcare system. Christensen serves on several public and privately traded boards and is the founder of a successful consulting company and an investment management firm. He holds a B.A. with highest honors in economics from Brigham Young University and an M.Phil. in applied econometrics and the economics of less-developed countries from Oxford University, where he studied as a Rhodes Scholar; he received an MBA with high distinction from the Harvard Business School in 1979, graduating as a George F. Baker Scholar, and was awarded his DBA from the Harvard Business School in 1992.
Topic: Bringing Disruptive Innovation to Healthcare
Christensen: A good way to visualize how disruptive innovations transform an industry is if you think of the geography of an industry as a set of concentric circles.
I’m Clayton Christensen, the Robert and Jane Cizik Professor of Business Administration at the Harvard Business School.
Question: How can disruptive innovation transform healthcare?
Christensen: The advent of sophisticated healthcare technology in the form of surgical suites and advanced imaging equipment and these big high speed multi-channel blood testing and analytical equipment has driven a centralization of the healthcare industry, so we have to take the patients to the hospital rather than to bring the solution to the problem. Now, do you think hospitals will ever become cheap by competing against each other? No. They’ll actually become more expensive. So what we need to do is drive the disruptive decentralization of the healthcare industry and we do that by bringing technology to outpatient clinics, so you can begin doing there the simplest of the things that within the past required a hospital and then keep driving that technology so that they can do more and more and more sophisticated things in that setting. And then we bring technology to doctor’s offices so they can begin doing the simplest of the things that previously had to be referred to a more expensive clinic and then drive that technology so that you can do in the doctors' office more and more the things that were required at the higher cost clinic. And then use technology to drive care to the home. And in a similar way, do you think healthcare will become cost effective if we just expect doctors to take pay cuts? That will never happen but instead we need to bring technology to physicians assistants and nurse practitioners so that they can begin doing the simplest of things that previously required a doctor and then drive that technology so that they can do more and more of those things. In other words, it’s by enabling lower cost venues of care and lower cost caregivers to become more and more capable of doing more remarkable things. That’s the mechanism by which healthcare becomes affordable not by expecting the expensive ones to become cheap.
Question: What specific innovations are most vital to the future of healthcare?
Christensen: Personal electronic medical records are very important to the future of healthcare. The challenge that we have to confront is care has to be coordinated and the reason why care has to be coordinated is there are interactions amongst drugs which if one provider prescribes a patient to take one set of drugs and another provider prescribes a different set for different disorders, those two things might interact in the patient’s body in really adverse ways and create real problems. One provider needs to know what other providers have previously done, so that we know whether or not a patient responded to a therapy so that we don’t duplicate tests and so on. Electronic medical records are really very important to assure that the right care is delivered to the right people without duplication or contradiction. In the past, a doctor could provide all of that coordination. The problem is there are so many more drugs now and so much more is known about how these drugs interact with each other and the system is fragmented enough that coordinating a patient’s care is actually beyond the cognitive ability of the world’s smartest doctors. They simply cannot keep in their mind a coordinated picture of all of the possible interactions and all of the possible sequences of care that all of their patients are experiencing. The only way to do it is to have the coordination be done by an information technology system where information about these issues is brought together and algorithms exist that will flag for the doctor and for the patient where there are problems or where there are experiences in the past from which we can learn. So these records are really very important. I think the perception in Washington of the state of digital medical records is very skewed. What they see is the patient with the doctor in the doctor’s office and the doctor continuing to write prescriptions on paper and keep the records on paper but that’s kind of the equivalent in telecom of the last 50 feet of the last mile and that indeed hasn’t been well-digitized, but 97% of all transactions and activities in the healthcare systems already are digitized and so the drug companies, the pharmacies, pharmacy benefit managers, insurance companies, everything they do is digitized. The major healthcare systems like Kaiser Permanente or Intermountain Health, Geisinger or here in the Boston area Partners, their activities are all digitized. So 97% of the data is already there. The problem is that as a natural first step in creating these electronic systems, the systems are not yet compatible. So each company has its own system and that’s a very natural first step. Now, we need technology that virtualizes the interface that enables the systems to talk to each other. That’s the problem and it will just take a little bit of time but it’s been solved in many other contexts. So it used to be that financial records were kept by different companies in different formats but they were able to ultimately virtualize those records so that all of us have a single place we can go to get our credit score even though the inputs come from many different people. This will happen.
Question: Are any low-cost technologies transforming the industry?
Christensen: There are a lot of wonderful devices that are simple and affordable that is driving the decentralization of healthcare. One set of devices have come a Seattle based company called SonoSite and from GE Medical Systems and this a little handheld ultrasound, a piece of ultrasound equipment. Now, if you ask the radiologist who has a very expensive Philips cart-based ultrasound system, these little handheld devices are just really crummy, don’t have anywhere near the functionality that the big system has. But if instead you bring that handheld system to the primary care physician or a nurse practitioner who is doing your annual physical exam, you know, in the past, the only way they could sense what was going on in the body was to feel for it or to listen for it with the test stethoscope and you give this people this little handheld ultrasound equipment, and my goodness, now they can look inside your body and do so much better a job at identifying nasant problems that might be emerging. And so at the periphery, at the distributed end of this disruptive decentralization, we’re bringing much greater capability to be more precise in the practice of medicine. The very same technology tried to deliver in the middle of the circle actually compromises quality. So that’s just one example. Let’s see…. other examples are the ability to determine whether you're pregnant or not, the ability to measure how quickly your blood clots. Point of care diagnostics are distributing the ability to figure out what’s gone wrong too a much larger population of people who can then act on that without the advise or direction of the experts in the middle.
Business strategist Clayton Christensen argues that nurse practitioners and retail health outlets should have increased authority in treating patients.
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A new episode of "Your Brain on Money" illuminates the strange world of consumer behavior and explores how brands can wreak havoc on our ability to make rational decisions.
- Effective branding can not only change how you feel about a company, it can actually change how your brain is wired.
- Our new series "Your Brain on Money," created in partnership with Million Stories, recently explored the surprising ways brands can affect our behavior.
- Brands aren't going away. But you can make smarter decisions by slowing down and asking yourself why you're making a particular purchase.
How Apple and Nike have branded your brain | Your Brain on Money | Big Think youtu.be
Brands can manipulate our brains in surprisingly profound ways. They can change how we conceptualize ourselves and how we broadcast our identities out to the social world. They can make us feel emotions that have nothing to do with the functions of their products. And they can even sort us into tribes.
To grasp the power of brands, look to Apple. In the 1990s, the company was struggling to compete with Microsoft over the personal computer market. Despite flirting with bankruptcy in the mid-1990s, Apple turned itself around to eventually become the most valuable company in the world.
That early-stage success wasn't due to superior products.
"People talk about technology, but Apple was a marketing company," John Sculley, a former Apple marketing executive, told The Guardian in 1997. "It was the marketing company of the decade."
So, how exactly does branding make people willing to wait hours in line to buy a $1,000 smartphone, or pay exorbitant prices for a pair of sneakers?
Branding and the brain
For more than a century, brands have capitalized on the fact that effective marketing is much more than simply touting the merits of a product. Some ads have nothing to do with the product at all. In 1871, for example, Pearl Tobacco started advertising their cigarettes through branded posters and trading cards that featured exposed women, a trend that continues to this day.
It's crude, sure. But research shows that it's also remarkably effective, even on monkeys. Why? The answer seems to center on how our brains pay special attention to information from the social world.
"In theory, ads that associate sex or status with specific brands or products activate the brain mechanisms that prioritize social information, and turning on this switch may bias us toward the product," wrote neuroscience professor Michael Platt for Scientific American.
Brands can burrow themselves deep into our subconscious. Through ad campaigns, brands can form a web of associations and memories in our brains. When these connections are robust and positive, it can change our behavior, nudging us to make "no-brainer" purchases when we encounter the brand at the store.
It's a marketing principle that's related to the work of Daniel Kahneman, a psychologist and economist who won the 2002 Nobel Memorial Prize in Economic Sciences. In his book "Thinking Fast and Slow", Kahneman separates thinking into two broad categories, or systems:
- System 1 is fast and automatic, requiring little effort or voluntary control.
- System 2 is slow and requires subjective deliberation and logic.
Brands that tap into "system 1" are likely to dominate the competition. After all, it's far easier for us as consumers to automatically reach for a familiar brand than it is to analyze all of the available information and make an informed choice. Still, the most successful brands can have an even deeper impact on our psychology, one that causes us to conceptualize them as something like a family member.
A peculiar relationship with brands
Apple has one of the most loyal customer bases in the world, with its brand loyalty hitting an all-time high earlier this year, according to a SellCell survey of more than 5,000 U.S.-based smartphone users.
Qualitatively, how does that loyalty compare to Samsung users? To find out, Platt and his team conducted a study in which functional magnetic resonance imaging scanned the brains of Samsung and Apple users as they viewed positive, negative, and neutral news about each company. The results revealed stark differences between the two groups, as Platt wrote in "The Leader's Brain":
"Apple users showed empathy for their own brand: The reward-related areas of the brain were activated by good news about Apple, and the pain and negative feeling parts of the brain were activated by bad news. They were neutral about any kind of Samsung news. This is exactly what we see when people empathize with other people—particularly their family and friends—but don't feel the joy and pain of people they don't know."
Meanwhile, Samsung users didn't show any significant pain- or pleasure-related brain activity when they saw good or bad news about the company.
"Interestingly, though, the pain areas were activated by good news about Apple, and the reward areas were activated by bad news about the rival company—some serious schadenfreude, or "reverse empathy," Platt wrote.
The results suggest a fundamental difference between the brands: Apple has formed strong emotional and social connections with consumers, Samsung has not.
Brands and the self
Does having a strong connection with a brand justify paying higher prices for their products? Maybe. You could have a strong connection with Apple or Nike and simultaneously think the quality of their products justifies the price.
But beyond product quality lies identity. People have long used objects and clothing to express themselves and signal their affiliation with groups. From prehistoric seashell jewelry to Air Jordans, the things people wear and associate with signal a lot of information about how they conceptualize themselves.
Since the 1950s, researchers have examined the relationship between self-image and brand preferences. This body of research has generally found that consumers tend to prefer brands whose products fit well with their self-image, a concept known as self-image congruity.
By choosing brands that don't disrupt their self-image, consumers are able not only to express themselves personally, but also broadcast a specific version of themselves into the social world. That might sound self-involved. But on the other hand, humans are social creatures who use information from the social world to make decisions, so it's virtually impossible for us not to make inferences about people based on how they present themselves.
Americus Reed II, a marketing professor at the University of Pennsylvania, told Big Think:
"When I make choices about different brands, I'm choosing to create an identity. When I put that shirt on, when I put that shirt on — those jeans, that hat — someone is going to form an impression about what I'm about. So, if I'm choosing Nike over Under Armour, I'm choosing a kind of different way to express affiliation with sport. The Nike thing is about performance. The Under Armour thing is about the underdog. I have to choose which of these different conceptual pathways is most consistent with where I am in my life."
Making smarter decisions
Brands may have some power over us when we're facing a purchasing decision. So, considering brands aren't going away, what can we do to make better choices? The best strategy might be to slow down and try to avoid making "automatic" purchasing decisions that are characteristic of Kahneman's fast "system 1" mode of thinking.
"I think it's important to always pause and think a little bit about, "Okay, why am I buying this product?" Platt said.
As for getting out of the brand game altogether? Good luck.
"I've heard lots of people push back and say, "I'm not into brands,"" Reed II said. "I take a very different view. In some senses, they're not doing anything different than what someone who affiliates with a brand is doing. They have a brand. It's just an anti-brand brand."
Powerful branding can not only change how you feel about a company, it can actually change how your brain is wired.
- Powerful branding can not only change how you feel about a company, it can actually change how your brain is wired.
- "We love to think of ourselves as rational. That's not how it works," says UPenn professor Americus Reed II about our habits (both conscious and subconscious) of paying more for items based primarily on the brand name. Effective marketing causes the consumer to link brands like Apple and Nike with their own identity, and that strong attachment goes deeper than receipts.
- Using MRI, professor and neuroscientist Michael Platt and his team were able to see this at play. When reacting to good or bad news about the brand, Samsung users didn't have positive or negative brain responses, yet they did have "reverse empathy" for bad news about Apple. Meanwhile, Apple users showed a "brain empathy response for Apple that was exactly what you'd see in the way you would respond to somebody in your family."
A global survey shows the majority of countries favor Android over iPhone.
- When Android was launched soon after Apple's own iPhone, Steve Jobs threatened to "destroy" it.
- Ever since, and across the world, the rivalry between both systems has animated users.
- Now the results are in: worldwide, consumers clearly prefer one side — and it's not Steve Jobs'.
A woman on her phone in Havana, Cuba. Mobile phones have become ubiquitous the world over — and so has the divide between Android and iPhone users.Credit: Yamil Lage / AFP via Getty Images.
Us versus them: it's the archetypal binary. It makes the world understandable by dividing it into two competing halves: labor against capital, West against East, men against women.
These maps are the first to show the dividing lines between one of the world's more recent binaries: Android vs. Apple. Published by Electronics Hub, they are based on a qualitative analysis of almost 350,000 tweets worldwide that presented positive, neutral, and negative attitudes toward Android and/or Apple.
Steve Jobs wanted to go "thermonuclear"
Feelings between Android and Apple were pretty tribal from the get-go. It was Steve Jobs himself who said, when Google rolled out Android a mere ten months after Apple launched the iPhone, "I'm going to destroy Android, because it's a stolen product. I'm willing to go thermonuclear war on this."
Buying a phone is like picking a side in the eternal feud between the Hatfields and the McCoys. Each choice for automatically comes with an in-built arsenal of arguments against.
If you are an iPhone person, you appreciate the sleekness and simplicity of its design, and you are horrified by the confusing mess that is the Android operating system. If you are an Android aficionado, you pity the iPhone user, a captive of an overly expensive closed ecosystem, designed to extract money from its users.
Even without resorting to those extremes, many of us will recognize which side of the dividing line that we are on. Like the American Civil War, that line runs through families and groups of friends, but that would be a bit confusing to chart geographically. To un-muddle the information, these maps zoom out to state and country level.
If the contest is based on the number of countries, Android wins. In all, 74 of the 142 countries surveyed prefer Android (in green on the map). Only 65 favor Apple (colored grey). That's a 52/48 split, which may not sound like a decisive vote, but it was good enough for Boris Johnson to get Brexit done (after he got breakfast done, of course).
And yes, math-heads: 74 plus 65 is three short of 142. Belarus, Fiji, and Peru (in yellow on the map) could not decide which side to support in the Global Phone War.
What about the United States, home of both the Android and the iPhone? Another victory for the former, albeit a slightly narrower one: 30.16 percent of the tweets about Android were positive versus just 29.03 percent of the ones about Apple.
United States: Texas surrounded!
Credit: Electronics Hub
There can be only one winner per state, though, and that leads to this preponderance of Android logos. Frankly, it's a relief to see a map showing a visceral divide within the United States that is not the coasts versus the heartland.
- Apple dominates in 19 states: a solid Midwestern bloc, another of states surrounding Texas, the Dakotas and California, plus North Carolina, New Hampshire, and Rhode Island.
- And that's it. The other 32 are the United States of Android. You can drive from Seattle to Miami without straying into iPhone territory. But no stopovers in Dallas or Houston – both are behind enemy lines!
North America: strongly leaning toward Android
Credit: Electronics Hub
Only eight of North America's 21 countries surveyed fall into the Apple category.
- The U.S. and Canada lean Android, while Mexico goes for the iPhone.
- Central America is divided, but here too Android wins hands down, 5-2.
Europe: Big Five divided
Credit: Electronics Hub
In Europe, Apple wins, with 20 countries preferring the iPhone, 17 going for Android, and Belarus sitting on the fence.
- Of Western Europe's Big Five markets, three (UK, Germany, Spain) are pro-Android, and two (France, Italy) are pro-Apple.
- Czechia and Slovakia are an Apple island in the Android sea that is Central Europe. Glad to see there is still something the divorcees can agree on.
South America: almost even
Credit: Electronics Hub
In South America, the divide is almost even.
- Five countries prefer Android, four Apple, and one is undecided.
- In Peru, both Android- and Apple-related tweets were 25 percent positive.
Africa: watch out for Huawei
Credit: Electronics Hub
In Africa, Android wins by 17 countries versus Apple's 15.
- There's a solid Android bloc running from South Africa via DR Congo all the way to Ethiopia.
- iPhone countries are scattered throughout the north (Algeria), west (Guinea), east (Somalia), and south (Namibia).
Huawei — increasingly popular across the continent — could soon dramatically change the picture in Africa. Currently still running on Android, the Chinese phone manufacturer has just launched its own operating system, called Harmony.
Middle East: Iran vs. Saudi Arabia (again)
Credit: Electronics Hub
In the Middle East and Central Asia, Android wins 8 countries to Apple's 6.
- But it's complicated. One Turkish tweeter wondered how it is that iPhones seem more popular in the Asian half of Istanbul, while Android phones prevailed in the European part of the city.
- The phone divide matches up with the region's main geopolitical one: Iran prefers Android, Saudi Arabia the iPhone.
Asia-Pacific: Apple on the periphery
Credit: Electronics Hub
Another wafer-thin majority for Android in the Asia-Pacific region: 13 countries versus 12 for Apple — and one abstention (Fiji).
- The two giants of the Asian mainland, India and China, are both Android countries. Apple countries are on the periphery.
- And if India is Android, its rival Pakistan must be Apple. Same with North and South Korea.
Experts point to the fact that both operating systems are becoming more alike with every new generation as a potential resolution to the conflict. But as any student of human behavior will confirm: smaller differences will only exacerbate the rivalry between both camps.
Maps taken from Electronics Hub, reproduced with kind permission.
Strange Maps #1096
Got a strange map? Let me know at email@example.com.
Evolution proves to be just about as ingenious as Nikola Tesla
- For the first time, scientists developed 3D scans of shark intestines to learn how they digest what they eat.
- The scans reveal an intestinal structure that looks awfully familiar — it looks like a Tesla valve.
- The structure may allow sharks to better survive long breaks between feasts.
Considering how much sharks are feared by humans, it is a bit of a surprise that scientists don't know much about the predators. For example, until recently, sharks were thought to be solitary creatures searching the seas for food on their own. Now it appears that some sharks are quite social.
Another mystery is how these prehistoric swimming and eating machines digest food. Although scientists have made 2D sketches of captured sharks' digestive systems based on dissections, there is a limit to what can be learned in this way. Professor Adam Summers at University of Washington's Friday Harbor Labs says:
"Intestines are so complex, with so many overlapping layers, that dissection destroys the context and connectivity of the tissue. It would be like trying to understand what was reported in a newspaper by taking scissors to a rolled-up copy. The story just won't hang together."
Summers is co-author of a new study that has produced the first 3D scans of a shark's intestines, which turns out to have a strange, corkscrew structure. What's even more bizarre is that it resembles the amazing one-way valve designed by inventor Nikola Tesla in 1920. The research is published in the journal Proceedings of the Royal Society B.
What a 3D model reveals
Video: Pacific spiny dogfish intestine youtu.be
According to the study's lead author Samantha Leigh, "It's high time that some modern technology was used to look at these really amazing spiral intestines of sharks. We developed a new method to digitally scan these tissues and now can look at the soft tissues in such great detail without having to slice into them."
"CT scanning is one of the only ways to understand the shape of shark intestines in three dimensions," adds Summers. The researchers scanned the intestines of nearly three dozen different shark species.
It is believed that sharks go for extended periods — days or even weeks — between big meals. The scans reveal that food passes slowly through the intestine, affording sharks' digestive system the time to fully extract its nutrient value. The researchers hypothesize that such a slow digestive process may also require less energy.
It could be that this slow digestion is more susceptible to back flow given that the momentum of digested food through the tract must be minimal. Perhaps that is why sharks evolved something so similar to a Tesla valve.
What is Tesla's valve doing there?
Above, a Tesla valve. Below, a shark intestine.Credit: Samantha Leigh / California State University, Domi
Tesla's "valvular conduit," or what the world now calls a "Tesla valve," is a one-way valve with no moving parts. Its brilliance is based in fluid dynamics and only now coming to be fully appreciated. Essentially, a series of teardrop-shaped loops arranged along the length of the valve allow water to flow easily in one direction but not in the other. Modern tests reveal that at low flow rates, water can travel through the valve either way, but at high flow rates, the design kicks in. According to mathematician Leif Ristroph:
"Crucially, this turn-on comes with the generation of turbulent flows in the reverse direction, which 'plug' the pipe with vortices and disrupting currents. Moreover, the turbulence appears at far lower flow rates than have ever previously been observed for pipes of more standard shapes — up to 20 times lower speed than conventional turbulence in a cylindrical pipe or tube. This shows the power it has to control flows, which could be used in many applications."
A deeper dive
Summers suggests the scans are just the beginning. "The vast majority of shark species, and the majority of their physiology, are completely unknown," says Summers, adding that "every single natural history observation, internal visualization, and anatomical investigation shows us things we could not have guessed at."
To this end, the researchers plan to use 3D printing to produce models through which they can observe the behavior of different substances passing through them — after all, sharks typically eat fish, invertebrates, mammals, and seagrass. They also plan to explore with engineers ways in which the shark intestine design could be used industrially, perhaps for the treatment of wastewater or for filtering microplastics.
It could fairly be said, though, that Nikola Tesla was 100 years ahead of them.