Austin Walters's Profile

I’ve mostly been commenting on healthcare MCIs, but just read a newly published article from a former professor of mine who studies the political economy of Germany. His piece has fascinating overlap with the Capitalist’s Dilemma in that it clarifies the risks of a capital-hoarding nation (like Germany) to both the domestic and international liberal economic order. Well-worth studying: http://www.transatlanticacademy.org/publications/surplus-germany . I am happy to connect you with him; his input would be invaluable.

Glad you enjoyed the article as much as I did. Re: FDA reform, I’m certain that their approval processes could improve in ways that would better facilitate disruptive innovations. To give them a fair shake, they are bringing in new talent and leadership that just a few years ago introduced a new approval process for “Mobile Medical Applications” (things like wearables and apps to help manage chronic conditions), and here are the guidelines they released about their expedited approval process for such technologies:
https://www.fda.gov/downloads/MedicalDevices/…/UCM263366.pdf

I think it does, Farsh. In BSSE we talk about how culture arises from repeating the same thoughts, practices, rituals again and again with some success. Western medicine has been remarkably successful by certain measures, and the FDA for all its problems is still considered the regulatory gold standard internationally. The protocols and algorithms of medicine have been developed over many, many years and medicine is an apprenticeship system that’s conservative because of the difficulty of mastering these protocols and algorithms, as well as the underlying science. The bio-ethics you mention are also conservative for a host of reasons.

This all sets up a high bar for disruptive innovations to succeed, but many are. Medical wearables are a good example. Omada health for diabetes care is another. Telemedicine is another. Most of these innovations are taking hold in diagnostics at primary care as Clay predicted in The Innovators Solution. A recent article by Atul Gawande highlights an effort by one of the incumbents (a neurosurgeon) to plead for a change of culture to accept, reward, and elevate primary care in American medical culture: http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care . I think there are many more clues in the article about how traditional U.S. medical culture can contribute to failure to commercialize disruptive technologies.

But the two biggest factors I’d point to in answer to your questions are CMS fee-for-service reimbursement, and the FDA regulatory approval process. The first skews incentives towards traditional protocols with codes for reimbursement, and the second sets a high financial hurdle for even entering the market even before a company has found product-market fit.

I believe that many of the ‘base of the pyramid’ healthcare innovators in India are introducing a number of market-creating innovations by radically expanding the accessibility of medicine relative to Western MNCs. Recently minted billionaires like Kiren Mazumdar-Shaw are introducing ‘appropriate technology’ that’s both disruptive and market-creating. There are several more nascent examples like those listed here: http://www.globalhealth.care/p/running-list-of.html . The Swasthya Slate holds promise, as does Jana Care. Jaipur Foot has already succeeded in creating a large national industry at least. Companies like Medtronic and GE do create MCIs through their India-based divisions, e.g. Micra TPS and Vscan ultrasound, respectively, but they fail to commercialize these technologies disruptively on a global scale for reasons of the Capitalist’s Dilemma. Sussing this out in interviews w/ them could be fruitful.