Innovation in Medicine – It’s About Time

• Aging
• Curing Alzheimer's

Everyone favors innovation and diversity, as long as you’re not innovative or diverse. This remark, snarky as it is, is also (heartbreakingly) accurate. We argue that we support innovation, but we fight to prevent innovative concepts or industries. The more innovative an idea, the more we actively resist, regulate, and revolt against that idea. Diversity too, is something we favor only in small doses, despite naïve protestations to the contrary.

It’s not really surprising. If I have devoted my entire life to perfecting the best possible leather equipage for a horse-and-buggy, then my idea of innovation is better quality leather, and I actively disparage the idea of a horseless carriage with its internal combustion engine. In the 16th century, prior to Copernicus, most astronomers favored “innovation” by looking for more precise epicycles in their models of a geocentric universe. In the last years of the 19th century, prior to relatively and quantum theory, most physicists favored innovation in making ever more precise measurements of the universe of classical physics.

Much the same could be said of medicine. In medieval Europe, the physician’s view of innovation in treating and preventing bubonic plague was to find just the right flowers and herbs. Innovation consisted of finding more highly scented plants, not in finding a vaccine. In revolutionary America, the physician’s view of innovation lay in tweaking the process of blood-letting to get just the right amount of blood loss and at just the right time. So much for medical innovation.

Yet there have been successes. If Salk hadn’t found a truly innovative approach to preventing polio in 1954, we would still be working on “innovative” approaches to better iron lungs, stronger leg braces, more effective rehabilitation exercises and other sub-optimal approaches to polio. Despite some successes in medical history – sterile surgical procedures, antibiotics, better hygiene, and vaccines all come to mind – we still aren’t particularly innovative. The FDA, for example, routinely turns down two thirds of all applications for “breakthrough therapy” on the grounds that the proposed therapy isn’t even vaguely innovative, let alone effective. Yet we continue to push a “new” statin, a “better” artificial joint, or a “more successful” heart transplant approach as being innovative, which they are not. We even see medical journals touting cost-saving methods as being “innovative”. Useful, safer, faster, or cheaper perhaps, but they are only incremental, certainly not innovative.

To actually prevent and reverse age-related disease would be innovative. It is also feasible, yet many physicians and researchers – despite protestations of how innovative they are in finding a more potent pain reliever, a statin with fewer side effects, a cheaper biphosphonate, or a more predictive gene for an age-related disease – still can’t quite bring themselves to be innovative or to think innovatively. To be innovative requires that – like Copernicus, Einstein, or a diverse group of innovators – we step back, we examine our assumptions, and, while looking at the same data that others are looking at, we see things that no one else has seen.

Innovation requires us to see the world as it is, not merely as everyone thinks it is.