After last Thanksgiving, the US Centers for Disease Control reported that US life expectancy declined again in 2017, after falling in 2015. The last time the US experienced a two-year decline in life expectancy was during the early 1960’s, before Medicare and Medicaid, and before much of modern medicine! The last three-year decline was a century ago- a result of the Spanish flu epidemic in the aftermath of World War I. Spread over a population of 327 million, the drop of 0.3 years in American life expectancy since 2014 represents a loss of almost 100 million life years! For a country with a nearly $20 trillion economy and that is spending more than $3.5 trillion annually on healthcare, this is both a disgrace and an international embarrassment.
Health analysts pointed to the epidemic of drug deaths as the principal cause. (And it wasn’t just opiates that did the damage; more than 24 thousand of the more than 70 thousand overdose deaths in 2017 were from methamphetamine and cocaine, problems that many lay observers may believe we put in the rear-view mirror years ago). Suicides claimed 47 thousand Americans in 2017, a 33% increase since the turn of the millennium! So between suicides and drug overdoses, which are really a form of suicide, American lost 117 thousand people in 2017.
Clayton Christensen/World Economic Forum via Wikimedia Commons
Clayton Christiansen’s 1997 classic Innovators Dilemma explored how established businesses are blindsided by lower cost competitors that undermine their core products, and eventually destroy their businesses. Classic examples of disruption are the displacement of film-based cameras by digital cameras and, now, cell phones, the destruction of retail shopping by Amazon and of video rental outlets by streaming video services.
Because of the anxiety it generated, Christiansen’s disruption thesis has dominated corporate strategy ever since. However, I believe this notion of “disruptive innovation, twenty years on, has reached its “sell-by” date, at least in healthcare, and is now doing more harm than good.
The healthcare version of the disruption thesis was found in Christiansen’s “Innovator’s Prescription”, written with health industry maverick Dr. Jerome Grossman, in 2009. Christiansen and Grossman forecast that innovations such as point-of-care testing, retail clinics and special purpose surgical hospitals threatened to take down healthcare incumbents- physicians and hospitals.
This book gave rise to a swarm of breathless healthcare disruption forecasts. Eric Topol predicted that the cell phone and a swarm of diagnostic apps would shortly replace the physician as the patient’s principal source of diagnostic wisdom. Vinod Khosla said that 80% of physicians would be replaced by AI.