For people starting out in their careers or contemplating a mid-career change, an honest conversation with a mentor can make a big difference. Mentoring seems to have gone out of fashion in a tech-driven world where nearly instantaneous feedback from wide networks of “friends’ seems to have taken the place of confidential conversation with older people. But reflecting on my own career, I can say with certainty that mentors made a huge difference. And I was lucky enough to have three of them, at different stages of my career. I am grateful to them for helping me navigate in a changing world.
As an undergraduate at Reed College in the late 1960’s, I became interested in social science research, specifically how institutions selected out types of people by their personalities and interests. While my academic work focused on classics and psychology, a research project on Reed’s brutal attrition rate (only a little more than a third of people who entered Reed as freshmen graduated in four years) that sought out the selection factors that predicted “success”, at least surviving the four years of a very intense undergraduate experience.
This work brought me in contact with Professor David Riesman at Harvard, whose 1954 book “The Lonely Crowd” made him a leading public intellectual and social critic (and landed him on the cover of Time). “Lonely Crowd” decried the erosion of individualism and the rise of the “other directed” personality in America. This work eerily presaged (by a mere fifty years) today’s obsessive internet-driven hunger for the approval of strangers. Reisman, who was then in his early 60’s, had come to Harvard, and had become a leading sociologist of higher education. I sent him my Reed research to see what he thought, and the correspondence led to a friendship that stretched over the next thirty years.
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.