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Orthopedic and Dental Industry News Complete Archive »

The Cleveland Clinic Discusses Innovation BY JOHN MCCORMICK, NOVEMBER 9, 2006

This week we attended the Cleveland Clinic Medical Innovation Summit where industry luminaries gathered to discuss the future of medicine. The predominant themes were economics and advanced neurosciences. Notably, the ultimate form of evidence based medicine was highlighted: an elated Parkinsons patient whose tremors were switched on and off at will via a deep brain stimulation implant system no bigger than an iPod. An audience of senior executives, politicians and surgeons thundered in applause when Cheryl, a longtime victim of this debilitating disease, could write her name flawlessly after years of being incapacitated. Not a dry eye was in the house.

Despite the neuro focus and high brow attendees, much was to be gleaned for the ortho community especially on the topic of innovation and economics. Celebrity futurist and scientist , Ray Kurzweil, kicked off the discussions with his famous singularity framework that describes the mysterious power of exponential growth in technology innovations. The essence of the singularity phenomenon is simple: there is an observable extension of Moore's law across a range of technologies which will ultimately cause a convergence. Imagine telepathically surfing the web via nano robots embedded in your brain. Medicine will will surely play a part in the singularity.

Medical innovation following the exponential thrust of Moore's law sounds magnificent, but we found a conundrum on this point. Sure enough, a $300 iPod of today can now hold 80GB (25 movies) versus the $300 iPod of 2002 which could hold about 8GB (barely 2 movies). But why has the $3,000 orthopedic implant of today not improved clinical outcomes by a factor of 10 in only four years - let alone improve at all? Why are medical costs in the US expected to double to $4 trillion by 2015 with only a marginal improvement in life expectancy?

Differentiating the supply and demand factors of innovation may shed light on this riddle. The supply side of medical innovation may well have the potential to achieve exponential improvements of the kind Kurzweil is alluding to. Notice the rapid innovation occuring from Dr. Gary Michelson's garage to R&D labs at biololgics companies to the unexpected ahead-of-schedule completion of the genome project.

We think constraints to exponential innovation are more likely exist more at the demand side of the equation. We found the conference confirmatory on this point. Seeing executive after executive from the insurance industry bemoaning medical costs inflation led us to believe that this is the case. Such demand constraints to innovation may include:
- Poor information technology resources at the provider level
- Regional cost disparities leading to ineffecient allocation of resources
- Lack of benchmarks that accurately measure quality of care
- Lengthy FDA approval processes
- Statistical control bias associated with evidence based medicine
- Poor patient compliance
- Adverse selection in insurance markets
- Many others

Demand for computing power and lack of regulation has allowed the supply side to deliver astounding improvements over a relatively short period of time. Likewise, major medical technology breakthroughs such as artificial red blood cells that could allow you to swim underwater for extended periods are being developed today. Whether or not these reach the market is determined by patient demand, efficient provider deployment and reasonableness among regulators, however. Let's hope we don't have to hold our breath for serious improvements on the demand side to take hold.

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