The Sunday Times featured an op-ed by Mark Britnell, a professor at the UCL Global Business School for Health, with the headline Our creaking NHS can’t beat its admin chaos without a tech revolutionSubstitute “U.S. healthcare system” for “NHS” and the headline still would work, as would most of the content.
I wouldn’t hold my breath about that tech revolution. In fact, if you’re waiting for disruptive innovation in healthcare, or more generally, you may be in for a long wait.
A new study in Nature argues that science is becoming less disruptive. That seems counterintuitive; it often feels like we’re living in a golden age of scientific discoveries and technological innovations. But the authors are firm in their finding: “we report a marked decline in disruptive science and technology over time.”
The authors looked at data from 45 million scientific papers and 3.9 million patents, going back six decades. Their primary method of analysis is something called a CD Index, which looks at how papers influence subsequent citations. Essentially, the more disruptive, the more the paper itself is cited, rather than previous work.
The results are surprising, and disturbing. “Across fields, we find that science and technology are becoming less disruptive,” the authors found, “…relative to earlier eras, recent papers and patents do less to push science and technology in new directions.” The declines appeared in all the fields studied (life sciences and biomedicine, physical sciences, technology, and social sciences), although rates of decline varied slightly.
The authors also looked at how language changed, such as introduction of new words and use of words that connote creation or discovery versus words like “improve” or “enhance.” The results were consistent with the CD Index results.
“Overall,” they say, “our results suggest that slowing rates of disruption may reflect a fundamental shift in the nature of science and technology.”
“The data suggest something is changing,” co-author Russell Funk, a sociologist at the University of Minnesota in Minneapolis, told Nature. “You don’t have quite the same intensity of breakthrough discoveries you once had.”
It’s not all bad news, though. The absolute number of highly disruptive works was surprisingly consistent over time, but they make up decreasing percentage of all papers. Fortunately, “declining aggregate disruptiveness does not preclude individual highly disruptive works.”
“A healthy scientific ecosystem is one where there’s a mix of disruptive discoveries and consolidating improvements, but the nature of research is shifting,” Professor Funk said. “With incremental innovations being more common, it may take longer to make those key breakthroughs that push science forward more dramatically.”
The authors speculated about a couple possible factors for the decline. One is that many researchers face “publish or persist” incentives that reward volume over innovation. “A lot of innovation comes from trying new things or taking ideas from different fields and seeing what happens,” co-author Michael Park said. “But if you are worried about publishing paper after paper as quickly as you can, that leaves a lot less time to read deeply and to think about some of the big problems that might lead to these disruptive breakthroughs.”
A second contributor could be a narrowing of scope. Papers were less likely to cite a wide diversity of sources, were more likely to cite the paper’s authors instead of papers by other authors, and tended to cite older works, “suggesting that scientists and inventors may be struggling to keep up with the pace of knowledge expansion and instead relying on older, familiar work.” In any event: “All three indicators point to a consistent story: a narrower scope of existing knowledge is informing contemporary discovery and invention.”
Reliance on large research teams has also been cited as a culprit for the switch towards incremental change over disruption; a 2019 paper by Wang, et. alia warned “large teams develop and small teams disrupt.”
“A healthy ecosystem of science and technology is likely to require a balance of different types of contributions,” Professor Funk told Physics World. “The dramatic declines that we observe in disruptive work suggests that this balance may be off, and that encouraging more disruptive work could help to push scientific understanding forward.”
The research makes me think about a recent article in MIT Technology Review by Shannon Vallor: We used to get excited about technology. What happened?“The goal of consumer tech development used to be pretty simple: design and build something of value to people, giving them a reason to buy it,” Professor Vallor laments, “whereas now it is about designing “a product that will extract a monetizable data stream from every buyer.”
“The fact is, the visible focus of tech culture is no longer on expanding the frontiers of humane innovation—innovation that serves us all,” she worries. “Engineering and inventing were once professions primarily oriented toward creating more livable infrastructure, rather than disposable stuff.” Now, she fears, it is all about “Take the money and run.”
Healthcare needs a tech revolution, as Professor Britnell calls for, and I would argue that it needs disruption at every level, and instead we’re getting incremental change instead. Professor Funk would not be surprised.
Last year I wrote We Love Innovation. Don’t We?,highlighting research suggesting that for all we say we value innovation and creativity, in practice they can be a threat. As one researcher noted: “Novel ideas have almost no upside for a middle manager — almost none, The goal of a middle manager is meeting metrics of an existing paradigm.”
Apparently, the same is true for most scientists as well.
Professor Vallor believes: “When it stays true to its deepest roots, technology is still driven by a moral impulse: the impulse to construct places, tools, and techniques that can help humans not only survive but flourish together.” There’s nowhere where that should be more true than in healthcare.
If there has been a common theme in my writing over the years, it has been that there are good ideas outside of healthcare that should be considered for it/applied to it. The new research from Professor Funk and colleagues confirms that disruptive ideas are out there; they just may not be in the expected field. “Relying on narrower slices of knowledge benefits individual careers,” the authors noted, “but not scientific progress more generally.”
Or progress generally. Disruption is hard. It’s risky. It won’t come from committees or consensus. But I’m more interested in ideas that jump us to a 22nd century healthcare system than ones that incrementally just take us another year from a 20th century one.
