Wednesday, October 20, 2010

The Adjacent Possible

The title of this blog is inspired by Steven Johnson's Where Good Ideas Come From: The Natural History of Innovation In it, he describes Stuart Kauffman's concept of the adjacent possible. The concept represents all of the potential next steps that innovation could bring us to.

An example would be Apple computer's sale of cheap personal computers. Making inexpensive machines available to the masses vastly expanded the ability to explore the potential of computing in ways that massive mainframes, with their select group of highly trained experts, never could approach. Thousands of tinkerers and hackers eventually disrupted the mainframe industry because the innovative potential of many PC's, though inferior to the mainframes' capability, simply exploded throughout the adjacent possible.

Johnson is careful to point out that too much disruption can be deleterious to innovation. As Kauffman describes in his book At Home in the Universe: The Search for the Laws of Self-Organization and Complexity, the adjacent possible operates at the interface between the controlled and stable world of mainframes, and the wild and woolly world of hackers on cheap contraptions. The hackers themselves couldn't do it without monolithic centralized technological developments. The key here was Apple bringing the centralized expertise of the mainframe world into the hands of tinkerers.

I think this concept is formative for innovation in healthcare. What Apple did for decentralizing computing, the modern doctor can do for medicine. It is obviously a more delicate venture, given the sensitive issues at play. Nonetheless, these risks cannot be allowed to squelch the incredible opportunities of the adjacent possible within health.

I don't think it's fanciful to compare the changes of modern life brought about by decentralizing computers to the adjacent possible that can be realized by decentralizing medicine. Clayton Christensen, in his book The Innovator's Prescription, describes the process of decentralizing technology as inevitable. We need not travel to Carnegie Hall for music, to the telegraph operator for communication, or to the department store for retail, because we now retain such services in our pockets, cheaper and of superior quality. Will it be the case that we will not need to travel to a hospital or even outpatient clinic for imaging, chronic care, or minor surgeries?

I contend that today's medical students, having grown up amid today's powerful social tools, are uniquely suited to mediating a breakout of healthcare comparable in effect to the PC revolution.

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