Here’s to the Crazy Ones

Challenging the status quo in technology and medicine can take a heavy toll, but history has demonstrated that it often yields measurable benefits for both clinicians and patients.

By John Halamka, M.D., president, Mayo Clinic Platform, and Paul Cerrato, senior research analyst and communications specialist, Mayo Clinic Platform

On September 28, 1997, Apple aired its famous "Think Different" commercial, which started with: “Here’s to the crazy ones, the misfits, the troublemakers, the round pegs in square holes.”  The ad went on to praise unconventional thinkers willing to challenge the status quo and forge a path to innovative products and services. As the ad pointed out: They change things. In the history of technology and health care, that’s often been the case, as well.

Take, for example, Hungarian physician Ignaz Semmelweis, who in the 19th century discovered the cause of puerperal fever, which took the lives of many pregnant women who had been examined by physicians who had not disinfected their hands after working on cadavers. Semmelweis recommended they wash their hands with a chlorinated lime solution, which reduced mortality to less than 1%. Despite his success, his ideas were rejected by medical “experts” of his day. Many others have faced similar resistance.

Similarly, for decades the dominant wisdom stated that stomach ulcers were caused by stress, spicy food, and hyperacidity. When Australian doctors presented their evidence to show Helicobacter pylori also played an important role, they faced resistance from gastroenterologists who found it hard to believe that a microbe could cause ulcers. Barry Marshall, MBBS, one of the “crazy” thinkers who presented the data, commented: “That was my first experience of people being totally skeptical. To gastroenterologists, the concept of a germ causing ulcers was like saying that the Earth is flat. After that I realized my paper was going to have difficulty being accepted.”

That’s not to suggest that every innovation is routinely rejected by those in positions of authority. Jennifer Doudna and her colleagues developed CRISPR-Cas9, the genomic editing procedure that is slowly transforming the way certrain diseases are managed. Rather than being rejected, it garnered her and her associate the Nobel Prize in Chemistry. Similarly, the technologists at DeepMind have developed AlphaFold, which has revealed the complex 3 dimensional structure of virtually all proteins that are essential to life, a revolutionary development that is bound to have a profound impact on patient care and drug development for years to come. Rather than being ignored, they recently won the $3 million Breakthrough Prize for AI.

Despite these promising developments, health care still faces serious challenges, many of which are the result of outdated thinking and fear of upsetting the status quo. That’s where punctuated equilibrium comes into the picture. The notion is simple: for most of history, we see stasis or incremental change. Then a very significant event occurs that causes rapid change in a short time. This could be a meteor striking the earth, the invention of the internet, or a shift toward Platform thinking.

For 40 years, we've been working on interoperability. We've made gradual progress, but not breakthrough innovation. With Platform thinking and a distributed data network, suddenly Mayo Clinic Platform has removed the friction to discovery of new knowledge and enabled the creation of solutions that were previously impossible. The idea that we can quickly onboard a new collaborator instead of the industry standard of two years creates a burst of possibilities. The idea that we can add any new data producing organization to a distributed "data behind glass" model in six to nine months was once considered inconceivable. It’s now doable.

Mayo Clinic Platform is developing the strategy, structure, and staffing to quickly launch a variety of clinical and administrative solutions and products in a number of specialties, including radiology, gastroenterology, digital pathology, and oncology. Some might call us crazy to attempt these initiatives, which only reinforces the take home message at the end of that Apple commercial: “The people who are crazy enough to think they can change the world are the ones who do.”

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