The response was generally that if the discoverer can't get their innovation brought forward on their own, despite their personal shortcomings, scarcity of early non-academic funding or the institutional resistance to change in the field of medicine, then maybe it will come around again and be rediscovered in the future. This is actually congruent with history in which medical advances which have been initially rejected or failed to gain traction eventually were rediscovered and brought into conventional practice. For example, the breakthrough in understanding that Heliobacter pylori caused most gastric ulcers and could be cured by antibiotics led Barry Marshall and J. Robin Warren to a Nobel Prize in 2005 and revolutionized how we diagnose and treat gastric ulcers. Their discovery was preceeded by a Greek physician, John Lykoudis, more than 25 years earlier, who successfully treated his own gastroenteritis with antibiotics in 1958 and received a Greek patent in 1960. He subsequently treated an estimated 30,000 Greeks with antibiotics, curing their ulcers. His attempts to publish his findings in JAMA were rejected and he was fined by Greek medical authorities in 1968 for malpractice. But his discovery eventually arose again.
The status quo seems to be a natural selection model of medical innovation in which breakthroughs may be extinguished for many different reasons but if the niche (need) is still open, other versions of solutions will arise again and may become established in the right circumstances.
The right circumstances very often depend on who is originating or representing the idea. Coming from a well-recognized lab like Bob Langer's at MIT almost assures support, attention, funding and acceptance. Many of the most recognizable institutions like Stanford have numerous startup programs. I participate in two at Stanford, SPARK sponsored by the Medical School and iFARM sponsored by the Office of Technology Licensing, and there are many more like StartX that are very well known. This past week, Obama even participated in a Global Entrepreneurship Summit at Stanford. Bright shiny Institutions like these produce the bright shiny objects pursued by investors and companies alike. But other innovations are overlooked.
Bright shiny objects pursued by everyone are not necessarily the problem, but our inability to discover or, perhaps more painful, readiness to discard the diamonds in the rough. The status quo and the quest for perfect vehicles for investment drive decisions costs lives. To say we will wait until they come around again is to postpone a cure for sepsis or Alzheimer’s or drug resistant infectious diseases, keep sticking people with needles and catheters to get drugs through the skin, and replace lost tissues or organs only with ones harvested from others requiring immunosuppression and accepting a high failure rate. Each year we postpone a sepsis breakthrough, 8 million people die worldwide.
Breakthroughs are out there – the repurposed drug that might cure sepsis, the plant-based artificial skin that costs a fraction of the current products, the drug delivery device that cures MRSA and necrotizing fasciitis infections in 5 minutes, the sensor that measures IV drugs in real time to catch mistakes, the simple cap to cover and sterilize IV ports and prevent infections. What is missing? For many it is polishing and cutting the diamond to make it sparkle. For others, the breakthrough is still buried in the soil of inexperience or conflict that hides the potential. If the originator knows how to polish and cut, then she can make it a bright shiny object. But if the entrepreneur is new to the game and does not have the resources to do the initial trial, engage the regulatory specialists, file the broad IP and recruit a “world class” team, all without outside capital, and the talent to create a business vision with a quick return for investors, then there will be no polish, no shine, and no funding. And I understand more than most how entrepreneurs can be their own worst enemy. But isn’t it worth giving some of these diamonds in the rough the attention they need to shine? Don’t our patients deserve it?