3rd August 2015, 4 min read

Coping with accelerating progress: no more five-year plan

Today, the life expectancy of a corporation is about 15 years. Though corporations die for many reasons, technology and innovation are often the driving force underneath the death of a previously powerful company.

Amazon.com, a silly web site, has recently surpassed in value the largest private employer in the world: Walmart. Yet Walmart is, itself, a relatively recent giant. Though it currently employs about 1% of the US workforce, back 45 years ago, it barely existed.

An accelerating progress means that we have to adapt faster and faster. The pressure felt by individuals and organizations can be tremendous because plans fall apart along with the rushing technological progress.

Scott Gottlieb is a physician and held a prestigious position at the FDA. He observes that much of the same is happening in medicine. For example, one of the big step forward in medicine was the germ theory, finally established by Pasteur (1860). This greatly improved life expectancy and saved countless lives… but the time from the first theories to the application was enormous… Eventually, we got penicillin (1928). You could safely go a lifetime without major progress in medicine.

Back when I was a kid, organ transplants where viewed critically. I remember one family member pointing that we should let these poor folks die instead of creating unnecessary suffering. Today, kidney transplants are common place. Many transplant recipients enjoy normal lifespans.

If that would be all, that would be shattering enough. But I saw countless advances: vaccines against pneumonia, hepatitis A and B and meningitis, the eradication of the smallpox, test-tube babies, the first “complete” human genome, the creation of stem cells from skin cells, and so on.

According to Gottlieb, there are 400 ongoing gene therapy clinical trials going on right now. Yet, before 1990, the very concept of “gene therapy” would have sounded like a work of science-fiction.

Recently, it was announced that we may have a definitive vaccine against the Ebola virus. What people do not realize is that such vaccines are remarkable technological feats in themselves… they are the result of genetic engineering that would have been unthinkable decades ago.

Why is a rapidly advancing medicine a problem? For one thing, it is an actuarial issue. Bureaucrats like to know ahead of time how many people will suffer from such or such disease, and what the treatments will cost.

Though it is sad to see someone slowing rotting away from a crippling disease, it is easy to manage financially. And there are no hard decisions to take since you have no option.

But once new, possibly revolutionary treatments, can come every five years or faster, how do you draft the next five-year plan? You can’t. Or rather, you do but then soon look like a fool.

The sad thing is that people never learn.

Let me pull out some juicy quotes about Ebola from very recently.

Here is what we could read in the National Geographic about Ebola less than a year ago…

Without any approved drugs, current Ebola treatment consists mainly of so-called supportive therapy, in which the patient is kept hydrated and symptoms including fever and other illnesses, like malaria, are treated.

(…)

Some public health officials debate whether it would even have been ethical to spend time and money on Ebola when so many other diseases claim more lives.

Here is what Naomi Shavin wrote even more recently:

The companies and other individual and government investors have poured over $300 million into the race for a vaccine, and the high-stakes competition has elicited ample media coverage. But all of the buzz around—and the money being invested in—finding an Ebola vaccine is distracting us from an urgently needed medical innovation that’s proven highly effective against a range of diseases, and is much easier to achieve: basic, around-the-clock nursing care.

$300 million, and we have a vaccine that will probably contribute greatly to eradicate Ebola… I’d call it money well spent. It is a terrible and crippling disease. Even if good nursing care could ensure you survive, it is quite clear that you do not want to catch Ebola. The vaccine will be off patent by 2023 and probably dirt cheap afterward. So we inherit lasting benefits.

Here is what human beings like to do:

• We have this crippling condition. We have been researching a solution for quite some time and we have made no progress. Surely, this means we will probably never make any worthwhile progress.
• Let us organize good care and do the best we can using existing technology. Maybe we will lose 10% or 50% or 100% of the patients, but that is all we can do.- Look at these crazy people who hope to find a “cure”. What a waste. Even if they find a cure, it is going to be tremendously expensive. And they won’t find a cure. Not in my lifetime.

This heuristic worked very well up till about 30 years ago. It is now obsolete. Simply put, you should never plan on the specific problem you face to be still around in the same shape five years in the future. You should expect a disruption every 15 years.