A speech at Pisa University Summer School, about sustainability for innovation and basic research in a public healthcare system

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Academic vs
Health System Driven Research:
Overcoming Dichotomy through an Integrated Public System?

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We are talking about
A.Evolution
B.Discoveries
C.Innovation
D.Sustainability

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from evolution to sustainability

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A.Evolution
“Survival of the fittest”
Herbert Spencer
(27 April 1820 – 8 December 1903)
Principles of Biology (1864)

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A.Evolution from Darwin …
“better designed for an
immediate, local environment”
Carles Darwin
(12 February 1809 – 19 April 1882)
On the Origin of Species (edition 1869)

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A.Evolution … to Gould
“Our evolutionary colleagues
also failed to grasp the
implication(s), primarily
because they did not think at
geological scales”
Stephen Jay Gould
(10 September, 1941 – 20 May 2002)

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A.Evolution Punctuated Equilibrium

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A.Evolution
Evolution is inefficient

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Cambrian sea

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A.Evolution in culture
Rosvall and Bergstrom (2010) PLoS One 6:e18209

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A.Evolution of culture is quite lamarckian
1. Use and disuse – Individuals lose
characteristics they do not require and
develop characteristics that are useful
2. Inheritance of acquired traits – Individuals
inherit the traits of their ancestors
Jean-Baptiste Lamarck
(1 August 1744 – 18 December 1829)

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B.Discoveries

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B.Discoveries: Basic research needs contamination

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B.Discoveries
we can’t know the future in advance

15. Principi
Metodi
Strumenti www.leanuk.org
Conventional Workshop Examples
Through Time
"...so many centuries after the Creation it is unlikely that anyone could find hitherto unknown
lands of any value.”
Committee advising King Ferdinand and Queen Isabella of Spain regarding a proposal by
Christopher Columbus, 1486
"The view that the sun stands motionless at the center of the universe is foolish,
philosophically false, utterly heretical, because contrary to Holy Scripture. The view that the
earth is not the center of the universe and even has a daily rotation is philosophically false,
and at least an erroneous belief."
Holy Office, Roman Catholic Church, ridiculing the scientific analysis that the Earth orbited
the Sun in edict; 1616
"Everything that can be invented has been invented.”
Charles H. Duell, Commissioner, U.S. Office of Patents, 1899.
"Stocks have reached what looks like a permanently high plateau.”
Irving Fisher, Professor of Economics, Yale University, 1929. (two weeks later, the stock
market crashed and the Great Depression started)
"We don't like their sound, and guitar music is on the way out anyway.”
President of Decca Records, rejecting The Beatles after an audition, 1962
Copyright Lean Enterprise Academy 2009

16. Principi
Metodi
Strumenti www.leanuk.org
Conventional Workshop Examples:
Aviation
"Man will not fly for 50 years.”
Wilbur Wright, American aviation pioneer, to brother Orville, after a
disappointing flying experiment, 1901 (their first successful flight was in 1903)
"Airplanes are interesting toys but of no military value.”
Marechal Ferdinand Foch, Professor of Strategy, Ecole Superieure de Guerre,
1904(?)
"Flight by machines heavier than air is unpractical and insignificant, if not utterly
impossible.”
Simon Newcomb, Canadian-born American astronomer, 1902
"If God had intended that man should fly, he would have given him wings.”
Widely attributed to George W. Melville, chief engineer of the U.S. Navy, 1900
"It is apparent to me that the possibilities of the aeroplane, which two or three
years ago were thought to hold the solution to the [flying machine] problem,
have been exhausted, and that we must turn elsewhere.”
Thomas Edison, American inventor, 1895
"Heavier-than-air flying machines are impossible.”
Lord Kelvin, British mathematician and physicist, president of the British Royal
Society, 1895
Copyright Lean Enterprise Academy 2009

17. Principi
Metodi
Strumenti www.leanuk.org
Conventional Workshop Examples:
Computing
" 640k ought to be enough for anybody.”
Bill Gates, 1981
"There is no reason anyone would want a computer in their
home.”
Ken Olson, president, chairman and founder of Digital
Equipment Corp., 1977
"But what ... is it good for?“
Engineer at the Advanced Computing Systems Division of IBM,
1968, commenting on the microchip.
"I think there is a world market for maybe five computers.”
Thomas Watson, chairman of IBM, 1943
"Computers in the future may weigh no more than 1.5 tons.”
Popular Mechanics, "predicting" the relentless march of
technology, 1949
"The world potential market for copying machines is 5000 at
most.”
IBM , to the eventual founders of Xerox, saying the photocopier
had no market large enough to justify production, 1959Copyright Lean Enterprise Academy 2009

18. Principi
Metodi
Strumenti www.leanuk.org
Conventional Workshop Examples:
Telephone
"It's a great invention but who would want to use it anyway?"
Rutherford B. Hayes, U.S. President, after a demonstration of
Alexander Bell's telephone, 1872
"The Americans have need of the telephone, but we do not. We have
plenty of messenger boys.”
Sir William Preece, Chief Engineer, British Post Office, 1878
Transmission of documents via telephone wires is possible in principle,
but the apparatus required is so expensive that it will never become a
practical proposition.”
Dennis Gabor, British physicist and author of Inventing the Future,
1962
"A man has been arrested in New York for attempting to extort funds
from ignorant and superstitious people by exhibiting a device which he
says will convey the human voice any distance over metallic wires so
that it will be heard by the listener at the other end. He calls this
instrument a telephone. Well-informed people know that it is impossible
to transmit the human voice over wires.”
News item in a New York newspaper, 1868
"Well-informed people know it is impossible to transmit the voice over
wires and that were it possible to do so, the thing would be of no
practical value.”
Boston Post, 1865
Copyright Lean Enterprise Academy 2009

19. FG 2014
Human Genome Sequencing

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C.Innovation
we can’t know in advance which discovery will
lead to innovation

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innovation
novelty in action
12-12-12

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Garjón et al. BMC Health Services Research 2012

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C.Innovation
are new drugs actually innovative?
“me-too”!?

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C.Innovation

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C.Innovation

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C.Innovation

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C.Innovation

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C.Innovation
Innovation is expensive

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D.Sustainability
Is innovation sustainable?

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D.Sustainability
“closed systems that maintain processes of productivit
Melvin K. Hendrix, Sustainable Backyard Polyculture: Designing for ecological resiliency. Smashwords Edition, 2014

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D.Sustainability

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D.Sustainability
Public value allows us to consider the role of hospitals in meeting object
Public value thus goes beyond utilitarian objectives of outcomes and eff
The diverse ‘public’ values wider, ethical objectives like equity, due proc

36. FG 2014
Sustainability is
for the future
Innovation is expensive
We can’t know in advance which
discovery will lead to innovation
Evolution is inefficient

37. FG 2014
but...
evolution is ineludible,
simply we need it!