Delivering healthcare to billions of the world’s poor

A review of Pharmacy on a Bicycle: Innovative Solutions for Global Health and Poverty, by Eric C. Bing and Marc J. Epstein

@@@@ (4 out of 5)

Despite the widespread conviction that the state of the world is deplorable and getting worse by the day, the human race has made measurable, even dramatic progress in some important ways. The collective state of our health is the most telling example. In part because of the eradication of smallpox, the near elimination of polio, and the significant recent progress on HIV/AIDS, humanity in general is living longer and healthier lives. Average life expectancy at birth in India around 1950 was 38 years; today it is 65. In China, it was 41; today it is 77. Over the same period, average life expectancy in the United States has risen from 65 to approximately 80. Numbers can be misleading, but these tell a compelling story.

Building on this amazing success story, major institutions — the United Nations, the U.S. Government, and the Bill and Melinda Gates Foundation, for example — have invested billions of dollars in recent years, targeting specific diseases, promoting the use of vaccines, and building public health infrastructure in developing nations. All these admirable efforts promise to continue the favorable trend in healthcare that has unfolded over the last half-century.

However, there is a hidden dimension in this picture. As Eric Bing and Marc Epstein explain in Pharmacy on a Bicycle, billions of poor people living in rural areas all too frequently fail to gain the benefit of these advances in healthcare. It’s fashionable to look on the world today from the perspective of the cities, but in spite of the massive migration of the last several decades, nearly half (49%) of the world’s population still resides in rural areas. Great numbers of these people live far from transportation hubs, often hours or even days of walking from the nearest road. It’s to these billions of people, nearly all of them desperately poor by American or European standards, that Bing and Epstein turn their attention in their illuminating little book.

Pharmacy on a Bicycle rests on a single, fundamental premise: “Most poor outcomes [in healthcare] are caused not by lack of effective medicines or medical know-how. The ability to prevent and treat many of these diseases inexpensively has been available for a very long time. But getting the right remedies to the right people in the locations where they are needed, in a way they will use them, and at a cost they can afford is continually a challenge. This is not a scientific problem. It’s a business challenge.”

Bing and Epstein argue that humankind has never before been in such a good position to meet this challenge. The costs of many widely-used drugs have fallen dramatically, and scientists have greatly simplified the treatment of many diseases by combining multiple drugs into single capsules or tablets. Extremely cheap diagnostic techniques that provide nearly instant assessments are now available. Through telemedicine, a single well-trained physician can now offer her or his expertise to much larger numbers of patients. The widespread use of clinical checklists and the application of franchising to the healthcare industry have both improved access and lowered costs. And new business models, successfully piloted in many countries, using bicycles, motorcycles, and trained village-level representatives, make it possible for healthcare agencies and for-profit companies to overcome the “last mile problem” that has traditionally limited most of the benefits of the market economy to population centers. “We are now at a tipping point to make lasting global health impacts,” the authors write.

One of the most promising recent developments is the now near-universal access to cell phones; by next year, the number of mobile phones is expected to be greater than the world’s population. “Mobile phones are now being used for patient education and awareness, treatment compliance, health care worker training, data collection, disease and epidemic outbreak tracking, and diagnostic and treatment support.”

Pharmacy on a Bicycle is intended to spark much wider adaptation of these advances by making them more widely known. The book presents a seven-point implementation model called IMPACTS, which encompasses innovation and entrepreneurship, maximizing efficiency and effectiveness, coordinating with partners, accountability, creating demand, task shifting (e.g., empowering nurses to take on some doctors’ responsibilities), and scaling. The book includes an abundance of excellent examples that bring these deadly-sounding prescriptions to life.

Eric Bing is an M.D. who also possesses a Ph.D. in epidemiology and an MBA. He’s the director of global health at the George W. Bush Institute at Southern Methodist University. His co-author, Marc Epstein, is an eminent and much-published professor of management at Rice University in Houston whose previous teaching posts were at the Harvard and Stanford business schools and INSEAD (European Institute of Business Administration).

 

A technology maven’s vision of humanity’s bright future

A review of Abundance: The Future Is Better Than You Think, by Peter H. Diamandis and Steven Kotler

@@@@@ (5 out of 5)

Peter Diamandis envisions a world in which humanity triumphs against all its challenges, from climate change, overpopulation, and poverty to the planetary deficits in energy and water.

This is not science fiction. It’s an eye-opening survey of what one celebrated technology visionary perceives as a feasible future for our species.

As Diamandis writes, “Abundance is a tale of good news. At its core, this book examines the hard facts, the science and engineering, the social trends and economic forces that are rapidly transforming our world. . . The point is this: When seen through the lens of technology, few resources are truly scarce; they’re mainly inaccessible. Yet the threat of scarcity still dominates our worldview.”

Diamandis is unusually well qualified to write this book. He is a Harvard-trained physician and an aeronautical engineer with a master’s degree from MIT. Ever since the age of 8, he has been preoccupied with space exploration. He has founded or co-founded a half-dozen businesses and organizations involved in that field and is widely credited with being the seminal figure in jump-starting the private space exploration business with the $10 million Ansari X Prize that led to the flight of SpaceShipOne.

In Abundance, co-written with Steven Kotler and published February 2012, Diamandis veers far from the course he set in space, settling down to earth to explore how humankind can leverage emerging technologies to confront its most pressing problems. Though Diamandis’ focus is squarely on the exponential growth in speed, capability, and spread of information processing technologies, he is not a gadget freak. He recognizes the social and political context in which technology is brought to light, although he may downplay the ferocity of humanity’s innate resistance to change. He writes about “game-changing” technologies, such as the “Lab-on-a-Chip . . . a portable, cell-phone-sized device [that] will allow doctors, nurses, and even patients themselves to take a sample of bodily fluid (such as urine, sputum, or a single drop of blood) and run dozens, if not hundreds, of diagnostics on the spot and in a manner of minutes.” He cites other potential breakthrough technologies now being developed by such luminaries as inventor Dean Kamen and biogeneticist Craig Venter.

For anyone but a Luddite, Abundance is exciting to read. Diamandis clearly believes that the technological advances he writes about hold promise of a much brighter future for humanity despite the anticipated growth in the world’s population to nine billion by 2050. (He even points to growing “in vitro” meat as one solution to the fast-rising demand for protein by ever more prosperous people.) For a science fiction fan such as myself, it’s difficult not to get starry-eyed.

However, the flaw in his line of reasoning is that, no matter how promising these new devices and processes might be, it’s not practical to assume that they’ll be quickly adopted around the world. That Lab-on-a-Chip sound wonderful? Great! But how many years will it take to put one billion copies of that device into the hands of the nurses running rural health clinics in Western Kenya and Uttar Pradesh and everywhere else in our wide, wide world? And how much will that cost? And will the spread of the device be rapid enough to prevent what other futurists see as the inevitable pandemics of new communicable diseases? Similar questions arise about nearly every one of the marvelous inventions cited in Abundance.

Peter Diamandis, founder and chairman of the X Prize Foundation and cofounder of Singularity University, laid out his vision of abundance in earth’s future in a brilliant TED2012 talk. The themes he introduced onstage at TED are explored in depth in this book.

To give some sense of the exalted circles in which Diamandis travels, here are some of the trustees of the X Prize Foundation: Larry Page, Elon Musk, James Cameron, Dean Kamen, Ratan Tata, Ray Kurzweil, Arianna Huffington, and Craig Venter, every one of whom would figure in anyone’s list of the brightest and most innovative thinkers and doers in the world.

Before Silicon Valley, Bell Labs was America’s hub of innovation

A review of The Idea Factory: Bell Labs and the Great Age of American Innovation, by Jon Gertner

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Ask yourself why the United States of America has remained the dominant economic and military power on the planet for nearly a century now. Is it the superior universal public education system we used to brag about? Is it the wealth of our natural resources: millions of acres of rich, arable land and bountiful mineral and petroleum wealth? Is it the peculiar American ability to build and manage efficient large enterprises? Is it the size and the demographic richness of our population, constantly renewed by the influx of resourceful people from other lands and cultures?

Jingoistic rhetoric aside, it’s most likely that your list of reasons — even, possibly, your only reason — is “American know-how,” the homegrown phrase that points to what seems an unusual national talent for creative thinking and innovation. In fact, it’s difficult to overlook the disproportionate presence of the United States on the lists of Nobel Prizewinners, industrial patents, and other markers of forward thinking in science and engineering throughout much of the 20th Century.

In The Idea Factory, Jon Gertner examines one period and one place where the evidence of American know-how was most pronounced: the time from the end of World War II to the late 1970s in Murray Hill, New Jersey, where AT&T’s Bell Laboratories was headquartered. There, an extraordinary assemblage of brilliant scientists and engineers, guided by a succession of equally brilliant managers, invented or developed into practical form the fundamental advances in science and technology that have shaped the world we live in today: the transistor, the laser, quality assurance methods, communications satellites, mobile telephony, digital photography, fiber-optic communications, and a number of much less well-known but equally important technological advances as well as a long list of innovations in weaponry and spy technology that many of us would prefer not to know about. (In fact, the relationship of Bell Labs to the Pentagon, especially its National Security Agency, remained close throughout the period studied in this book.)

It’s difficult to exaggerate the impact of the work at Murray Hill and its outlying sites following World War II. The transistor — the brainchild of three Bell scientists, John Bardeen, Walter Brattain, and William Shockley — is frequently cited as the single most important invention of the century. Certainly, the transistor lies at the heart of all things digital today. Even more fundamental to the world we inhabit is the information theory of Claude Shannon, who explained how computers might communicate with one another long before anything resembling today’s computers existed.

As Gertner explains in great detail, most of Bell Labs’ work was carried out in service of the growing AT&T telephone network. (If you’re young enough to confuse that AT&T with today’s business of the same name, be advised that AT&T was America’s government-regulated telephone monopoly from the 1920s through the 1970s.) Those familiar with the network called it the biggest and most complex machine in the world. “The system’s problems and needs were so vast that it was hard to know where to begin explaining them,” Gertner writes. “The system required that teams of chemists spend their entire lives trying to invent new, cheaper sheathing so that phone cables would not be permeated by rain and ice; the system required that other teams of chemists spend their lives working to improve the insulation that lay between the sheathing and the phone wires themselves. Engineers schooled in electronics, meanwhile, studied echoes, delays, distortion, feedback, and a host of other problems in the hope of inventing strategies, or new circuits, to somehow circumvent them.”

Gertner makes absolutely clear, however, that “this book does not focus on those tens of thousands of Bell Laboratories workers. Instead, it looks primarily at the lives of a select and representative few,” chiefly scientist-managers Mervin Kelly, Jim Fisk, and William Baker and scientists John Pierce and William Shockley. Every one of these individuals was exceptional, and Gertner does an excellent job giving us glimpses of their eccentricities and missteps as well as their extraordinary lives and character and their accomplishments.

I can fault this exhaustive study in only one way: it’s exhausting, expecially in its concluding chapters, where Gertner spends far too many pages dwelling on the eulogies offered up by the managers who ran Bell Labs when it was alive and well, before the break-up of the old AT&T that was consummated in 1983.

The how-to-guide to “the fortune at the bottom of the pyramid”

A review of Reverse Innovation: Create Far From Home, Win Everywhere, by Vijay Govindarajan and Chris Trimble

@@@ (3 out of 5)

Back in 2004, a respected marketing professor at the University of Michigan named C. K. Prahalad raised eyebrows in the business community with a widely-read book titled The Fortune at the Bottom of the Pyramid. In 25 words or less, he postulated that multinational corporations could grow their markets and their bottom line by reaching out to the billions of poor people who crowd emerging nations across the globe. Much of Prahalad’s book consisted of “case studies” — written by his graduate students — that purported to support his thesis. Unfortunately, practically none of them did.

Here, eight years later, is the book that Prahalad — now, unfortunately, deceased — should have written. Govindarajan, a professor at Dartmouth’s Tuck School of Business, and Trimble, a younger Tuck faculty member, have formulated a concept they call “reverse innovation” that is the key to doing business in those emerging markets that excited Prahalad’s lust. Their book, too, is dominated by case studies, but in this case the examples do a good job of illustrating how multinational companies have successfully developed products that gained a foothold in developing countries — though by no means necessarily at “the bottom of the pyramid.”

“Reverse innovation” — an ethnocentric term — begins with the conventional wisdom that business innovation takes place in rich countries but asserts that transnational corporations wishing to become established in developing markets must cast off traditional thinking and develop products and services within those markets and base them on the needs and wants of people living there. Govindarajan and Trimble advocate reverse innovation as the alternative to exporting rich-country products and services with minor adjustments, a strategy that many companies have found unsuccessful. (The authors call this strategy “glocalization.”)

The case studies in Reverse Innovation span a wide range of needs, desires, and prices. The authors write about an extremely inexpensive electrocardiograph machine developed and marketed in India by GE Healthcare, lightweight enough for use by individual physicians on rounds in villages. They relate the story of the development from scratch of a lentil-based new snack food by PepsiCo in India, and of a new automotive “infotainment” system crafted through an international effort by Harman and eventually purchased by Toyota. Other examples include Procter & Gamble, Logitech, and the nonprofit Partners in Health.

Most of the case studies are great stories, even if they are better illustrations of how multinational corporations can make more money than they are of how poor people in emerging nations can gain access to needed goods and services at affordable prices. However, the bulk of Reverse Innovation is given over to discussion about change management in large corporations: it’s clear that the real challenge these companies face in growing their markets is to get around the massive barriers thrown up by organizations that are too large, too successful, and too set in their ways. The authors write, “Reverse innovation begins not with inventing, but with forgetting . . . You must let go of the dominant logic that has served you well in rich countries . . . Reverse innovation is what we call clean-slate innovation.”

Govindarajan and Trimble make it clear that the only way for a transnational company to bring about reverse innovation is to (1) start with a champion at the top, usually the CEO; (2) appoint a brilliant and politically savvy person to head up an “LGT,” by which the authors do not mean to suggest gender preference but simply to abbreviate “Local Growth Team;” (3) recruit to the team a group of mavericks willing to ignore the conventional rules; and (4) work on site in one of the major emerging markets, far, far from headquarters.

Reverse Innovation is well-organized, well-written, and delivers on its promise. Why, then, have I awarded this book only three @@@ out of 5? Out of pique, perhaps, more than anything else. For one thing, the do’s and don’ts of management in large organizations are  . . . well, for me, the only apt word is boring. And I can’t get past my aggravation that this is yet one more instance of brilliant minds being lashed to the task of making the rich richer.

Tribes, by Seth Godin

@@@ (3 out of 5)

“Leaders have followers,” Seth Godin writes. “Managers have employees. Managers make widgets. Leaders make change.”

Tribes, one of Godin’s recent efforts to enlighten humanity with the wisdom of Silicon Valley, builds on this underwhelming insight to paint a picture of leadership that seems limited to questioning conventional wisdom and making a pest of yourself. There’s insight to be found in Tribes, as there is (more frequently) in Godin’s other books. But the true value of this little essay on making change in the world lies in the innumerable examples and anecdotes liberally scattered throughout.

Oh, yes: that title. “Tribes,” in Godin’s phrasebook, are the apparently random collections of people who follow those he regards as leaders. No leader, no tribe. No tribe, no leader. Get it?

Now, don’t misunderstand me. Seth Godin is a very smart man with a brilliant marketing mind. Here’s how he defines marketing in this little volume: “Marketing is the act of telling stories about the things we make — stories that sell and stories that spread.” It’s hard to find a better contemporary definition of that widely misunderstood concept. And it ties neatly into Godin’s theme in this book because, he adds, “Today, marketing is about engaging with the tribe and delivering products and services with stories that spread.”

There is genuine insight in that statement, but Godin doesn’t develop it sufficiently. In a longer and more carefully written book, he might have explored how networks and networking are pushing aside traditional communications media . . . how celebrity affects the sales of books, music, and clothing . . . how ever-smaller and more specialized subcultures are multiplying like amoebae. Maybe somebody else will take this up someday. Or — who knows? — maybe somebody already has.

Godin is quick to lavish scorn on those he dislikes or disrespects, and apparently the 12 or 13 million people who work in or for the U.S. nonprofit sector are high on his list. (Presumably, that would include me.) For example, he writes, “Take a look at the top fifty charities on the Chronicle of Philanthropy‘s top four hundred charity list. During the last forty years, only a handful of charities on this list have changed. Why? Because donors didn’t want to take risks.” Godin’s writing is littered with silly generalizations like this.

So, with all these flaws, is Tribes worth the time and trouble to read? Yes. Here, for example, is how Godin illustrates his highly unconventional definition of faith: “People don’t believe what you tell them. They rarely believe what you show them. They often believe what their friends tell them. They always believe what they tell themselves. What leaders do: they give people stories they can tell themselves. Stories about the future and about change.” You’re not likely to find a simpler or more direct definition of leadership than that.

ISBN-10: 1591842336

ISBN-13: 978-1591842330