Why do some innovations spread so swiftly and others so slowly? In the era of the internet we want frictionless, “turnkey” solutions to the major difficulties of the world. We’ve come to expect that innovations will spread quickly. Plenty do but there’s an equally long list of vital innovations that have failed to catch on. The puzzle is why.
In Slow Ideas, Atul Gawande tackles this thorny question comparing the different trajectories followed by surgical anaesthesia and antiseptics, both of which were discovered in the nineteenth century. The first public demonstration of anaesthesia was in 1846. Within that year, it had been tested in hospitals and published in the medical community; and within seven years, it was a standard in almost every hospital across the United States and Europe. In 1867, Joseph Lister published landmark research in The Lancet introducing antiseptic as a means to prevent lethal surgical infections. Its adoption would take decades.
Incentives for both, anaesthesia and antiseptics, ran in the right direction, and both implied technical challenges to solve. Clearly, economics and technical complexity can help explain part of the difficulty for ideas to spread, but they are not enough. What were the key differences?
First, one combated a visible and immediate problem (pain); the other combated an invisible problem (germs) whose effects wouldn’t be manifest until well after the operation. Second, although both made life better for patients, only one made life better for doctors.
Surgeons finally did upgrade their antiseptic standards at the end of the nineteenth century. But, as it is often the case with new ideas, the effort required deeper changes than anyone had anticipated. In their blood-slick, viscera-encrusted black coats, surgeons had seen themselves as warriors doing haemorrhagic battle with little more than their bare hands. A few pioneering Germans, however, seized on the idea of the surgeon as scientist. They traded in their black coats for pristine laboratory whites, refashioned their operating rooms to achieve the exacting sterility of a bacteriological lab, and embraced anatomic precision over speed.
Many important but stalled ideas have followed a similar pattern. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. Everett Rogers showed that the diffusion of innovations is essentially a social process in which subjectively perceived information about a new idea is communicated:
Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.
This is something that salespeople understand well. I once asked a pharmaceutical rep how he persuaded doctors—who are notoriously stubborn—to adopt a new medicine. Evidence is not remotely enough, he said, however strong a case you may have. You must also apply “the rule of seven touches.” Personally “touch” the doctors seven times, and they will come to know you; if they know you, they might trust you; and, if they trust you, they will change. That’s why he stocked doctors’ closets with free drug samples in person. Then he could poke his head around the corner and ask, “So how did your daughter Debbie’s soccer game go?” Eventually, this can become “Have you seen this study on our new drug? How about giving it a try?” As the rep had recognized, human interaction is the key force in overcoming resistance and speeding change.
Atul Gawande shows that key ideas in healthcare and nutrition are still trying to make its way through an unequal world.
Here we are in the first part of the twenty-first century, and we’re still trying to figure out how to get ideas from the first part of the twentieth century to take root.
How many other bright ideas are still waiting its time, still unknown, somewhere in an old book, and obscure website, or still inside a brain struggling to communicate?