Is collaboration the key to innovation today?

"The Medici Effect," mentioned in my last entry, is about the fruits of collaboration. The author asserts that collaboration between seemingly unconnected disciplines is key to being truly innovative (i.e., coming with new ideas) today.

One anecdote he writes is about a team of Brown University scientists that created a way for a monkey to use not his hands but his brain to control a mouse cursor on a computer screen.

This story is especially compelling not just because of what the team of scientists discovered, but because it was the result of a deliberate effort to find an intersection of disciplines. The group... consisted of mathematicians, medical doctors, neuroscientists, and computer scientists...

This was no accident. Professor Leon Cooper, who pioneered the brain science research efforts at Brown University, made a special point of bringing together a wide range of disciplines to understand the human mind. (12)

This team was featured in a recent NY Times article, as mentioned by the author in a blog entry.

Such interdisciplinary collaboration is becoming more common, and not just in the science lab. A story in the WSJ earlier this year followed a capitalist who brings patent lawyers together with doctors, surgeons and scientists to brainstorm concepts. They get written down, and those that are applicable and profitable get written up as possible patents. Everyone gets compensated for their contribution if it becomes a product or service. (Unfortunately, I can't find the article.)

Coming back to the science world, there's the Institute for Systems Biology in Seattle, profiled by BusinessWeek in "Deconstructing Disease" whose vision is of "health care in which physicians predict who will develop certain diseases, and then tailor individual drug regimens to cure them." The institute was pioneered by Dr. Leroy Hood, considered the "godfather" of systems biology.

To understand the disease process, Hood believes, scientists must decode the complex biochemical pathways created by the more than 50,000 proteins that genes produce -- and link what they learn to the whole system. Only then can doctors figure out how to interfere with a pathway to cure or even prevent an illness.

This sums up how systems biology tackles the understanding of pathology. The relevant aspect of Dr. Hood's story is that he is "known for taking a cross-disciplinary approach to tackling diseases... [He has brought together] 180 specialists in biology, chemistry, math, and physics [to] work together to unlock a range of medical mysteries, from how cancer develops to how the immune system forms in childhood," according to the institute's website.

One doesn't have to be on an interdisciplinary team to find connections between seemingly unconnected things. Sometimes it can happen within someone's mind. In a section on success and failures in "The Medici Effect" is a story of a young medical student named Deborah Prothrow-Stith (now a public health professor at Harvard) who overcame many obstacles, especially from inside the medical establishment, to convince people that violence can and ought to be prevented.

The more [she] thought about it, the more she realized that physicians often got involved with prevention of harm by attempting to change patient behavior. She and other physicians pushed people to wear seatbelts, to eat right, to exercise, to avoid risky sexual behavior, and to avoid many other lifestyle hazards. But at the time they didn't do anything to prevent violence.

Is the interdisciplinary approach is ideal for ideation? Seems like it. After all, as a late 19th century conservationist John Muir once put it, "When one tugs at a single thing in nature, he finds it attached to the rest of the world."

A new health drink?

Well, it's not new really. What is new is how health researchers see coffee. Recent studies praise a cup of java for its many beneficial health effects, according to the NYT article "Coffee as a Health Drink? Studies Find Some Benefits."

Take a landmark study in JAMA last year which claimed habitual coffee drinking is associated with reduced risk of developing Type 2 Diabetes.

Coffee contains antioxidants that help control the cell damage that can contribute to the development of the disease. It is also a source of chlorogenic acid, which has been shown in animal experiments to reduce glucose concentrations.

Caffeine, perhaps coffee’s most famous component, seems to have little to do with it; studies that looked at decaffeinated coffee alone found the same degree of risk reduction.

Larger quantities of coffee seem to be especially helpful in diabetes prevention. In a report that combined statistical data from many studies, researchers found that people who drank four to six cups of coffee a day had a 28 percent reduced risk compared with people who drank two or fewer. Those who drank more than six had a 35 percent risk reduction.

Another study finds an association between coffee consumption and reduced cardiovascular disease.

The findings, which appeared in May in The American Journal of Clinical Nutrition, suggest that antioxidants in coffee may dampen inflammation, reducing the risk of disorders related to it, like cardiovascular disease. Several compounds in coffee may contribute to its antioxidant capacity, including phenols, volatile aroma compounds and oxazoles that are efficiently absorbed.

In another analysis, published in July in the same journal, researchers found that a typical serving of coffee contains more antioxidants than typical servings of grape juice, blueberries, raspberries and oranges.

“We were surprised to learn that coffee quantitatively is the major contributor of antioxidants in the diet both in Norway and in the U.S.A.,” said Rune Blomhoff, the senior author of both studies and a professor of nutrition at the University of Oslo.

These same anti-inflammatory properties may explain why coffee appears to decrease the risk of alcohol-related cirrhosis and liver cancer. This effect was first observed in 1992. Recent studies, published in June in The Archives of Internal Medicine, confirmed the finding.


Of course, drinking coffee isn't all good. A prevailing belief is that caffeine decreases bloodflow (and thus oxygen delivery) to the heart via coronary artery vasoconstriction, and can elevate blood pressure too by vasoconstricting other arteries in the body.

There are many studies (1, 2, 3) , in these same journals, that point to the detrimental effects of coffee. And who can overlook the toll coffee takes on one's teeth?

Is becoming an expert counterproductive to becoming innovative

In the book "The Medici Effect" by Frans Johansson, about how the best applicable innovations arise from the intersection of disciplines, there is an anecdote about a guy with no medical background who creates a technique to discover cancer, as told by one venture capitalist cited by the author.

Paul Maeder is also a very well educated man. He earned his undergraduate degree at Princeton University, his master's in mechanical engineering at Stanford, and his MBA at Harvard Business School. With all of these degrees, you would think he places an extraordinarily high value on education. But only seconds into our conversation he started listing individuals and groups who have radically innovated because they did not have formal training... (50)

The idea that the lack of formal training is a good thing isn't far-fetched. Many great scientific innovators, people like Einstein, Edison, Franklin, and da Vinci, lacked formal education in the fields they excelled in. (I wonder if the same applies to innovation in the arts or other fields.)

"Take this guy Stan Lapidus," he told me one day. "He doesn't have an M.D. or a Ph.D., but he has come up with an amazing way of analyzing stool samples for colon cancer pathology. Put it in a blender, mix, and you can spot cancer with hardly any false positives. It's really an amazing invention. Now, why did he think of this? Because he's not a doc."

Mr. Johansson says the capitalist doens't think education is a bad idea. "But he clearly sees it as potentially limiting creativity."

Through school, mentors, and organizational cultures, education tends to focus on what a particular field has seen as valid. If, for instance, you wish to be a great medical doctor, there are rules that must be mastered. A good education will teach you these rules. You learn what past experts and thinkers concluded and use their experiences to build your own expertise. You do this to learn what works. Expertise in a particular field could suffer if too much time were spent questioning basic assumptions. The price for such an approach, however, is that one more easily becomes wedded to a particular way of doing things. As a result, associative barriers are erected, making intesectional ideas less likely.

Food for thought.

A novel way of thinking about grapefruit juice

It's now common knowledge that one should stay away from grapefruit juice if taking certain medications like cholestrol-lowering statins. This is because compounds in the fruit inhibit a liver enzyme responsible for normal metabolism of these drugs. It thus slows the excretion of these drugs, which is dangeous if one is unaware of his drug levels and keeps ingesting the drug at his prescribe dosage, leading to overdose.

More details are given in this Wikipedia article, which come largely from a 1997 Journal of Clinical Investigation paper on how grapefruit juice slows down the breakdown of a calcium channel blocker.

So then, grapefruits slows down parts of the liver and thus prolongs the concentrations of some drugs in the bloodstream. Bad? Yes, for some people died because of the overdosing effect. But is there any good too?

Perhaps yes. Here's a short letter to the editor in the July 29th issue of Science News demonstrating some novel thinking on this matter:

It would seem to me that instead of looking to minimize the effect of grapefruit juice in slowing the metabolism and elimination of drugs, one could cut drug dosages by taking advantage of it ("Nabbed: Culprit of grapefruit juice-drug interaction," SN 5/20/06 p. 317). Grapefruit juice costs less than any drug and has far fewer side effects. This could only benefit the patient by lowering drug exposure and costs.

Pretty neat idea, using something that affects physiology in a seemingly adverse way to improve health instead but with an economic benefit.

The idea is untested of course, and as an UNC researcher points out in his rebuttal, nobody knows how grapefruit juice exactly affects metabolism, or what dosages would be effective and safe. Still, kudos to the letter writer for being creative in the realm of medicine. Creativity is about roaming into the unknown, unconstrained by conventional views and even logic sometimes, which is what the writer did.

Early detection can help, but is it worth it for everybody?

Featured in the March 27, 2006 Businessweek article "Beyond the Annual Physical" is an Austin company, Biophysical Corp., that caters to Americans who want to be fully tested for everything that could be possibly wrong with their health. The B-week writer calls them "medical worriers."

The company's hallmark service is "a $3,400 blood test named the Biophysical250 that screens for 250 possible diseases, at least 150 more than most standard physicals." The vast majority of insurance plans do not cover the costs. So how does it work?

The company sends a nurse to your home to draw two tablespoons of blood, then the samples get shipped to Austin to test for everything from the mundane -- cholesterol and blood sugar levels, infection -- to the downright scary, such as dozens of proteins and enzymes that could indicate the presence of cancers, autoimmune diseases, or weird genetic anomalies. The test screens for 39 markers for heart disease alone.

Smartly perhaps, and in line with current medical thinking, the company "does not... screen for diseases about which nothing can be done -- Alzheimer's and Parkinson's, for example." And admittedly, this battery of tests isn't necessary according to the writer's own doctor and even the writer himself in the final analysis: "All in all, Biophysical250 is a nice affirmation if you're fairly certain you're in good health, and an early warning system if you're not."

Interestingly, this extremely thorough physical isn't confined to medical startups. Well-regarded institutions like Mayo Clinic offer similar services called "executive physicals," which are more costly. The added value is that the physician takes a detail history.

"We do run the standard evidence-based tests, but we also listen very carefully to the patient and pursue any clues they may give," says Dr. Deborah J. Rhodes, director of Mayo's program. She gives the example of a 37-year-old man who mentioned in passing that he recently noticed one testicle seemed smaller. This common asymmetry would have barely been noted, except that the patient said it was a recent change. As a result, Rhodes ordered a test for testicular cancer and discovered that the man had the very earliest stages of the disease, catching it long before it would have been found in a physical exam.

Is this kind of extreme physical necessary to maintain good health? Probably not, as the writer points out, for the majority of us. But as quoted in a Scientific American June 2006 article titled "Early detection can lead to better outcomes," and actually seen on Biophysical Corp's site:

Millions of adults—even those who appear healthy—live with undetected illnesses. In the U.S. alone, 1.4 million people will be diagnosed with cancer this year. Another 17 million will suffer an adverse cardiovascular event. The good news is that the sooner specific diseases and medical conditions are detected, the sooner—and more effectively—they can be treated.

There is real value in a test that could detect an early-stage cancer or new-onset (and subacute, meaning no symptoms) diabetes, as this could help a person not only increase her chances of surviving, but also of living with a better quality of life in most cases (e.g., preventing kidney and eye disease in diabetics and curing cancers by resection before it metastasizes). Still, is there value for everyone if most people do not have such disease that are in the early stages of development? I'm not so sure.

And in the end, this jury isn't convinced one way or the other quite yet about the value of these comprehensive physical lab exams.

Ayurvedic tourism & the AOL founder's healthcare revoltution

"In the Land of Four-Star Asceticism" is a NYT travel article about health resorts in the south Indian state Kerala where visitors, mostly German tourists and Lonely Planet types, take the "the humble oath of four-star asceticism" to immerse in ayurveda, "the 3,500-year-old herb-based healing tradition that still flourishes in the daily life of India." So what is that humble oath?

...to forsake all known forms of vacation decadence (rice gruel for dinner, anyone?), to give up meat, alcohol, caffeine, leather accessories, naps, sunbathing, swimming and mindless frivolity in order to purify and balance your whacked-out Western body and soul...

Why people would pay money to live like ascetics and get "detoxed" by unscientifically proven therapies is part of an interesting trend that I call the "wholesome trend," which has many aspects. Among them are care oriented around the whole person -- mind, body & spirit -- and not just one part, ingestion of wholesome (i.e., natural or organic) foods & herbs, wholesome (non-artificial, as in medications & surgical) interventions like yoga & acupuncture.

These resorts, centuries old, have detected that trend (rather their investors have) and have thus rebranded themselves to appeal to Westerners with deep pockets. The one featured here, the Kalari Kovilakom, "markets itself as combining 'the indulgence of a palace with the austerity of an ashram.'"

Is this just another Eastern fad? AOL founder Steve Case doesn't believe so. According to a recent Honolulu Advertiser article on him.

Case, who last year started a company focusing on healthcare and luxury resorts, tells his audience that the U.S. is ripe for a transformation.

"The objective of this movement must be to make healthier, more sustainable lifestyles available to every American," says Case, 48, who's wearing an open-collar shirt and khakis. "If we achieve that, we will effectuate nothing short of a revolution in this country."

The founder of Revolution LLC is making big promises. He's done it before. In 2000, as chief executive officer of America Online Inc., Case pitched the acquisition of Time Warner Inc. to his shareholders, saying it would create new ways for people to shop and communicate.

And according to an older Washington Post article, Case is "bet[ting] that activities once associated with a new-age lifestyle are going mainstream."

Case was right more than a decade ago with Internet use, confined at the time to academics, going maintream, and he took advantage of a widely undetected demand among ordinary Americans to get onto the WWW.

So perhaps he's right about the "wholesomeness trend," about the desire for middle and upper-class Americans to live more "holistically" and to pay more to do so. And perhaps Case's new company, and the rebranding of ayurvedic health resorts in India, are based on a bigger trend, one labeled the "experience economy" by a 1999 book of the same name. (Dan Pink writes about it here.)

If so, then entrepreneurs & investors beware. An experience economy thrives in times of economic wealth, but when that economic wealth is being sapped, like now largely thanks to higher oil prices, interest rate hikes and inflationary pressures, people tend to stop spending on experiences and become more price and value-conscious.

This is the gist of this past week Slate's Daniel Gross article, "The Rising Cost of Living Well," detailing the falling fortunes (and stock prices) of companies like Starbucks and Whole Foods, companies steeply entrenched in the experience economy (and the wholesome one too).

It will be interesting to see if companies that service people's desire to live more wholesomely can still thrive during economic recessions, because then the trend is truly deeper than a superficial new-age desire.

Despite controversy, steady progess

This is the point of writer Deborah Blum's August 1st essay "A Pox on Stem Cell Research."

How is the research to advance from hopeful to helpful when national policy inhibits the work from being done? Discouraged proponents have suggested that the president’s decision, which was applauded by conservative religious groups, has the potential to keep American science locked in the past.

The past, however, seems to encourage a more optimistic outlook. Medical progress has stirred religious and moral objections throughout history — objections that were overcome as the benefits of medical advances became overwhelmingly obvious.

After detailing some instances of when medical advances, initially perceived as an affront to God, was widely accepted, the essay delves into the story of Dr. Edward Jenner, who introduced inoculation to prevent infections from the deadly smallpox -- admist objections from religious leaders and even fellow doctors.

He designed a procedure using fluid from cowpox lesions to inoculate against smallpox. His approach was untested, but Jenner believed it offered the potential to become “essentially beneficial to mankind.”

The religious authorities of Jenner’s day viewed smallpox inoculation as an affront to God and man. A widely published British sermon was titled “The Dangerous and Sinful Practice of Inoculation.” American clergy warned that inoculation usurped God’s power to decide the beginning and end of life. Only hypocrites would undergo the procedure and still pray to God, one theologian declared.

Jenner responded with a risky demonstration of his idea. In 1796, the doctor persuaded his own servant to allow the man’s 8-year-old son to be inoculated with cowpox material; two months later, Jenner exposed the child to smallpox.

The experiment was a success...

Why despite antagonizing moral and even expert opinion has the healthcare innovation -- the inoculation for prevention of infectious disease -- been so widely practiced since?

Not by hyping the potential of his ideas, as some stem cell supporters occasionally have done, but by doggedly gathering more evidence based on more inoculations. Fueled by his success, the practice spread, and smallpox rates plummeted. In time, the life-saving merits of inoculation eventually overwhelmed all doubt; the evidence, Jenner wrote, became “too manifest to admit of controversy.”

The writer's premonition is "stem cells — especially the amazingly versatile cells evident in early human development — have the potential to hold off our own ministers of death. And history suggests that’s a proposition too powerful to remain shackled by the moral strictures of the moment."

Antibodies galore!

It seems like lab-designed antibodies that block effects of hormones, receptors and neurotransmitters are becoming a hot concept.

I wrote in passing about an antibody designed by Pfizer that blocks nicotine receptors, preventing on a molecular level the chemical nicotine from binding onto its receptors on brain cell membranes, and thus preventing on a human level the craving for the "nicotine effect" from smoking cigarettes.

There's a new antibody therapy aimed at obesity that's not close to testing in humans, but is apparently successful in stopping lab mice from getting fat. Read more about it in the Reuters article "Scientists take step toward obesity vaccine." Ghrelin is the hormone that this experimental antibody targets.

For more on antibodies, go to this Wikipedia article.