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Why some things go viral, and some don't

Surgeon Christoph Lischer operates on a horses's fractured leg as a colleague points to an image of the leg on a monitor.

There are things out there -- totally innovative things like the iPhone or the Prius -- that seem to catch on really quickly. There are others -- Internet radio, for instance -- that don't, even though they're useful, or even essential. They can take decades to become the norm.

In the medical profession that can mean the difference between life and death. Atul Gawande is a surgeon and a staff writer at the New Yorker, where his latest piece is titled "Slow Ideas."

Gawande contrasted the study of anasthesia, which he calls a "fast idea" -- "it spread worldwide within weeks of its discovery in the 19th century" -- to the study of antiseptics, which he said took more than a generation for surgeons to accept the idea of washing their hands.

"We want these frictionless solutions to all the major difficulties of the world -- whether it's hunger, health care, poverty," Gawande says. "But the reality is that when you're changing norms, technologies and incentive programs are just not enough."

He uses the dangers surrounding childbirth in India as an example. A lot of the problems that cause death to both mother and child can be prevented -- and many without fancy technological gadgets. For example, the method of skin-to-skin contact between a mother and her baby can cut mortality rates of premature babies by one-third, proving much more effective than some kind of man-made electronic solution.

"And we think, 'Well how do we get people to do that?' We think ad campaigns, incentives -- it hasn't worked," he says. "But when you go face-to-face, understand what they're doing, why they don't do it -- they change."

About the author

Kai Ryssdal is the host and senior editor of Marketplace, public radio’s program on business and the economy.
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The two comments that precede mine are part of an important discussion about healthcare, but might be a little off-topic, here. I think that what Dr. Gwande is observing that there is an informal social network that exists in medicine (as it does in all fields) that can enable or disable the spread of a medical improvement.

As it happens, there is a good body of work in many social and business sciences that support his observations. It suggests that our friends, coworkers, mentors, and personal heros have a lot of influence over how we think about that new-fangled thing, policy, methodology that just landed on our workflow. In my job I help companies introduce organizational change, and I face the problem Dr. Gwande describes all the time.

In short, one can't just drop a new way of doing things into a group and expect people to embrace it like a cute puppy. Because it is about hearts-and-minds, and you better do your sociological groundwork if you want to win both.

I applaud the doctor's insightfulness.

There is so much wrong with the comment of Mr. avisonenthal: Yes: Doctors are no longer capable of supervising their own profession. But most states have boards that oversee physicians, and they are just about useless. They are useless because of a process known as regulatory capture. I suggest that Mr. avisonenthal look it up. The FAA does not keep airlines safe. Fear of bad publicity and getting sued into bankruptcy keeps airlines safe. What will keep doctors honest is making it easier, not harder, for patients harmed by physicians to sue them. If you wish to prevent frivilous lawsuits than you give the jury an option to find that the suit was, indeed, frivolous and to find a judgment against the plaintiff for the amount for which he was suing. If the plaintiff can not deliver, than the lawyer representing him will be liable.

But there is room for differing opinions on that. This comment was absurd:
Would we allow jet turbine mechanics to each individually decide when to overhaul an engine? No, that is establised through engineering knowledge and the same standard imposed on all. Doctors should be required to perform certain procedures in a certain way if it is known to be better.

That would assume that all people were alike, or at least very similar, you know ... like jet engines. News flash. People are not like jet engines. What works on one for a given problem may or may not work on another.

One does not need a government body to keep doctors from using procedures that are known to be dangerous. One needs to allow the victims to sue the Bas***s into bankruptcy, and maybe the hospital also. But suppose the technique is fixing a clogged artery? There are at least three procedures that I as a layman can think of and that is just surgery. You really want a government agency telling physicians which ones to use, and how to do them?

Atul Gawande is being a bit disengenuous. He is trying to make it seem that the present medical system works, and you need to figure out how to convince all knowing doctors of good ideas. This is incorrect. Today in our country, doctors kill 200,000/yr becuase of medical mistakes. Doctors are no longer capable of supervising their own profession.

What is needed instead is an external authority such as the Federal Aviation Administration to supervise health care. Would we allow jet turbine mechanics to each individually decide when to overhaul an engine? No, that is establised through engineering knowledge and the same standard imposed on all. Doctors should be required to perform certain procedures in a certain way if it is known to be better.

An example is central line adminsitration. The previous technique of bedside installation resulted in an 80% infection rate. However, one intrepid nurse discovered that by treating central line installation as an operation with a sterile field, the infection rate drops to 2 %. Doctors should not be allowed to use the old procedure, and should be disciplined if they do.

Doctors kill too many people today. Techniques that work should be mandated, not persuaded.

http://www.youtube.com/watch?v=obSOaKTMLIc

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