Ideas

Ideas | Caroline Buckee

Sorry, Silicon Valley, but ‘disruption’ isn’t a cure-all

When it comes to addressing epidemics — and a lot of other global challenges — the Silicon Valley startup mentality doesn’t work.

I study how infectious diseases spread. Late last year, a colleague and I found ourselves pitching our science to an organization that spends millions of tech-industry dollars to accelerate and disrupt the kind of research we do. Their representative was just out of college, and he carried himself with the aggressively relaxed manner of a new Silicon Valley convert. Despite his confidence, it soon became clear that he knew virtually nothing about epidemiology, biostatistics, health systems, or health policy. He was nevertheless convinced that cash and some programmers should be able to fix global health.

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Some things are amenable to the kind of disruption that tech companies love. Having instant access to my files whenever I am online has changed the way I work. Taxicab owners don’t like Uber, but using location-based apps to connect drivers with customers does improve service.

Unfortunately, it has become fashionable to assume that any problem can be solved in the same way — by throwing money, smart young people, and a disruption mentality at it. There has been a recent surge of funding for this approach in medicine and public health.

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But the next global pandemic will not be prevented by the perfectly designed app. “Innovation labs” and “hackathons” have popped up around the world, trying to make inroads into global health using technology, often funded via a startup model of pilot grants favoring short-term innovation. They almost always fail. The emerging field of mobile health, or mHealth for short, is a wasteland of marginally promising pilot studies, unused smartphone apps, and interesting but impractical gadgets that are neither scalable nor sustainable.

Meanwhile, the important but time-consuming effort required to evaluate whether interventions actually work is largely ignored. Maybe funders are relying on the convenient but complacent notion that bad ideas will disappear naturally — and good ideas, like Facebook or Dropbox, will take off on their own.

The problem is that a public health program is not the same as a company, which becomes self-sustaining once it’s profitable; public health requires continuous investment and evaluation.

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It isn’t surprising that some Silicon Valley executives think health research is ripe for disruption. Academic research often moves at a glacial pace, and the publish-or-perish model of promotion and tenure favors high-impact articles over real impact on health. When experts spend most of their time writing grant proposals, they’re not doing science.

Furthermore, the funding model is often reactionary. Washington hastily allocates money to epidemics like Ebola after the outbreak has already started. Researchers then waste their time writing project grants to take advantage of the opportunity instead of working together to help control the outbreak.

If we are to take pandemic preparedness seriously, then researchers who can contribute quickly must be funded in a sustainable way and called upon to respond when the moment inevitably arrives. In the wake of Ebola, Bill Gates, whose foundation has been around long enough to grapple with the tough realities of global health, outlined some useful additional priorities: speeding up the design and deployment of therapeutics and vaccines, for example, and building a global outbreak surveillance and response system.

I am sure there are valuable ways that the tech startup model could complement these efforts. However, in a world where technology moguls are becoming major funders of research, we must not fall for the seductive idea that young, tech-savvy college grads can single-handedly fix public health on their computers. It’s ironic that an industry so full of Ivy League-educated youths is so dismissive of subject-area expertise, so inclined to foster confidence over competence, so willing to accept TED talks and elevator pitches as a substitute for rigorous, peer-reviewed science.

Pandemic preparedness requires a long-term engagement with politically complex, multidimensional problems — not disruption. When the next outbreak hits, we will need all the experts we can get.

Caroline Buckee is an infectious-disease epidemiologist at the Harvard T.H. Chan School of Public Health.
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