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 / Fourth Quarter 2001 / Issue 25(originally published by Booz & Company)


Clayton M. Christensen, The Thought Leader Interview

S+B: Well, the big pharma companies have done a lot of both, either outgunning the biotechs in patent litigation or acquiring them, and most of the revenues in biotechnology are still flowing to the large established companies. But is there another way in which biotech can disrupt health care?

CHRISTENSEN: There are other dimensions of biotechnology. If you think of biotechnology like the Internet, it’s not a category — it’s an infrastructure that can be deployed to sustain or disrupt. In health care, the most complex problems at the high end have to be dealt with in a problem-solving mode by the best, most experienced physicians you can find. In the middle tiers of the market you’ve got a set of problems that can be dealt with in a pattern-recognition mode — Type 1 diabetes, for example. If you’re always thirsty, you’re losing weight, you urinate frequently, and your eyesight is blurry, you have diabetes. It doesn’t take nearly as much skill and intuition to deal with and treat problems in a pattern-recognition mode as it does in a problem-solving mode. Finally, down at the bottom of the market, you’ve got stuff in a rules-based mode — things such as, “If it turns blue, you’re pregnant.” These things take even less skill to diagnose and treat.

The important thing is that over time, scientific progress transforms things that used to have to be dealt with in a problem-solving mode down to the pattern-recognition space; and from pattern recognition into the rules-based mode. This is the mechanism by which less-trained people are enabled to do more sophisticated things. This is always the way disruption happens. It enables a larger population of less-experienced people to do more sophisticated things.

S+B:You see biotechnology pushing more diseases down from the specialists?

CHRISTENSEN: Well, it can, and it often does. This is what I mean by biotechnology being an infrastructure that can be deployed to sustain or disrupt.

Sustaining applications won’t transform health care. But disruptive applications will. For example, some senior scientists at Millennium Pharmaceuticals recently published a paper showing that leukemia isn’t a disease; it’s actually an umbrella symptomatic description of six distinct diseases. It used to be that when we thought it was a disease, you’d go to the oncologist and she’d run a bunch of tests; analyze the data; come up with a hypothesis; and then embark upon a course of treatment. If it worked, then it meant she had diagnosed the problem right. If it didn’t work, she’d conclude that there must be something else going on, and she would try another therapy.

But Millennium has shown that you can identify which of those six diseases you have by looking at a pattern in about 50 genes. So, when Millennium develops a test using this discovery, and this gets FDA approval, if you think you have leukemia, you could go to a technician. He’d draw a sample, look at the pattern in your genes, and compare it against the template, and say, “You’ve got Number 5.” Knowing that you have Number 5, a specific therapy can be defined for Number 5 that would be different from the others. Then a nurse could administer that therapy. \

Previously, only oncologists could administer the therapy because what worked for one patient wouldn’t work for the next — the problem-solving mode required the oncologist’s judgment. The reason, of course, was not that Tuesday’s batch of chemo drugs was off-spec. The patients had different diseases. Millennium’s discovery, which is truly disruptive, means that in the future, a technician could give a more accurate diagnosis and a nurse could give more effective therapy than could the oncologist.

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