Why healthcare might not have benefited from a Steve Jobs-style disruptor

Steve Jobs holding a non-emergent object

The website Stat has an article titled "Why healthcare needs a Steve Jobs-style disruptor". The article which is by a physician named Damon Ramsey focuses on Jobs' ability to rethink design and to reinvent many of the ways in which we interact with the digital world. Ramsey thinks that Jobs would have had much to offer our current healthcare system with its convoluted regulatory mechanisms and information systems; it draws inspiration from an account by Jobs's sister in which she recounts him sketching out new designs for hospital systems even on his deathbed.

It's a pleasing vision, and Jobs was certainly a visionary who will go down as one of the most important people in the history of modern civilization, but I actually don't think that someone like him will be a disruptor in healthcare. The main reason is that healthcare is very different from electronics and computer science in terms of the complexity and predictability of its essential elements. Jobs might certainly have been useful in designing some of the electronic interfaces in hospitals, but that's a very limited part of the system. A major part of healthcare lies in the process of drug discovery, and in this vast arena I think Jobs would have been far less effective. In fact his working philosophy might have even been a hinderance.

Jobs' main achievement was to make computers and other electronics easy to use: even more than Bill Gates he brought computer technology to the masses. He was probably the best interface designer of his time, and he also had a genuine capacity to see the interconnections between various aspects of software and hardware.

And yet Jobs was designing his iPhones and Macs based on extremely well understood principles of software and hardware engineering. He certainly needed to think creatively in order to understand how to make these principles play well with each other, but he did not have to worry about the truth of the principles themselves. In addition the systems he was looking at were very modular, so most creative ways to package them together would work since they would not suffer from unexpected interactions. Put simply, there was very little chance that Jobs's devices would blow up.

In contrast, biological systems are startlingly non-modular and non-linear. Getting them to work is not a matter of designing interfaces. Not only do we not yet understand how to discover new drugs well, but we don't know how to do that because we lack an understanding of the human body to begin with. The "software" in case of drug discovery would be the genome which dictates the actual workings of the cell. The "hardware" is the universe of proteins that serve as workhorses for regulating every single important process in our body, from reproduction to the immune response. Unlike a microprocessor in which the welding together of software and hardware is a matter of engineering, welding together the software and hardware of the human body is currently impossible, simply because we are ignorant both about the nature of these components and their interactions.

I think Steve Jobs would have been completely befuddled if he had been confronted with the task of reinventing drug discovery. In fact one wonders if he would have fundamentally misunderstood the problem; it's worth noting that some people think that he died an early death because he wasted critical time in refusing standard chemotherapy for his cancer, opting to pursue untested "alternative" cures instead (although he does seem to have regretted his decision later). Knowing what we do about his philosophy, I get the feeling that he preferred the simple to the complex, the intuitive to the un-intuitive and the predictable to the chaotic. iPads and Macs are all of the former, biological systems are all of the latter. Notwithstanding his drive and intelligence, a Steve Jobs in drug discovery might have likely have taken his team down some very dark and interminable alleys.

The challenges that Jobs met were very impressive, but they were primarily engineering challenges which could be solved by putting together a bunch of smart people in a room and giving them enough money. The systems he was looking at were largely homogeneous, did not involve too much unexpected feedback and were non-emergent. The challenges that healthcare faces - and this includes the regulatory, economic and informational challenges which the article mentions - deal with highly emergent systems composed of very unexpected feedback and non-linear phenomena arising from extremely heterogeneous and diverse players. Solving those systems is not a matter of designing a better mousetrap, it's one of understanding what a mouse is in the first place. Steve Jobs would not exactly have been the right candidate for unraveling that particular pickle.