Less Is More

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My favorite piece of camping equipment is a BioLite stove.   Using only the kind of tiny twigs that would barely serve as kindling for a fire, it not only produces enough heat to boil a pot of water in less than 5 minutes, it also generates electricity for charging a phone.  Designed for poor countries where access to electricity and fuel is a challenge, it happens to be far better than the large majority of “high tech” stoves I’ve seen.  It’s a great example of so-called reverse technology transfer: more “primitive” technology is adopted by a more “advanced” culture.  (Sorry for all the “quotes.”)

Another great example is known as kangaroo mother care.  Developed in the 1970’s in Bogotá, Colombia, as an alternative to expensive and unavailable incubators for the care of premature infants, it involves, according to the World Health Organization, early, continuous, and prolonged skin-to-skin contact between the newborn and mother; exclusive breastfeeding; early discharge from the health facility; and close follow-up at home.  It doesn’t get more low tech than basically holding and nursing the baby.  Seems like a reasonable alternative to fancy equipment like a neonatal incubator.

Except it isn’t.  It’s better.  A recent review of 124 studies of kangaroo care, published in Pediatrics, demonstrated that for babies under 2000 grams (4 pounds 4 ounces), infants receiving kangaroo care had 36% lower mortality and sharply reduced rates of a number of serious complications compared with those receiving conventional care.  Because of the large number of studies included, the authors could look for important differences between them to test the robustness of the findings.  Of note, one third of the studies were performed in high income countries like the US (where conventional care is high tech), and the advantages of kangaroo care were similar.  We provide kangaroo mother care for eligible infants in the neonatal ICU at Children’s Hospital of Wisconsin.  While it may seem incongruous in one of the most sophisticated NICUs in the world, the evidence shows that it is better and cheaper.  That’s the definition of value.  And parents love it!

Oral rehydration therapy is another example of reverse technology transfer – a third-world technology that is equally or more effective than the more expensive, resource intensive , first-world alternative.  I wonder how many more such value-laden options are on the horizon, especially as we become increasingly aware of the hidden costs (e.g., carbon footprint) of much of our technology.  Agriculture may become a prime example; many of the techniques of sustainable agriculture, which is growing exponentially in the US and Europe, started as alternatives to the modern miracles of fertilizer and pesticides in resource-poor settings.

At a recent conference on innovation in pediatrics, there was a good deal of discussion about “design thinking.” This is a method of innovation in which the first steps are to truly understand and define the actual need, not just the stated or perceived need.  It is tempting, especially in the industrialized world, to define the problem in terms of technology.  But technology is not an ends, it’s merely a means.  The question isn’t necessarily how to build a better mousetrap, it’s what are other ways of getting rid of mice.   If Dr. Sanabria had defined his problem as “how do I make a less expensive incubator?” he would have come up with something different.  His insight was to see that the actual problem was “how do I provide appropriate womb-like conditions for preterm infant outside the womb?”  In the US, that meant an incubator.  But in Colombia, that became kangaroo care.

As we seek to provide better value in healthcare, we have to continue to look everywhere to find it, even in the most unusual places, like the pouch of a marsupial.

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