If you follow this blog, you already know that I consider it fundamental to learn from errors—especially from others’ mistakes or unsuccessful experiments.
Today, I’d like to explore why a medical innovation, even if effective and potentially lifesaving, might not succeed. I’ll discuss the factors that underpin the success of innovation.
Let’s begin with one example of medical innovation that failed to gain traction.
A Very Old Example
In the past, scurvy was a deadly disease, especially among sailors. In fact, in 1497, the crew of Vasco da Gama—the first to sail around the Cape of Good Hope—was decimated. At the time, scurvy killed more sailors than any other cause.
In 1601, English captain James Lancaster conducted an experiment to test the hypothesis that lemon juice could prevent scurvy.
He decided to serve a daily dose of lemon juice to the sailors aboard the largest of his four ships on a voyage to India. Not a single sailor on that ship developed scurvy, whereas on the other three ships, 100 out of 278 sailors died from it.
The results were compelling, yet the British Navy did not adopt this simple, cheap, and effective preventive measure.
In 1747—about 150 years later—British Navy physician James Lind carried out another experiment aboard the HMS Salisbury. He prescribed citrus fruits to treat scurvy patients, with excellent results.
Still, it wasn’t until 1795—nearly two centuries after Lancaster’s successful trial and forty-eight years after Lind’s evidence—that the Navy began prescribing citrus to all sailors. Astonishingly, it took another seventy years, until 1865, for the merchant marine to adopt a similar policy.
Why did it take so long to adopt a simple innovation that could have solved the leading cause of death among sailors?
It’s difficult to pinpoint a clear explanation for such a delay. However, this example illustrates that a beneficial medical innovation alone is not enough to ensure adoption.
A More Recent Example
You might think that the slow diffusion of useful innovations only occurred in the past, before the scientific method became standard. But consider a more recent case: the Dvorak keyboard.
The QWERTY keyboard was originally designed for typewriters to slow down typing and prevent adjacent mechanical arms from jamming.
The QWERTY layout is highly inefficient, making us work about twenty times harder than necessary.
The Dvorak keyboard offers clear advantages over QWERTY, especially in terms of typing speed and comfort.
Nevertheless, since 1873, QWERTY has remained the standard—and we still use it, despite the availability of a much more efficient alternative.
Once again, we see that good ideas and effective innovations don’t necessarily spread quickly—or at all.
How Innovations Are Adopted
These two examples are drawn from Diffusion of Innovations by Everett Rogers, whose work was later expanded upon by Geoffrey Moore in the well-known book Crossing the Chasm.
I’ve already discussed the topic of early adopters and how innovative products gain traction in the market.
Looking at the adoption curve from the perspective of innovation, Rogers identified five key characteristics that drive a product along the adoption path.
The Five Attributes of Innovations
- Relative Advantage
- Complexity
- Compatibility
- Trialability
- Observability
These five factors form a comprehensive framework for understanding innovation. Rogers demonstrated that individuals’ perceptions of these attributes predict the rate of adoption.
The crucial insight here is that all five attributes must be addressed. The examples above show that focusing on just one is not enough—and neglecting even one may prevent adoption altogether.
In Part 2 of this article, I’ll analyze each of these factors in detail.
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