EDITOR’S NOTES
What Does Jared Diamond’s ‘Guns, Germs, and Steel’ Have To Do With the Current Moment in
U.S. Healthcare?
The Pulitzer Prize-winning book makes it clear that initial inventions need much time and effort to be refined into society-wide usefulness
J Mark Hagland M k H l d
ared Diamond’s 1997 book Guns, Germs, and Steel: The Fates of Human Societies is such an intellectually rich work that it really does take
more than one reading in order to be fully absorbed. For its conceptual achievement, the book won the 1998 Pulitzer Prize for Diamond, a geography and physiology professor at the UCLA School of Medi- cine, as well as a 1999 National Medal of Science, and a MacArthur Foundation fellowship. As the Wikipedia entry on Diamond notes, Guns, Germs, and Steel “asks why Eurasian peoples conquered or displaced Native Americans, Austra- lians, and Africans, instead of vice versa. It argues that this outcome was not due to biological advan- tages of Eurasian peoples themselves but instead to features of the Eurasian continent, in particular, its high diversity of wild plant and animal species
suitable for domestication and its east/west major axis that favored the spread of those domesticates, people, and technologies for long distances with little change in latitude.” In chapter 13 of the book, “Necessity’s Mother: The Evolution of Technology,” Dia- mond discusses at length the various theories around why certain societies have been more assertive and forward-thinking in developing and adopting new technologies over time. At one point, he writes this: “The starting point for our discussion is the common view expressed in the saying ‘Necessity is the mother of invention.’ That is, inventions supposedly arise when a society has an unfulfilled need: some technology is widely rec- ognized to be unsatisfactory or limiting. Would-be inventors, motivated by the prospect of money or fame, perceive the need and try to meet it. Some inventor finally comes up with a solution superior to the existing, unsatisfactory technology.” That said, he notes that many of the inventions most fundamental to the technological advancement of modern industrialized societies did not initially come out of immediate necessity; among those, he notes, are Thomas Edison’s phonograph (1877), and Nikolaus Otto’s first gas engine (1866). In both of those cases, the author points out, the inventors started from a place of intellectual, scientific curiosity.
Indeed, Diamond notes, “Because Otto’s engine was weak, heavy, and seven feet tall, it did not recommend itself over horses. Not until 1885 did engines improve to the point that Gottfried Daimler got around to installing one on a bicycle to create the first motor- cycle; he waited until 1896 to build the first truck.”
I thought of that chapter of Diamond’s book as I was completing our cover story for this issue on the plunge of advanced multispecialty medical groups into value-based care delivery and payment contracts, including into two-sided risk contracts. What those lead- ers are finding is that strategic vision, very strong provider network-building, cultural change, and continuous clinical and operational performance, facilitated by and driven by the leveraging of data and analytics, are all absolute critical success factors. And the reality is that, just as in the very early days of gas engines and automobiles, it’s impossible to see far into the future which delivery and payment models will end up being the most successful and moving us into the future of healthcare. Right now, the healthcare delivery system resembles, by analogy, what the auto indus- try (which wasn’t even an industry in any true sense back then, decades before Henry Ford’s assembly line) looked like in the 1890s. So much work remains to be done, but it’s exciting to be moving into the new, coordinated, value-based healthcare—with so many discoveries yet to be made to get us into a transformed system.
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