What precisely does innovation mean in the context of healthcare? Delos "Toby" Cosgrove, MD, the newly appointed president and CEO of the Cleveland Clinic, addressed that question in his opening remarks for the Medical Innovation Summit. "Our willingness to innovate will determine the clinical, social and economic future of medicine in this country," he told a rapt capacity crowd. "Our challenge is to create an architecture that supports innovation."

Cosgrove said that if the era of the 1980s was about quality, and that of the 1990s was about re-engineering, "certainly, the 21st century is going to be about speed."

This speed, he said, has come about because of an explosion of new knowledge. He noted that 90% of all the world's scientists who ever lived are alive today, and they have created more new knowledge in the last 40 years than in the preceding 5,000. "That means that the total amount of knowledge doubles every 2-1/2 years," he said.

With such an explosion, Cosgrove said that new techniques in the healthcare field are becoming obsolete, on average, every seven years. Despite this rapid push toward obsolescence, he said that we must think of medicine in terms of what it brings to society and the importance of innovation to bring new inventions to society.

As an example of the benefits to society of this rapid innovation, Cosgrove traced survival rates in the U.S. back to 1900, when, he noted, 18% of all males died by the age of one. A century later, 18% of the male population was not dead until age 70. And innovations in medicine – particularly in the past half-century – have helped extend average life expectancy overall to 76.

With this year's focus at the Medical Innovation Summit on cardiovascular healthcare, Cosgrove noted that innovation has contributed to a 40% decline in deaths from heart disease in the U.S. since 1950. He attributed this decline in death to three things, breaking down roughly to a third apiece: behavioral modification, drug therapy and invasive procedures such as heart bypass surgery and stenting.

While acknowledging that the cost of healthcare continues to increase, Cosgrove also pointed out that advances in healthcare have contributed greatly to gross domestic product (GDP) in the U.S. over the past 30 years. Half of the increase in the GDP over that time period was attributable to the increases of life expectancy, he said. And of that number, he estimated roughly 50% was the result of reduced deaths from cardiac disease. To obtain these advancements in medicine and healthcare, the right people are, and still will be, needed – "the innovators," Cosgrove said.

Many of these past innovators were at the cusp of what was acceptable at the time in the field of medicine, he said. Importantly, he emphasized the presence of forward-thinking institutions that tolerated and nurtured these "renegades." To further demonstrate the importance of the rebellious spirit in medicine, Cosgrove cited the example, at the Cleveland Clinic, of Mason Sones, MD, who pioneered moving cine-coronary angiography in the mid-1950s. His discovery in turn led to Cleveland Clinic colleague and fellow renegade Rene Favaloro's performance of the world's first published coronary artery bypass procedure in 1967.

Cosgrove said he is "fully aware" of the difficulties that entrepreneurs and innovators face going forward, since "no one particularly appreciates change to the established order of things and this singly has been true forever."

Holland Johnson, Associate Managing Editor

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