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Clayton Christensen’s Prescription For Health Care

In the 1990s, Clay Christensen championed disruptive innovation.Then he got hit with diabetes, a heart attack, cancer and a stroke. Now he’s talking health care. We’ll listen.

Clayton Christensen (Courtesy of Evgenia Eliseeva/Harvard University)

Clayton Christensen (Courtesy of Evgenia Eliseeva/Harvard University)

In the 1990’s, big-thinking business guru Clayton Christensen was a colossus in the world of business theory. His “Innovator’s Dilemma” and theory of “disruptive innovation” were at the heart of the Internet revolution.

Then, Christensen turned to health care. Very personally. He had long had diabetes, but in recent years, in just his fifties, Christensen the colossus was hit with heart attack, cancer, stroke.

A brutal parade of health challenges. Now he’s really thinking about health care. Disruptively.

This hour On Point: disruptive innovation champion Clay Christensen on American health care.

- Tom Ashbrook


Clayton Christensen, “one of the most influential business theorists of the last 50 years,” according to Forbes. Professor, Harvard Business School and author of “The Innovator’s Prescription: A Disruptive Solution for Health Care” and “The Innovator’s Dilemma: The Revolutionary Book that Will Change the Way You Do Business.” He is co-founder of the consulting firm Innosight and founder of the investment firm Rose Park Advisors. He was featured last month in Forbes magazine in an article titled “Clayton Christensen: The Survivor.” He has suffered from diabetes, a heart attack, cancer and a stroke.  See a photo gallery and some video on the Forbes site.

George Miller, congressman representing the 7th District in the East Bay of San Francisco since 1975. He was one of three committee chairmen who wrote and passed President Obama’s healthcare plan. He is senior Democrat of the House Education and Workforce Committee, which helps oversee the implementation of the healthcare plan and chairman of the Democratic Policy Committee.

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  • Bfabbio

    WhiteGlove House Call Health is bringing change and innovation to healthcare in America — and is completely aligned with Clayton’s thinking!

  • Peter

    Like you sir I got hit by heart problems and cancer. My wife is a nurse and when teh kids were young worked for an insurance company, she knew the system. When I needed by-pass surgery we did it by the book for gettinmg clerances from the insurance company.

    After the surgery for a six way by-pass teh first letter from the insurance company who had approved teh procedire going in was they were not going to pay anything because we had not followed the alternative teatment, which in this case was death.

    Once reminded they had approved to begine with the second letter was you had two surgeries, one to harvest the grafts $5,000 and te second to do the actual by-passes $50,000, and they were going to pay for the harvesting only.

    If left to their own devices as teh Republocan plan wants to do the death toll will be comperable to that one would expect to see in a war. The repuiblican plan is based on the idea healthcare is not a right but a privilage and only those who can afford it are entitled to it.

    The question for America is, are American’s entitled to healthcare regardless of their ability to pay or is healthcare only for thos e who can pay?

  • Glenn K.

    He is one of my favorite authors. Glad you’re having him on!

    I think even more radical changes will be needed in our culture at large to really reform our health, but at least Clayton is thinking outside the typical partisan box we hear so often these days.

    Disruptive Innovation involves vision and that is so important now.

  • TerryTreeTree

    The biggest problem with Health Care in the U.S., is the ‘Death Panels’ of Insurance Company Executives, that can deny services, due to a one cent payment shortage, or just their whim! Any guilty of such, should have their, and their family’s health care REVOKED, and be on a list like the victims of the Tuskeegee Experiment, for any treatment. Maybe they would trade a bit of their blood money! Probably not, money is their god!

    Terry , in Brewstertown, Tenn

    • Anonymous

      It is only a death panel if it is the government. When corporations do it is freedom!

  • http://pulse.yahoo.com/_X3Z6OE5BMIXVJTBKLRJL2JOUMU HiltonE

    Want to really know what’s wrong with the American sick care system?
    Read or listen to this:


    The premise of Massachusetts RomneyCare and its metastatic descendant ObamaCare is that uninsured patients are gouging insured patients when they walk into a hospital without an insurance card.

    However, as Mr. Sloan points out an uninsured patient can be charged 3x, 4x even 5x as much as the card carrying patient guaranteeing the patient’s inability to pay.

  • Joe Beckmann

    Massachusetts has cut the number of new cases of HIV/AIDS from 1100 to less than 600 in five years. At $500,000 per case for a lifetime of care, that alone is worth $250,000,000 per year for every year the number is at 600. In fact, the drop is 10% a year, or another $25,000,000 PER YEAR in real savings compared to where we were just six years ago, and even more compared to Texas and North Carolina with more and more cases every year.

    Where’s the money?

  • Rex Henry, Washington, DC

    What the hell was this guy eating? Shouldn’t we be talking about preventing these diseases by addressing the FDA and what is deemed healthy?

  • Howard

    I wish someone would tell Ashcroft that the point of a talk show (at least for me as a listener) is to let the GUEST talk. Why does Ashcroft think it’s so important to keep running his mouth?

    I wish, too, that someone would do a count of the number of words spoken by Ashbrook, and by guests (on average) and see how those numbers compare.

  • Anonymous

    All right, enough metaphors. We need reform that works now. Lay out what you want to do.

  • Grotman

    I have the greatest admiration for you sir, but I fear that unless you can get America to do a 180 degree turn in basic human morality, you will change nothing. Healthcare America is simply another capitalistic business where money and profits are everything. We will never change our outlook or learn from others who actually care about their fellow human beings.

    The Hypocrites Oath abounds with the motto “Capitalism Uber Alles”!!

  • Anonymous

    I’m buying into the system that Christensen is proposing. How will it work for someone with a chronic illness, such as the diabetes that he has?

  • Michael

    Interesting guest.


  • http://profiles.google.com/elisemarie24 Elise Rapoza

    I’m curious to know where the pharmaceutical companies fit into all of this. It seems to me that we are very over medicated, especially at young ages.

    • Anonymous

      And the medicines that are needed are exceedingly expensive.

      • Obelix05

        Still, drugs only account for approximately 10% of health care costs. While it is always reasonable to see if there is excessive spending, let’s not loose sight of the other 90%. A point in case – for profit insurance companies account for more spending than pharma drugs!

        • http://profiles.google.com/elisemarie24 Elise Rapoza

          Good point, but there’s also a social cost.

  • Yar

    How I would change health care costs. I would add an hour of exercise each day in grades k-12, I would add two years of community services upon graduation from high school. I would use a single payer system and use those in their two years of community service to provide the grunt work of patient care.

    Currently we don’t even know what we pay for our health-care. It is added in every product we buy and every service we use. We pay for it with insurance and taxes. Twenty percent of our GDP is health (sick) related.
    If I could get one law passed, it would be that all health care costs must show on the pay stub. And all health services charges must be publicly posted online.
    We buy health care like we buy a used car but without knowing the price we will end up paying.

    • Ellen Dibble

      Recent bill from Blue Cross for a bunch of blood tests: It showed that the charge was something like $650. They were pleased to tell me I only have to pay about $250, which is the full price, but it is Blue Cross’s special deal for their insureds. I had negotiated with my doctor, that it was important for medicine to see what my blood is doing. It is not important to me.

  • Waitabit

    I agree with a lot of what Clayton says, but the big issue about changing the system is that there is a gigantic flow of money in place in a very dysfunctional pattern. All the players who feed on that are firmly in control of Congress and will never allow the money to be cut back. Kaiser Permanente style HMOs make lots of sense, but how can we get there?

    • wcwinder

      More true words were never spoken! The biggest lobby in the world and they have about 60% of congress, (100% of Republicans) in their pocket.

  • Ronald Mignery

    In Germany, health coverage includes some weeks at a health spa. Though this sounds extravagant to us, it does get the patient to focus on health even when healthy. Is this an example of disruptive innovation?

  • http://pulse.yahoo.com/_X3Z6OE5BMIXVJTBKLRJL2JOUMU HiltonE

    The Apple way as a solution to the sick care system? Hmm. Last time I saw Macs cost twice as much as Dells and use the same Intel processors.

    • Rick

      A part for part comparison of a Mac Book Pro with the equivalent Dell indicates that the costs are within 50-100 bucks of each other.
      Neither your point nor mine says anything about the point being made with the analogy.

    • Evan

      The PC vs Mac analogy is about components working better together and being aware of one another (i.e. doctor’s preventing hospital visits).

      Yes, the *price* of a Mac is higher than a PC. But the *cost* of making a Mac and a PC is about the same. Apple simply charges much higher profit because the product is better. This isn’t the important part of the analogy.

      The important part is to prevent viruses and other expensive repairs!

      • http://pulse.yahoo.com/_X3Z6OE5BMIXVJTBKLRJL2JOUMU HiltonE

        “The important part is to prevent viruses and other expensive repairs!” —

        Viruses are an OS problem an not a hardware architecture problem. A PC running Linux is not virus prone. And, before Macs converted to an OS with an underlying unix type kernel they were susceptible to viruses.

        No about the point of integration. PCs have had industry based standards for integration since the cloners broke away from IBM proprietary architecture. The need to have a monopolistic dictatorial Jobsian overseer is greatly exaggerated.

        • Potojava2001

          ALL current operating systems are vulnerable to viruses and other types of exploits. Just because there aren’t very many viruses that target Macs and Linux does not mean they are inherently any safer than the Windows platform. You should check out the results of Pwn2Own, the industies highest profile hacking competition, to see how all these competing platform stand up.

          OF course this is all a bit besides the point. The bottom line is that the analogy that was drawn was a terrible one because it was incorrect on the facts. If you take the covers off your Macs and your Dells, you see the same thing: the same parts built by the same guys from the same places. The analogy was silly.

  • Mary

    As a nurse, the patients I care for most often have caused their own problems through lifestyle choices and poor compliance. These people are in the hospital repeatedly, seeking narcotics or free meals. They are often truly sick but only do things to make themselves worse. We waste our resources on them. What can we do to remove these people from the healthcare system so we can focus on the people who really need us and will work to get healthy.

    • Mimi

      Your attitude is more suited to someone who counts beans. May God protect us from the judgment of sanctimonious and arrogant nurses. Most nurses are angles of mercy and compassion thankfully.

    • Mimi

      Most nurse are ANGELS of mercy and compassion. Thank God.

  • wendy

    Not only do I find Clayton Christensen’s work remarkably “on point”, but I was thrilled to hear his reference to dental sealants at Kaiser Permanente. We infrequently recognize oral health as a critical component of overall health, nor do most folks understand the link between oral disease and other systemic diseases including heart disease and diabetes. We need to address health from the perspective of the entire body, removing body parts from the silos of our specialty-driven non-system.


  • Sam Soltani

    Our start-up company, BioSensics is focused on development of wearable sensors for biomedical applications with emphasis on in-home monitoring and biofeedback systems for patients. These types of technologies will bring costs down.

  • Tom Rodgers

    why have we in medicine abandoned our oaths by accepting low effort, profit driven “Best Practices” instead of the caring diligence embodied in our “evidence based medicine” of 30 years ago?

  • Tfenberg

    It seems that the physician is constantly portrayed as the villain. As if cutting their pay is the sure way to save money. I also have to disagree that all doctors are out there just waiting to cut you open to get a buck. My husband is finishing his 10th year of training and we are finally getting a job so that we can pay back the thousands of dollars of debt we have incurred. If we go with systems like IHC then the money is simply transferred from the physician to the ceo/cfo or whoever else is at the top of the chain. Would it not lead to the “wal-mart effect” where you have one company who is providing services telling us what we can or cannot get in healthcare. The citizens of this nation want a quick fix for any ailment on the spot and for free.

  • Karen in Newton MA

    Mr. Christensen, Aren’t you not talking about “HMO’S”? This is what we were doing a long time ago and “HMO” became synonomous with “Bad Health Care”.
    ANother comment, having dealt with the medical system as my parents died, it was evident that hospitals and nursing homes are clearly aware of how much they will be paid my Medicare. My sister and I could predict when my father would be “kicked out of the hospital” when the Medicare payment for his illness would stop paying. Disgusting. Terrible care. For my mother, we were better educated and kept her out of the hospital. Visiting nurses were wonderful and gave her such good care at home.
    Good luck in changing the system.

    • Rick

      HMOs were focused still on fee-for-service type model. Insurance companies actually set ratios per patient visit, say ‘x’ blood test per visit, ‘y’ prescriptions. If the ratios weren’t hit, the reimbursement per patient-visit is reduced during the next insurance period. That’s not what Christiansen is recommending

    • citizen dan

      He’s not talking about HMO’s, but about lateral integration: doctors, hospitals, insurance systems, research , all with a working knowledge of each other’s limitations, & all focused , through a mission statement , I suppose , on better health outcomes first and foremost.

  • Duke

    The biggest problem in health care reform is going to be, not the profit made by the Doctors, so much as the profit made by the insurance companies and their Wall Street investors.

  • ddm

    I am no expert, but I question your guest’s research if he can only throw out a “tech will fix it” argument. His computer analogy is also weak. But let’s take his computer analogy as a starting point. He proposed to examples that are really two sides of the same coin. It breaks down as monopoly A (the Dell computer, really the win-tel monopoly) vs. monopoly B (the Apple computer monopoly). In computers, there is a third option, the open source movement. That movement doesn’t have profit at its heart, and should also be applied to health care, if we’re going to proceed with this analogy. Applying the open source movement to health care is appropriate because many health care professionals decide to become doctors/nurses/etc. to actually help people, not just make money. Just because the system, as currently setup, is channeling obscene amounts of cash to them, you can’t fault them for taking it. The long term problem is we won’t be able to continue to keep up with the current pay schedule and escalation. Eventually, it will consume too much of the GDP. In my opinion, we’ll only change when health care has totally broken down and absolutely broken the bank.

    My recommendation to Christensen is to go back an watch Michael Moore’s Sicko, and see if there is not something he can learn from what that movie says about how the rest of the world deals with the same problem.

    • a will . a way

      I think the computer metaphor was a bit misleading. Christensen also said that cutting doctors pay will not help.

      The Health care systems at Kaiser and i believe at the Mayo clinic are very successful and are known for having the best patient care at a more reasonable cost. I cannot understand why the government and President Obama do not use their model to change things. Actually i do know why…the insurance industry has the largest lobby system in the world and the own the republicans and a good portion of the democrats. until you fix that problem health care is going to keep rising and their death panels will flourish.

  • Mary

    Why don’t we determine what percentage of GDP we will devote to healthcare each year. Then we take that amount and decide how it can be INVESTED to promote the overall health of the citizenry. If we cannot find the money to pay for expensive treatments that buy very little time or quality of life, those treatments are not paid for and we do not provide them to people. Also if someone does not follow their treatment plan, they do not get further treatment beyond hospice care.

  • Worried for the country(MA)

    Mr. Miller, how many of the 2,200 pages of health care bill were you responsible for? How many more pages will you add to now add Clayton’s innovation to the scheme?

  • BHA in Vermont

    Get rid of the cavity, no work for the dentist?
    Bad logic. There are many things the dentist does that require more of their training than filling cavities. I suspect any decent hygienist could easily be trained to fill most cavities.

    An analogy: My uncle was a CPA for 25 years – rose from employee to president. He HATED doing income taxes. The tax laws changed yearly, evnt the IRS employees have no hope of understanding them. Of course he got paid for to do taxes but as far as he was concerned, getting rid of income taxes would allow him to spend more time helping his customers run their businesses more efficiently.

    The point? Keep peoples’ mouths healthy and the dentist won’t be spending time on necessary but boring work.

    • BHA in Vermont

      Oops, typo, make that 35 years,

  • Randyrinaldo

    I have been in a similar circumstance with health. I have had cancer (an aggressive type of skin cancer) I’ve had AF (atrial fibrillation) I’ve had several lower back surgeries etc; what I’m trying to say I have seen the ins and outs on how the SYSTEM works.

    Out culture has been duped and dumb down by the powers that be. When the Manhattan project was done there were only a few people at the top who knew how to build the a bomb. There were thousands of people who were “experts” and or specialists in their field but didn’t have a clue what they were building.

    I would also say that I started my life in the field of medical field because I had this “innate” desire to be a person and give back to people and become a servant of the people for many different reasons but it wasn’t about money, my pay at that time was less than 500.00 dollars a month.

    Why is the “desire” of being a physician being murdered by the collective forces of the for profit organizations where profit has become the forefront of the “profession” and that “practicing” medicine is a false assumption of the community of physicians? In the minds of the patient “practicing” doesn’t ring a bell because the SYSTEM has been allocated into divisions where the effort to maximize profits have taken “practicing” medicine out of existence and the word “practice” has been replaced with the “specialist” agenda. A specialist can do his JOB and go home and never allocate his time to his medical standing because he has be allowed to narrow his field of medicine so he is granted a reprieve from being a physician with such a “desire” to accumulate more knowledge about the body as a whole thus the problem lies in the way that the structure of the system is bound to such elements that put up barriers of information that the system has created as a behemoth that sends me to so many different “specialist” thereby the system claims me as a piggy bank that is sent around the lot to shake money out of. I am irritated by the conditional circumstances that appeal to such a clientele of people and AND the preferential corporations that have become leaches and riding on the coattails of the SYSTEM who are not in medicine for the right reasons and are “driven” into the “market” for other reasons and as a cultural mindset the real physicians and or those who would have been physicians end up never becoming one because the landscape of such a profession has taken on a new suit of cloths that drives the people with such an innate desire away; as I was. It like who in their right mind would want to be president today thinking about in what capicity a president is under today verses when one person went in so he could be of service to his fellow man instead of being a “politician”

  • Bob

    Disruption has to come in the form of advanced technology that dramatically reduces the cost and improves the access and the health care experience. In addition, there must be disruption around the fundamental business model used to pay for medical services and prescription medications where providers move away from fee-for-service. The fundamental health care delivery system in the U.S. costs too much and until new, integrated, technology enabled delivery systems emerge like that offered by WhiteGlove House Call Health where 60-70% of the medical services can be offered to consumers and employers at a fraction of the cost of the current system with a much higher quality experience, little will change! This is what needs to be fixed.

  • Katherine

    Why don’t we know what every service, test and procedure costs – upfront. This is the norm in France, where medical costs are about a quarter of what they are here. The cost of everything is posted in detail in every doctor’s office there. French patients pay at the time of their medical visit and get reimbursed 70 percent. Here it benefits the medical industrial complex for us not to know the price of care. Wouldn’t car dealers love such a system.

    • Anonymous

      Had a doc who really pushed me to get an unnecessary procedure. They don’t publish the costs because in a fee for service scenario it’s best not to let you know what you’ll have to pay!

  • Jen in VT

    An excellent and thoughtful guest. I invite him to come to Vermont and contact the Governor and Senate and House Health Care committees, who at this moment, are trying to design a new, hopefully integrated system that Mr. Christensen envisions. His input would be greatly appreciated here.

    • Cmc

      Jen, I’d be delighted to meet with them — I’m close, in Boston. Are you in a position to introduce me to someone in the committees or the Governor’s office? If you can help, please call our office at HBS: 617-496-4379, and I or Emily Snyder can connect them. Thanks!!

  • http://LicenseToKill.us Thomas L Rodgers

    Why have we in medicine abandoned our oath and accepted low effort, high profit driven “Best Practices” (foisted upon us by the insurance and bankers in medicine) as opposed to the caring diligence of “evidence base medicine” efforts we practiced 30 years ago

    I have several cases where “Best Practices” fails and actually set up the victims for death (even prosecution in law). See what I have published wherein 34 million are at risk and are being betrayed by “Best Practice” in its failure to identify a common poisoning. See http://LicenseToKill.us or http://CarbonMonoxideCoverup.com

  • Sara

    I waited for 20 mins to speak and then you turned the show into a political forum for Mr. Miller. I have 2 comments: 1. The healthcare system needs to go back to a more patient-centered approach, and 2. We should shift more$$ into education and prevention. These are both disruptive ideas. Sara Meeks, PT ,MS, GCS from FL with 50 years in health care. Thanks for a great show (until it became a political forum.)

  • Benharpo

    I agree that education and prevention are the way to go. I further accuse the Medical Scientific establishment of following orthodoxy and not practicing good science. Herbal medicine certainly works. Most medicines are molecules isolated from living things. Doctors seem to know the benefits and risks of commercial chemicals discovered only a few years ago and be completely ignorant about plants like comfrey.

  • http://profiles.google.com/awarelisa Lisa Tansey

    I hope he’s read David Goldhill’s September 2009 Atlantic article – “How American Health Care Killed My Father”! Talk about a useful innovation!
    Let folks spend their own money; seek value; eliminate the insurance company middleman, etc.

  • Incarau

    I’m really surprised that Mr. Christensen got so sick when he knows better, that “we are what we eat”. Since he is a good reader, specially of The Book of Mormon, and Doctrine and Covenants, which in one of its Section says: “I, the Lord, have ordained for the use of man with thanksgiving; nevertheless they are to be used of sparingly; 13. And is pleasing unto me that they should not to be used, only in times of winter, or of cold, or famine.” (D&C 89:13). That’s the key to be healthy, those that follow this ” shall receive health in their navel,and marrow in their bones; 19. And shall find wisdom and great treasures of knowledge, even hidden treasures;20. And shall run and not be weary,and shall walk and not faint.” what a promise!. Prevention is the best policy, in other countries they call Doctors; agents 007, (James Bond) because “they have license to kill.”

    • Sanyarey

      Dibiates is not caused by what we eat only. Experts cannot tell why some skinny guys are getting. It is a dangerious disease — and you have fallen for the sterotype of the disease for those who do not know much about

      • Anonymous


    • Gfunk Chan

      Furthermore, he has type 1 diabetes, which is a disease caused by an auto-immune reaction most people get when they are small children.

  • Jens

    Two amazing factlets:

    1. Atul Gawande wrote a fantastic piece in the New Yorker a couple of months ago (http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande). Innovation is not only in new drugs and more spending within the health care system – there’s an important social component. Helping the ‘Hot Spotters’ to manage their health benefits all of society.

    2. Around 50% of Medicare spending occurs during the last 60 days of life. A society-wide discussion about life-extending measures is unavoidable if we want to save Medicare.

    Breakthrough innovation cannot only be found in science but also resides in societal consensus on important issues like ‘health management’ and end-of-life questions. Unfortunately, these are topics folks like Congressman Paul Ryan have not in their vocabulary.

    • Anonymous

      > A society-wide discussion about life-extending measures is unavoidable if we want to save Medicare.

      I think one of the great things about the Kaiser system is that doctors are paid a salary, not a fee-for-service. So many of the treatments in those last 60 days are NOT kind to the dying patient (two great books on the subject: “Overtreated” and “A Life Worth Living”.)

      On a different program someone said, “It’s difficult to convince someone of something if their salary depends on the opposite”. This is true in medicine too.

      I watched two grandmothers suffering compounded by the system. I don’t even want to talk about.

  • Newtfink

    Tom, You are brilliant! But sometimes you use too too many words rephrasing and summarizing .. when you often have such a clearly-speaking guest as Clayton Christensen and you should let him talk! And then today, you interrupted him (as necessary on-air) when he was about to make a huge point I think about building incentives into the system to encourage people to adopt a healthy lifestyle. He was saying only about 15% act as though they care about being healthy ….. And when you came back live, you didn’t pick it up. Same happened earlier during your budget piece when the retired air force guy said the military was still in cold-war mode and could cut half. I love your show, but stay “on point.”

  • Beth

    Very interesting show today. I mentioned Clayton Christensen’s views to my dad and asked him to look into it further. I know he will. Aside, I want to say how much I look forward to your show each day. The kindness in your voice resonates deeply. We can feel how genuine you are and how you care and respect your guests. The warmth you impart makes me listen carefully to your intelligent questions and I can only imagine what a fully participating and loving father and husband you must be. Thank you for your hard work in producing insightful and current programming.

  • Rick O’Neal

    It’s such a joy to hear a big-picture type of thinker for nearly a whole hour of radio. Also what a relief (for nearly an hour) not to hear the anxiety-provoking jangle and claptrap coming out the halls of Congress these days. Just an hour of calm, clear thinking. I believe it is quite accurate as well. Would love to hear more like this.

  • Guest

    Mr. Christensen needs a new and factual analogy because, Apple hardware systems are no better integrated than Dell’s. Both use components from dozens of vendors and in fact Apple’s are less flexible for change in configuration because the Apple platform and vendor’s don’t have as much software/support for something say like the latest generation videocard. Companies in Asia (other than Dell and Apple, like Foxconn) make the computers for them too. Apple and Dell hardware is so similar, generic, and commodity based, you can run OSX, Windows, or Linux on either machine – http://wiki.osx86project.org/wiki/index.php/Main_Page

    Even the heart of Apple’s most integrated product (which Apple again uses Foxconn for), the iPhone 4, was made and designed by Samsung – http://www.engadget.com/2010/06/08/apple-ipad-and-samsung-wave-share-a-brain/

    While the software EXPERIENCE may be better integrated, the initial and total cost of ownership for Apple system remain higher than Dell which almost no fortune 500 companies use primarily Apple systems (especially in the back office for things like server – Apple’s server were a huge flop). Apple also intentional leaves features out so as to force early upgrades/obsolesce – its certainly not a good way to lower cost – not a good example to follow for healthcare.

    • Potojava2001

      I could not agree more with what you are saying here. I probably could have shrugged this truely awful analogy off if Mr. Christensen and Mr. Ashbrook did not continue to belabor it again and again. It seems apparent that Mr. Christensen has not actually taken the cover off of his Mac recently.

    • http://www.deegardner.com Dee Gardner

      7 years ago I purchased a dell laptop for $2500. That included their 3 year gold next day service. During the 3 years of service. I had the motherboard replaced 3 times because the USB port on the side would break off. I also had the screen replaced once. I had to re install the operating system and all my software multiple times, as is typical with windows machines. I then purchased a mac book pro, I looked at selling the dell. I could get $150 on ebay. So I gave the laptop to my mother. I purchased the Apple Macbook Pro 2.4ghz in Sept 2007 for $2200. I did not buy the apple care. I say that because a year or so after my screen died and Apple replaced it for free. I upgraded the ram from 2gb to 4gb which cost me $100. I have never had to reinstall the operating system or software. And I don’t have to buy virus protestion. It’s been 3.5 years and I can sell my dell on ebay for between $750 and $850. Do some research. Cost of owning a dell is higher from both a money and time spent supporting perspective. I am adding this not to try and convince the apple haters to change. but as another view to those who may read your post.

      • Guest

        I’ve worked for over a decade in IT supporting Unix, Linux, Windows, and OSX. I’ve worked on hardware from thousands of Sun workstation and servers to the most basic PCs from Apple and Dell – this includes work at large companies like Sony Electronics and Lehman brothers to helping out friends and neighbors.

        Your anecdote provides no insight to the actual reality of PC hardware. Outliers are irrelevant, the TCO from Dell is better than Apple which is why there is no trend for businesses to switch on a large scale and Apple’s marketshare in PCs is flat (end-users frequently fail to grasp this simple concept – sample size of one has no significance and does not represent the average picture):


        Also see – failure rate is average as best for Apple according a random Consumer Reports I googled:


        Apple’s marketing, although it fooled you, does not change reality.

        The modern Apple is a consumer electronics company first and foremost, not a relevant PC or server manufacturer.

  • Cindy C

    Congratulations to Clay Christensen for speaking live on radio with aphasia! I started listening later in the show, and was surprised by his stumbling over words, then wondered if he’d had a stroke – and he has. My sister has aphasia from a hemorrhagic stroke (http://myhappystroke.blogspot.com/) and I can only guess how much courage it takes to speak in public when you can’t get the words out.

  • Anonymous

    .The right to the highest attainable standard of health is codified in numerous legally binding international and regional human rights treaties. The right, or other health-related rights, is also enshrined in over 100 constitutions worldwide.


    Improving depression and enhancing resilience in family dementia caregivers: a pilot randomized placebo-controlled trial of escitalopram.
    Lavretsky H, Siddarth P, Irwin MR.
    Am J Geriatr Psychiatry. 2010 Feb;18(2):154-62.PMID: 20104071 [PubMed - indexed for MEDLINE
    Anti-inflammatory effects of antidepressants: possibilities for preventives against Alzheimer's disease.
    Hashioka S, McGeer PL, Monji A, Kanba S.
    Cent Nerv Syst Agents Med Chem. 2009 Mar;9(1):12-9. Review.PMID: 20021334 [PubMed - indexed for MEDLINE]

    Imipramine, in part through tumor necrosis factor alpha inhibition, prevents cognitive decline and beta-amyloid accumulation in a mouse model of Alzheimer’s disease.
    Chavant F, Deguil J, Pain S, Ingrand I, Milin S, Fauconneau B, Pérault-Pochat MC, Lafay-Chebassier C.
    J Pharmacol Exp Ther. 2010 Feb; 332(2):505-14. Epub 2009 Nov 4.

    Involuntary emotional expression disorder in Alzheimer’s disease – psychopharmacotherapy aspects.
    Mimica N, Drmić S, Presecki P.
    Psychiatr Danub. 2009 Sep;21(3):425-8.

    Untangling the roles of antidepressants and mood stabilizers in the treatment of Alzheimer’s disease. Introduction.
    Reiman EM.
    J Clin Psychiatry. 2009 Jun;70(6):913-4. No abstract available.

    Effect of a serotonin reuptake inhibitor on irritability, apathy, and psychotic symptoms in patients with Alzheimer’s disease.
    Siddique H, Hynan LS, Weiner MF.
    J Clin Psychiatry. 2009 Jun;70(6):915-8. Epub 2009 May 5.

    Antidepressants and dementia.
    Kessing LV, Søndergård L, Forman JL, Andersen PK.
    J Affect Disord. 2009 Sep;117(1-2):24-9. Epub 2009 Jan 12.
    Int Rev Psychiatry. 2008 Aug;20(4):382-8.
    Depression in Alzheimer’s disease: phenomenology, clinical correlates and treatment.
    Starkstein SE, Mizrahi R, Power BD.
    School of Psychiatry and Clinical Neurosciences, University of Western Australia, Western Australia, Australia. ses@cyllene.uwa.edu.au
    Effect of citalopram in treating hypersexuality in an Alzheimer’s disease case.
    Tosto G, Talarico G, Lenzi GL, Bruno G.
    Neurol Sci. 2008 Sep;29(4):269-70. Epub 2008 Sep 20
    Dement Geriatr Cogn Disord. 2008;25(4):372-9. Epub 2008 Mar 20.
    Is antidepressant treatment associated with reduced cognitive decline in Alzheimer’s disease?
    Mossello E, Boncinelli M, Caleri V, Cavallini MC, Palermo E, Di Bari M, Tilli S, Sarcone E, Simoni D, Biagini CA, Masotti G, Marchionni N.
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. enrico.mossello@unifi.it
    J Biol Chem. 2007 Nov 9;282(45):32676-88. Epub 2007 Sep 2.
    Involvement of prostaglandin E2 in production of amyloid-beta peptides both in vitro and in vivo.
    Hoshino T, Nakaya T, Homan T, Tanaka K, Sugimoto Y, Araki W, Narita M, Narumiya S, Suzuki T, Mizushima T.
    Graduate School of Medical and Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Kumamoto 862-0973, Japan.
    J Biol Chem. 2007 Nov 9;282(45):32676-88. Epub 2007 Sep 2.
    Involvement of prostaglandin E2 in production of amyloid-beta peptides both in vitro and in vivo.
    Hoshino T, Nakaya T, Homan T, Tanaka K, Sugimoto Y, Araki W, Narita M,
    Starkstein SE, Merello M, Brockman S, Bruce D, Petracca G, Power BD.
    School of Psychiatry and Clinical Neurosciences, University of Western Australia, WA, Australia. ses@cyllene.uwa.edu.au
    Fukushima J Med Sci. 2006 Dec;52(2):143-8.
    Effects of fluvoxamine on behavioral and psychological symptoms of dementia in Alzheimer’s disease: a report of three cases.


    As depression predisposes to Alzheimer’s disease, it is reasonable to suspect that antidepressants are capable of preventing, alleviating and arresting the disorder. Excessive synthesis of prostaglandin E2 generates amyloid. Such non-steroidal anti-inflammatory drugs as aspirin and ibuprofen, as well as antidepressants, inhibit prostaglandin E2. Epidemiological studies have shown that ibuprofen (Motrin) that specifically inhibits prostaglandin E2, can significantly delay the onset of Parkinson’s disease, a neurodegenerative disorder closely related to Alzheimer’s.

    Antidepressants offer great advantages, and few disadvantages, in addressing Alzheimer’s, and beggars can’t be choosers Alzheimer’s was recently referred to as “the coming tsunami,” but you would not think so, given the lack of enthusiasm of Alzheimer’s organizations and health policy makers, when notified of this resource.


  • Anonymous

    Excessive synthesis of prostaglandin E2 induces depression, depressed immune function, infectious disorders, and a plethora of others. Excessive synthesis of prostaglandin E2 causes disease, genes the variations. Carboxylic acids (prostaglandins) regulate nuicleic acids (DNA and RNA). Accordingly, prostaglandins, paradoxically, regulate the synthesis, inhibition, and expression of genes.

    Disruptive innovations for the ages.

  • Joe Beckmann

    This is a classic case of very poor reporting: Ashbrook should have cited the history of Harvard Community Health Plan, patterned after Kaiser and destroyed by the greed of characters like Charlie Baker who split the “community health care” model into an insurer and a care provider, wiping out the incentives for preventive and early health care and throwing the system into a traditional insurance model. But, instead, he let it slide. If we are to have a “new” system, we ought to examine why “new” 20 years ago got screwed up by “reforms” on the way to where we are.

  • Alexis

    Clayton Christensen may be a business guru but he does not know much about health care, despite his own travails. His discovery of the HMO model is about 60 years late, since I believe Kaiser started at the end of World War II. What he overlooks is the for-profit motive in health care delivery. This is rather amazing in light of the fact that he is a professor at Harvard Business School. If he had done his homework rather than focusing on grand ideas he would have discovered that the HMO model is flawed precisely because of the profit motive. Health maintenance organizations, if they seek a profit or simply want to stay afloat, need to limit care. The bias then shifts from too much care, in the case of cost-plus care, to too little care. In Congress in the 1980′s, we saw a major scandal develop in southern Florida when for-profit HMO’s were allowed to enroll Medicare patients. Enrollees were denied much needed care. Today, in Seattle, Group Health, a very old nonprofit HMO, struggles to contain costs. Health care costs won’t be contained until the profit motive is removed from medicine. But other very difficult issues must be tackled as well. Two-thirds of adult Americans are overweight or obese. There has to be a technology policy so that ineffective technologies are not allowed to proliferate and drive up costs. There are no easy solutions; and no guru, however brilliant, has the answer.

    • Thomson

      Unfortunately for us I believe you are correct.

    • http://pulse.yahoo.com/_M5W5OWFNBSZUBC2WX4SK67FOKU dan clayton

      It is not the profit motive that needs to be killed. If you kill the profit motive what encourages doctors to be educated for years to care for patients… The answer is the focus of profit and reward. Today Medicare has driven the payment model to a fee for each service performed. Therefore service volume not health becomes the motivation of providers. If Cost reduction and outcome of care could be linked to providers payment and reward, then good care delivery which considers low cost would naturally control costs.

      • Travis Bliffen

        I sadly have to agree with Dan on this one. When volume becomes the main goal, healthcare will most certainly suffer and so will the patients of the system. The last thing our country needs is to adapt such an ill concept… hopefully we will avoid using this and focus on healthcare that heals.


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Sep 2, 2014
U.S. Sen. Mitch McConnell, R-Ky., talks with Mark Wilson, event political speaker chairperson, with his wife Elain Chao, former U.S. Secretary of Labor, at the annual Fancy Farm Picnic in Fancy Farm, Ky., Saturday, August 4, 2012. (AP)

Nine weeks counting now to the midterm elections. We’ll look at the key races and the stakes.

Sep 2, 2014
Confederate spymaster Rose O'Neal Greenhow, pictured with her daughter "Little" Rose in Washington, D.C.'s Old Capitol Prison in 1862. (Wikimedia / Creative Commons)

True stories of daring women during the Civil War. Best-selling author Karen Abbott shares their exploits in a new book: “Liar, Temptress, Soldier, Spy.”

Sep 1, 2014
Pittsburgh Steelers outside linebacker Jarvis Jones (95) recovers a fumble by Carolina Panthers quarterback Derek Anderson (3) in the second quarter of the NFL preseason football game on Thursday, Aug. 28, 2014 in Pittsburgh. (AP)

One outspoken fan’s reluctant manifesto against football, and the big push to reform the game.

Sep 1, 2014
This Friday, Aug. 22, 2014 photo shows a mural in in the Pullman neighborhood of Chicago dedicated to the history of the Pullman railcar company and the significance for its place in revolutionizing the railroad industry and its contributions to the African-American labor movement. (AP)

On Labor Day, we’ll check in on the American labor force, with labor activist Van Jones, and more.

On Point Blog
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