How America can get its groove back

A medical school alumnus argues that the nation is not doing enough to foster innovation.

By Cathy Shufro

John J. Kao, M.D. ’77, M.B.A. ’82, does not even mention his medical degree in the biography for his latest book, Innovation Nation: How America Is Losing Its Innovation Edge, Why It Matters, and What We Can Do To Get It Back.

Medical school at Yale and a psychiatry residency at McLean Hospital were just starting points for a career that has earned Kao the designation of “Mr. Creativity” from The Economist. Along the way he has played keyboards for Frank Zappa; taught at MIT and at Harvard, where he earned his business degree; started two biotech companies; and was production executive on the Palme d’Or-winning film sex, lies, and videotape. Recently he founded a nonprofit, the Institute for Large Scale Innovation.

Despite his distance from hospital corridors, however, Kao said he still draws on what he calls “the implicit curriculum of medicine,” which taught him, “You work hard, and no one works harder than you. You take responsibility and make things happen. And you’re it: when someone comes into the ER at three in the morning, you’re it. I’ve never forgotten those lessons.”

Lately Kao’s hard work has involved advising corporate and government leaders around the world on fostering innovation—and warning Americans that they are not doing enough. Business Week called his book “scary, insightful, and ultimately very useful,” and listed it among the top 10 business books for 2007.

Kao believes that Americans lack a cogent vision of where innovation is taking them, even though half of the world’s research and development money is invested within this country. “No country, not even the United States, can afford to be without a strategy,” he said. Kao defines innovation as the ability of individuals, corporations and nations “to continuously create their desired future.” If the United States wants to chart its own course rather than simply reacting to developments elsewhere, it must foster innovation.

Kao cites Singapore’s innovation strategy as instructive. The island nation of 4.5 million has built a huge research complex called Biopolis, paid for talented young people to earn doctorates in the sciences and recruited researchers and advisors from around the world. In his book, Kao quotes former University of Washington President Lee L. Huntsman, who has called Singapore a “venture capital company masquerading as a government.”

Like Singapore, each nation should foster innovation consistent with its national character and endowments, Kao said. Otherwise, he said, “you don’t make the best use of your opportunities and resources.” The United States, for example, has both strong links between academia and business and a mature venture capital industry willing to take chances on unproven ideas. “And,” said Kao, “we have a very forgiving attitude toward what I would call noble failure. … If you fail in European countries or Asia, typically you’re out of the game.”

America has also benefited by welcoming immigrants: half of those with doctoral degrees in computer science, for instance, come from abroad. “We’d be stupid to imperil that flow of talent into this country,” Kao said. “Many other countries are stepping up to the plate and making their countries highly desirable to immigrant talent.”

Kao advises physicians who value innovation to seek skills and knowledge beyond medicine. For instance, he recommends that doctors earn master’s degrees in business or in public administration. “These days it’s arguably as important to understand how discoveries get into the marketplace as it is to pursue discovery itself. … The more we can do a variety of things in addition to having our core skills, the more we can contribute to society.”

Bookshelf focuses on books and authors at the School of Medicine. Send suggestions to Cathy Shufro at cathy.shufro@yale.edu.

Book notes

Transgenesis and the Management of Vector-Borne Disease
by Serap Aksoy, Ph.D., professor of epidemiology (microbial diseases) (Springer) The author explains the reasons for the resurgence and spread of vector-borne disease. No effective vaccines exist for these diseases, and only limited therapeutic interventions are available to treat them in mammalian hosts. Aksoy describes the causes of the spread of these diseases, including habitat change, irrigation practices, atmospheric and climate change, insecticide and drug resistance and increases in global tourism, human traffic and commercial activities. The author also explores the potential of such molecular technologies as transgenesis in developing disease management strategies.

Anemias and Other Red Cell Disorders
by Kenneth R. Bridges, M.D., and Howard A. Pearson, M.D., professor emeritus of pediatrics (hematology/oncology) (McGraw-Hill Professional) This resource provides a practical framework for identifying and managing acute, congenital and chronic anemias as well as other red blood cell disorders. The book describes the principles of anemia evaluation and specific deficiencies in adults and children.

Practical Guide to the Evaluation of Clinical Competence
by Eric S. Holmboe, M.D., HS ’93, professor (adjunct) of medicine, and Richard E. Hawkins, M.D. (Mosby) This guide to outcomes-based assessment in clinical education describes evaluation methods, tools and faculty training approaches for all medical educators. The book can serve as a resource in developing, implementing and sustaining effective systems for evaluating clinical competence in medical school, residency and fellowship programs. The book comes with a DVD.

Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment and Treatment
by Katarzyna Chawarska, Ph.D., assistant professor in the Child Study Center, Ami J. Klin, Ph.D., Harris Associate Professor of Child Psychiatry in the Child Study Center and associate professor of psychology, Fred R. Volkmar, M.D., the Irving B. Harris Professor of Child Psychiatry, Pediatrics and Psychology in the Child Study Center, and Michael D. Powers, Psy.D., assistant clinical professor in the Child Study Center (The Guilford Press) This book synthesizes research on the diagnosis and treatment of autism spectrum disorders in very young children. The authors examine critical research issues and present innovative approaches to assessing social, cognitive, adaptive, communications and sensorimotor impairments in the first two years of life. The book also addresses ways to support families in coping with an early diagnosis and in becoming effective advocates for their children. The book includes case studies and discusses popular but controversial treatments for these disorders.

Freeing the Human Spirit: A Psychiatrist’s Journal
by Louis B. Fierman, M.D., HS ’53 (Blue Dolphin) This book consists primarily of 21 case vignettes intended for readers who are involved in or interested in psychotherapy and psychiatric private practice. The book also includes an essay on the development of nondirective therapy, an approach that the author regards as increasing the effectiveness of treatment.

Beating Lyme: Understanding and Treating This Complex and Often Misdiagnosed Disease
by Constance A. Bean, M.P.H. ’50, and Lesley Ann Fein, M.D., M.P.H. (AMACOM) The authors offer readers an understanding of Lyme disease, its history and the controversy surrounding its diagnosis and treatment. Topics include what to do after a tick bite, the consequences of misdiagnosis, how to get the best treatment and what to do if insurance won’t cover it.

The Woman’s Heart: An Owner’s Guide
by John A. Elefteriades, M.D. ’76, HS ’81, FW ’83, the William W.L. Glenn Professor of Cardiothoracic Surgery, and Teresa Caulin-Glaser, M.D. (Prometheus Books) In this guide, the authors focus on the unique factors affecting women’s cardiovascular health. Topics include such diseases of the heart as mitral valve prolapse, symptoms of heart disease that women need to know, cardiac tests, medications and surgery, and the ways in which pregnancy and childbirth affect women’s hearts.

Current Diagnosis & Treatment: Psychiatry, 2nd ed.
by Michael H. Ebert, M.D., professor of psychiatry, Peter T. Loosen, M.D., Barry Nurcombe, M.D., and James F. Leckman, M.D., the Neison Harris Professor of Child Psychiatry in the Child Study Center and professor of pediatrics and psychiatry (McGraw-Hill Medical) This reference work addresses day-to-day questions about psychiatric illness in both adults and children. It provides information on psychiatry and the law, psychological testing, emergency psychiatry, evaluation of infants, developmental psychology, neuropsychopharmacology, psychiatric genetics, psychoanalysis and the principles of evaluating and diagnosing patients, as well as treatment strategies.

How to Land a Top-Paying Federal Job: Your Complete Guide to Opportunities, Internships, Resumes and Cover Letters, Application Essays (KSAs), Interviews, Salaries, Promotions and More!
by Lily Whiteman, M.P.H. ’90 (AMACOM) This book guides prospective applicants through every stage of their federal job search, giving insight into finding openings and negotiating a top salary as well as suggesting techniques for securing promotions.

Educating Individuals With Disabilities: IDEIA 2004 and Beyond
by Elena L. Grigorenko, Ph.D., associate professor in the Child Study Center and of epidemiology (chronic diseases) (Springer) This volume discusses the identification and assessment of learning-disabled students today in light of the 2004 Individuals With Disabilities Education Improvement Act (IDEIA). Grigorenko describes the IDEIA in its historical, political and legal contexts and considers practical issues for school psychologists, neuropsychologists, speech-language therapists, policy makers and legal professionals who must deal with special education and learning disability issues on a daily basis.

Medical Humanism: Aphorisms From the Bedside Teachings and Writings of Howard M. Spiro, M.D.
edited by Robert E. Kravetz, M.D., FW ’65 (The Program for the Humanities in Medicine) This volume gathers many observations, lessons, admonitions, criticisms, witticisms and comments from Spiro’s books, essays and papers for the reader’s enjoyment and contemplation. Spiro, who served on the School of Medicine’s faculty from 1955 until his retirement in 2000, speaks as an experienced clinician and humanist with a broad and visionary outlook on medicine.
The descriptions are based on information from the publishers.

Send notices of new books by alumni and faculty to Cheryl Violante, Yale Medicine, 300 George Street, Suite 773, New Haven, CT 06511, or via e-mail to cheryl.violante@yale.edu.

In circulation

Expert medical help now available to Connecticut school nurses via new website

School nurse Marcia Wilcox, R.N., didn’t have much luck when she used Google to search for information about learning disabilities caused by a rare bone disorder. A teacher at her school in Connecticut needed to know whether a new student would need extra help as a result of the condition.

Wilcox contacted Janene Batten, M.L.S., at the Harvey Cushing/John Hay Whitney Medical Library, who sent Wilcox four journal articles on the condition, “She was able to find something a lot quicker than I would be able to,” said Wilcox, the sole nurse for about 400 primary school children. “Sometimes I have time, and sometimes I don’t.”

This expert help was available on the “Ask a Librarian” feature on a new website for Connecticut school nurses that Batten established with colleagues Jan Glover, M.L.S., and Lynn Sette, M.L.S. They created the site based on a questionnaire they had sent in the fall of 2007 to the nearly 2,000 nurses and nurse practitioners in Connecticut’s public schools and school-based clinics. Just under half the nurses who filled out the questionnaire said they were too busy during the school day to use the Internet; 44 percent said they lacked knowledge of electronic resources.

The site gives the nurses easy access to 14 databases, including PubMed, the biomedical database for clinicians, and MedlinePlus. Among other resources is a link to the National Library of Medicine’s Drug Information Portal, which provides details about 12,000 medications. The site also provides access to librarians who can help with difficult searches, as Batten helped Wilcox.

The librarians developed the site over two and a half years as part of a $40,000 grant from the National Library of Medicine. They hope that the site, called Connecticut School Nurses Information Resources, can serve as a model for others. In June, the librarians will present a paper about the project at the annual conference of the National Association of School Nurses.

“Unlike a lot of areas of nursing, school nursing is a very solitary practice,” said Joan Cagginello, R.N., M.S., the school nurse administrator of the Milford Health Department. The site is “invaluable,” she said.

The site’s URL is http://www.med.yale.edu/library/school_nursing/.

—Cathy Shufro

In Circulation focuses on activities at the Cushing/Whitney Medical Library. Send suggestions to Cathy Shufro at cathy.shufro@yale.edu.



Thomas		Pearl



Schiff		Patton

On campus

An orthopaedic surgeon fights for diversity in medicine

When Claudia L. Thomas, M.D., HS ’80, completed her residency 29 years ago, she was the nation’s first black woman to become an orthopaedic surgeon—though somebody had to inform her of her achievement. Thomas, who gave the Southwick Lecture for the Department of Orthopaedics in November, has devoted her career to making up for that oversight, fighting for diversity in both color and gender in medical schools and in doctors’ offices. Although there has been progress, she said, there’s still a long way to go.

African-Americans make up almost 11 percent of the population but just under 2 percent of orthopaedic surgeons, and only 2.3 percent of orthopaedic surgeons are women. And disparities also extend to treatment: Whites, for example, are 2.4 times likelier to get hip replacements than blacks. Race and gender disparities “are killing people,” Thomas said.

Thomas, an assistant professor of orthopaedics at The Johns Hopkins University School of Medicine, led a diversification effort there that increased the number of African-American orthopaedic residents to 32 percent. “When you have a diverse program,” she said, “it becomes self-perpetuating eventually.”

—John Dillon

How climate change affects public health

In 1967 U.S. Surgeon General William Stewart, M.D., announced that it was time to “close the book” on infectious diseases. There was a hitch to that announcement, said Mary C. Pearl, Ph.D. ’72, at a talk in November sponsored by The Elihu Club and Tropical Resources Institute: “No one alerted the bacteria and viruses.”

The diseases that have since emerged are deadlier and more expensive to fight, said Pearl, president of the Wildlife Trust, a conservation science group. And more than 61 percent of these diseases—including SARS, avian flu, Lyme disease and West Nile virus—have jumped from animals to humans. They’re also, she said, the result of human damage to the environment.

In 2006, the Centers for Disease Control and Prevention declared climate change to be the “largest looming public health challenge we face,” she said. Among its effects are excessive heat that stresses the heart; pollution that attacks the lungs and heart; water- and vector-borne diseases; more frequent floods and drought; and more environmental refugees, leading to overcrowding, civil unrest and ideal conditions for disease proliferation.

“Emerging diseases originate where there are lots of people living in rapidly changing ecosystems,” Pearl said. “Biodiversity is a buffer.”

—J.D.

A single-payer system is best Rx in a bad economy

A single-payer system may be the best way to provide health care coverage in the United States, especially when a faltering economy threatens to increase the ranks of the uninsured, an expert said at the Medical Student Council Perspectives on Medicine series in October.

“The employment-based approach is increasingly unworkable,” said Gordon D. Schiff, M.D., associate director of the Center for Patient Safety Research and Practice at Harvard’s Brigham and Women’s Hospital and past president of Physicians for a National Health Program. Roughly 47 million Americans were uninsured in 2007, a figure that will surely rise due to the credit crunch, Schiff said. Half of the nation’s 2 million personal bankruptcies were due to medical expenses, even though 76 percent of those filers had health insurance.

It’s time “people got over this bogeyman” of government’s inefficiency at managing health care, Schiff said. Whereas up to 40 percent of premiums in private plans are spent on nonmedical, largely administrative purposes, Medicare and Medicaid spend only about 2 percent, he said.

While a single-payer plan “isn’t perfect,” Schiff said, “it is the only approach that ensures universal health insurance for everyone.”

—J.D.

Noah Webster—from listing definitions to tracking disease

Noah Webster, a 1778 graduate of Yale College, is best known for his eponymous dictionaries, but his lexicographical work is far from his sole achievement. Webster was also the largely unheralded “father of epidemiology—indeed, father of all public health in America,” said Curtis L. Patton, Ph.D., professor emeritus of epidemiology.

Patton, speaking at a celebration marking Webster’s 250th birthday in October, said Webster provided “the base upon which modern epidemiology is based, warts and all.” The “warts” stemmed from Webster’s doubts over the theory of contagion and his belief that meteors and other atmospheric conditions aggravated such outbreaks as the yellow fever epidemics he studied in the 1790s.

“We may laugh at all this, but we didn’t have any idea about disease causation at the time,” Patton said. Still, Webster knew enough to inoculate himself against smallpox and to warn of the limited benefits of quarantining people.

“He didn’t get everything right, but he was conscientious and careful” about gathering data, Patton said. Webster assembled enough of that data to write A Brief History of Epidemic and Pestilential Diseases (1799), which became a standard text in medical schools in the 19th century.

—J.D.


			Originally published in Yale Medicine, Winter 2009. Copyright © 2009 Yale University School of Medicine. All rights reserved.