Abstract

ABSTRACTNon-medical innovation has become progressively more open, harnessing the enterprise and creativity of a variety of players and relying on diverse structured and unstructured methods to generate and select advances. Medical innovation, however, remains more closed and regimented because of age-old traditions, reinforced by modern funding and regulatory practices that require the costly ex-ante demonstration of efficacy. These practices, which seek to replicate those of the natural sciences, militate against the pluralistic creation and use of medical innovations and suppress ad-hoc, accretive—and potentially life-saving—advances.