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review Make, Think, Imagine, a new book by engineer and former BP CEO John Browne that’s a paean to engineers and engineering. The review, written for a general audience, stands on it own, but Browne addresses several themes related to technology and translational that are likely of particular interest to biomedical entrepreneurs, and seemed worth a closer look:

  • The power and responsibility of engineering
  • The challenges of technology adoption
  • The (dismal) state of health
  • The continuum from basic to applied research
© 2018 Bloomberg Finance LP

Power and Responsibility of Engineering

Browne’s basic thesis is that engineering, as a whole, makes the world a better place, generating “innovations that allow us to solve our problems and improve our well-being, while expending less effort and cost.” He sees engineering as the expression of a core human desire to make and create, citing far-flung examples (in both time and geography) from ancient China (where the stirrup was invented, during the Jin Dynasty [265-420 CE]), to the ninth century Middle East (the word “algorithm” derives from the coarse transliteration of legendary Persian mathematician, Al-Khwarizmi; “algebra” comes from a prominent treatise, Al-jabr, he authored).

Engineering plays a critical, if reliably unappreciated, role in the advancement of science, he argues, adding that according to Harvard scientist George Church, “Almost all major scientific progress, almost all disruptive, transformative steps forward are based on technology.”

This is precisely the draw of technology – the ability to radically alter how we think, and the questions you can start to ask. As I wrote in 2017,

“Improved technologies have always driven insight in biology and medicine. ‘Progress in science,’ observed biologist Sydney Brenner, ‘depends on new techniques, new discoveries and new ideas--probably in that order.’ The invention of the microscope enabled the discovery of microorganisms and ultimately led to the germ theory of disease. Other advances have allowed us to characterize the molecules in our blood, to observe the heart beating, to contemplate the brain at work.”

This is also the basic thesis of Douglas Robertson’s 2003 Phase Change , as noted here.

What seems to get Church’s goat – and Browne’s – is the lack of respect engineers are often accorded; Browne complains we elevate “the esteemed work of the head that thinks over the disparaged work of the hand that makes,” a pattern he says “has been played out time and again,” associated with what he says the late Harvard professor Calestous Juma described as “very systematic appropriation of credit from engineers and reallocation of it to scientists. People don’t see the difference between technicians and inventors.”

Even while holding engineers, and the technology they create, in exceptionally high regard, Browne is as much of a techno-realist as he is a techno-optimist. “[A]nyone who worries about the arrival of supremely powerful artificially intelligent machines,” he writes, “should consider the challenges of maintaining machines even today – the unpredictable behavior of an office printer is a good example.” He also cites the example of trying to set up an intelligent house, with computer-controlled devices. His conclusion: “All of this is meant to make life as easy and seamless as possible, but in reality these features sometimes simply do not work.”

At a deeper level, Browne emphasizes that engineers need to recognize that every product they make “will also generate its own set of consequences, both intentional and unintentional, as well as constructive and destructive.” Thus, they must accept that “engineered solutions will never be perfect first, because mistakes and misuse are inevitable and every step forward has risks.”

Importantly, he states that while it’s essential to “think long and hard about how to react when things go wrong,” it’s also critical not to be frozen by that possibility, and to recognize that “striving to avoid all possible risks can halt or even reverse progress.” Preach!

The Challenges of Technology Adoption

The promise of engineering is highlighted by the development and evolution of GPS receivers, Browne tells us; the first, in 1974, cost around $750,000, required over twenty years to make fully operational, and was initially supported by the military with long time horizon and deep pockets; over time, and with considerable work funded by private companies, the price of GPS receivers plummeted, and today cost less than $2. In some ways, this is the fantasy narrative of technology.

But as Browne repeatedly emphasizes, the path from invention to adoption is rarely immediate or direct. Consider electric cars. Described by the New York Times -- in 1911! -- as “ideal, for they are clean, quieter, and much more economical than gasoline power cars,” electric cars nevertheless struggled to achieve traction, not only because of technical limitations like range and difficulty with hills, but also because of marketing, according to Browne. “Gasoline cars were associated with heroic masculinity,” Browne writes, “while electric vehicles were associated with weakness.” As he observes with wry understatement, “pure rationality is never the sole explanation for technological transitions.”

He further expands upon this theme:

“The gradual and uneven transition away from animals and towards mechanical power is a clear illustration that technology development is rarely orderly or predictable, because it is subject to many social, political, and economic forces. As David Rooney, formerly Keeper of Technologies and Engineering at London’s Science Museum, explains, ‘no technology is inevitable…history shows you get winners and losers for all sorts of reasons.’“

As discussed in my review, mass production was developed in France, where it was promptly suppressed due to concerns about impact on social fabric. Browne explains that in contrast, U.S. Ambassador to France Thomas Jefferson “quickly grasped it’s potential. As a result, it was the U.S. that first standardized production practices,” giving rise to a system of manufacturing soon inextricably associated with our growing nation.

Another example is the jet engine, which was first designed and built in the United Kingdom by Frank Whittle. Even so, the first airplane to fly solely under jet power was achieved in 1939 by German engineers, apparently because their government supported the work while the UK government “pooh-poohed” Whittle’s work and dramatically slowed it down.

Browne also emphasizes the incremental nature of most technology adoption (a point I’ve discussed in Forbes here, and in Clinical Pharmacology and Therapeutics, here), observing:

“[N]ew technologies almost never replace old ones completely, but rather are added to them and continue to co-exist, often for decades. [As Rooney explains,] ‘that’s not because people are conservative, lazy or doggedly sticking with the past. It’s because those [existing] technologies work, they are appropriate and people have invested in the networks needed to maintain them.’”

Browne notes that “significant advances that occur rarely, such as the first plane flight or the first manned rocket, always capture the public’s imagination” yet “many others will have more impact by making less dramatic but equally important incremental innovations.” He adds, “most of the experts I met described how their innovations diffuse into our lives at a much-slower rate than we realize.”

It’s clear Browne’s heart is with hardware (the things you can touch), which he feels has struggled for attention in our software-obsessed culture. He notes “most transition in manufacturing still unfold at a relatively slow rate,” and says he’s seen, first hand “how long it takes to integrate new digital manufacturing technology into the industrial sector.” As noted in my review, Browne introduces the almost heretical concept of the “first mover disadvantage,” the idea that since technology gets progressively better and cheaper, “waiting is often a winning strategy.” (Browne seems less charitable about the pace of technology adoption in medicine – more on this in a bit.)

How can technology development be accelerated? One important tool: standards. One example is the standardized screw, discussed in the review. Another example Browne cites is the relational database (an approach initially rejected by IBM, we learn, and then used to launch Oracle), driven by the idea of imposing “clear standards on electronic data management” which enabled, according to tech entrepreneur Suranga Chandratillake (as quoted by Browne), “businesses to grow and operate at scale. Finance, logics, and markets could be managed across the globe.” Indeed, the failure to adopt common standards – and the resultant, much-lamented “Tower of Babel - is often cited as a key impediment to the application of analytics to healthcare data.

The State of Health

Browne sees tremendous potential for engineering in health, highlighting the impact of engineers not only in the production of penicillin, discussed in the review, but also on the impact on nineteenth century London, which had struggled to contain successive cholera epidemics and manage an increasingly putrid Themes River – leading to the “Great Stink” of 1858 and the evacuation of Parliament. Urgently, the government turned to the ambitious plans of one Joseph Bazelgette, an engineer, who over the next decade, supervised an ambitious sewer construction project, which “added twenty years” to the life of Londoners, according to his 1891 obituary.

However, Browne is also clearly disappointed by that gap he's noticed between what biomedicine pioneers promised and what he’s seen delivered. He writes,

“I vividly remember the excitement that surrounded [the 2000 announcement by Clinton and Blair of the completion of the initial human genome sequencing] … [b]ut nearly two decades on, I wonder what happened to the promised revolution in healthcare. My physician does not yet base his prescriptions on my genetic profile and has expressed no interested in sequencing my DNA, though it is clear that the availability of data on DNA sequences is no longer a limiting factor.”

He continues, “Variants that have big effects on an individual’s susceptibility to disease are rare,” adding, “Genomics is a world of probabilities and conditionalities, and unpicking cause from correlation remains a stubborn problem.”

Browne is bullish on large rich datasets like the U.K. Biobank, and approvingly quotes John Savill, former Chief Executive of the UK Medical Research Counsel, who describes of big data as “the microscope of the 21st century.” Browne also emphasizes the value of rich datasets that can be used to train AI models.

He’s far more reserved about AI itself; he applauds AI successes, like the Google algorithm which expertly plays the board game Go, but also notes, citing computer scientist Fei-Fei Li, that these achievements are based on “virtual worlds with completely perfect clear, rules.” (A similar point was made by David Epstein in his captivating new book Range, as I recently discussed.)

AI, says Browne, “is still an emerging field” that, in the words of Li, “is going through a huge hype wave, and people extrapolate overzealously.” Browne perceptively notes that “people do not trust ‘black boxes,’” and references the suggestion of Andrew Adonis, Chair of the UK National Infrastructure Commission, that “people are generally more accepting of accidents that are caused by human error than those caused by errors in engineered systems,” a resonant observation.

Readers, no doubt, will be pleased to learn from Browne that the “sheer complexity of the human body, combined with the generally conservative leadership of medical institutions, means that we are not on the verge of creating sub-species of enhanced, eternally youthful human beings.” So, there’s that.

I was struck by Browne’s repeated emphasis on the impact of the supposedly conservative medical establishment on technology adoption; apparently, when fellow oil executives worry about “first mover disadvantage” associated with early adoption of digital technologies, it’s based on reasonable concerns about unproven tech, but when physicians pause, it’s a mindset issue. (In truth, I suspect it’s a bit of both.)

Continuum From Basic to Applied

Perhaps the most significant contribution to how we think about biomedical innovation Browne offers stems from his conversation with Paul Nurse, a Nobel Laureate for his work elucidating the cell cycle, and currently head of the Francis Crick Institute in the U.K. (Browne chairs the Board).

According to Browne, “The division between what others call basic science and engineering is artificial and counter-productive.”  He deplores the “unhelpful schism that exists between science, engineering and commerce.”

Browne views engineering as inherently translational.  As noted in the review, he describes engineering as “a head with two sets of eyes: one looks to the fruits of discovery, while the other looks to the demands of commerce and customers.” A pivotal moment in Browne's career trajectory, he said, was his realization that “no solution was complete unless it resulted in something practical that humanity wanted.”

Browne cites Nurse, who, Browne says, “has no time for the arrogance of scientists who claim to be ‘pure intellects’ and refuse to be ‘sullied with dirty commerce.’ To be engaged in the process of discovery is to be alive with possibility. The routes between the laboratory bench, the factory floor, and the shop shelf are many, varied, and hard to predict….There is not and never has been an obvious or linear conveyor belt that takes fundamental research and translates it into useful products.”

“It is definitely a complex network,” Nurse says (per Browne), continuing, “[our core mission should be] understanding the world and making use of that knowledge to improve the state of humankind."

And let us say: Amen.

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In tomorrow’s Wall Street Journal (available now online), I review Make, Think, Imagine, a new book by engineer and former BP CEO John Browne that’s a paean to engineers and engineering. The review, written for a general audience, stands on it own, but Browne addresses several themes related to technology and translational that are likely of particular interest to biomedical entrepreneurs, and seemed worth a closer look:

  • The power and responsibility of engineering
  • The challenges of technology adoption
  • The (dismal) state of health
  • The continuum from basic to applied research
© 2018 Bloomberg Finance LP

Power and Responsibility of Engineering

Browne’s basic thesis is that engineering, as a whole, makes the world a better place, generating “innovations that allow us to solve our problems and improve our well-being, while expending less effort and cost.” He sees engineering as the expression of a core human desire to make and create, citing far-flung examples (in both time and geography) from ancient China (where the stirrup was invented, during the Jin Dynasty [265-420 CE]), to the ninth century Middle East (the word “algorithm” derives from the coarse transliteration of legendary Persian mathematician, Al-Khwarizmi; “algebra” comes from a prominent treatise, Al-jabr, he authored).

Engineering plays a critical, if reliably unappreciated, role in the advancement of science, he argues, adding that according to Harvard scientist George Church, “Almost all major scientific progress, almost all disruptive, transformative steps forward are based on technology.”

This is precisely the draw of technology – the ability to radically alter how we think, and the questions you can start to ask. As I wrote in 2017,

“Improved technologies have always driven insight in biology and medicine. ‘Progress in science,’ observed biologist Sydney Brenner, ‘depends on new techniques, new discoveries and new ideas--probably in that order.’ The invention of the microscope enabled the discovery of microorganisms and ultimately led to the germ theory of disease. Other advances have allowed us to characterize the molecules in our blood, to observe the heart beating, to contemplate the brain at work.”

This is also the basic thesis of Douglas Robertson’s 2003 Phase Change , as noted here.

What seems to get Church’s goat – and Browne’s – is the lack of respect engineers are often accorded; Browne complains we elevate “the esteemed work of the head that thinks over the disparaged work of the hand that makes,” a pattern he says “has been played out time and again,” associated with what he says the late Harvard professor Calestous Juma described as “very systematic appropriation of credit from engineers and reallocation of it to scientists. People don’t see the difference between technicians and inventors.”

Even while holding engineers, and the technology they create, in exceptionally high regard, Browne is as much of a techno-realist as he is a techno-optimist. “[A]nyone who worries about the arrival of supremely powerful artificially intelligent machines,” he writes, “should consider the challenges of maintaining machines even today – the unpredictable behavior of an office printer is a good example.” He also cites the example of trying to set up an intelligent house, with computer-controlled devices. His conclusion: “All of this is meant to make life as easy and seamless as possible, but in reality these features sometimes simply do not work.”

At a deeper level, Browne emphasizes that engineers need to recognize that every product they make “will also generate its own set of consequences, both intentional and unintentional, as well as constructive and destructive.” Thus, they must accept that “engineered solutions will never be perfect first, because mistakes and misuse are inevitable and every step forward has risks.”

Importantly, he states that while it’s essential to “think long and hard about how to react when things go wrong,” it’s also critical not to be frozen by that possibility, and to recognize that “striving to avoid all possible risks can halt or even reverse progress.” Preach!

The Challenges of Technology Adoption

The promise of engineering is highlighted by the development and evolution of GPS receivers, Browne tells us; the first, in 1974, cost around $750,000, required over twenty years to make fully operational, and was initially supported by the military with long time horizon and deep pockets; over time, and with considerable work funded by private companies, the price of GPS receivers plummeted, and today cost less than $2. In some ways, this is the fantasy narrative of technology.

But as Browne repeatedly emphasizes, the path from invention to adoption is rarely immediate or direct. Consider electric cars. Described by the New York Times -- in 1911! -- as “ideal, for they are clean, quieter, and much more economical than gasoline power cars,” electric cars nevertheless struggled to achieve traction, not only because of technical limitations like range and difficulty with hills, but also because of marketing, according to Browne. “Gasoline cars were associated with heroic masculinity,” Browne writes, “while electric vehicles were associated with weakness.” As he observes with wry understatement, “pure rationality is never the sole explanation for technological transitions.”

He further expands upon this theme:

“The gradual and uneven transition away from animals and towards mechanical power is a clear illustration that technology development is rarely orderly or predictable, because it is subject to many social, political, and economic forces. As David Rooney, formerly Keeper of Technologies and Engineering at London’s Science Museum, explains, ‘no technology is inevitable…history shows you get winners and losers for all sorts of reasons.’“

As discussed in my review, mass production was developed in France, where it was promptly suppressed due to concerns about impact on social fabric. Browne explains that in contrast, U.S. Ambassador to France Thomas Jefferson “quickly grasped it’s potential. As a result, it was the U.S. that first standardized production practices,” giving rise to a system of manufacturing soon inextricably associated with our growing nation.

Another example is the jet engine, which was first designed and built in the United Kingdom by Frank Whittle. Even so, the first airplane to fly solely under jet power was achieved in 1939 by German engineers, apparently because their government supported the work while the UK government “pooh-poohed” Whittle’s work and dramatically slowed it down.

Browne also emphasizes the incremental nature of most technology adoption (a point I’ve discussed in Forbes here, and in Clinical Pharmacology and Therapeutics, here), observing:

“[N]ew technologies almost never replace old ones completely, but rather are added to them and continue to co-exist, often for decades. [As Rooney explains,] ‘that’s not because people are conservative, lazy or doggedly sticking with the past. It’s because those [existing] technologies work, they are appropriate and people have invested in the networks needed to maintain them.’”

Browne notes that “significant advances that occur rarely, such as the first plane flight or the first manned rocket, always capture the public’s imagination” yet “many others will have more impact by making less dramatic but equally important incremental innovations.” He adds, “most of the experts I met described how their innovations diffuse into our lives at a much-slower rate than we realize.”

It’s clear Browne’s heart is with hardware (the things you can touch), which he feels has struggled for attention in our software-obsessed culture. He notes “most transition in manufacturing still unfold at a relatively slow rate,” and says he’s seen, first hand “how long it takes to integrate new digital manufacturing technology into the industrial sector.” As noted in my review, Browne introduces the almost heretical concept of the “first mover disadvantage,” the idea that since technology gets progressively better and cheaper, “waiting is often a winning strategy.” (Browne seems less charitable about the pace of technology adoption in medicine – more on this in a bit.)

How can technology development be accelerated? One important tool: standards. One example is the standardized screw, discussed in the review. Another example Browne cites is the relational database (an approach initially rejected by IBM, we learn, and then used to launch Oracle), driven by the idea of imposing “clear standards on electronic data management” which enabled, according to tech entrepreneur Suranga Chandratillake (as quoted by Browne), “businesses to grow and operate at scale. Finance, logics, and markets could be managed across the globe.” Indeed, the failure to adopt common standards – and the resultant, much-lamented “Tower of Babel - is often cited as a key impediment to the application of analytics to healthcare data.

The State of Health

Browne sees tremendous potential for engineering in health, highlighting the impact of engineers not only in the production of penicillin, discussed in the review, but also on the impact on nineteenth century London, which had struggled to contain successive cholera epidemics and manage an increasingly putrid Themes River – leading to the “Great Stink” of 1858 and the evacuation of Parliament. Urgently, the government turned to the ambitious plans of one Joseph Bazelgette, an engineer, who over the next decade, supervised an ambitious sewer construction project, which “added twenty years” to the life of Londoners, according to his 1891 obituary.

However, Browne is also clearly disappointed by that gap he's noticed between what biomedicine pioneers promised and what he’s seen delivered. He writes,

“I vividly remember the excitement that surrounded [the 2000 announcement by Clinton and Blair of the completion of the initial human genome sequencing] … [b]ut nearly two decades on, I wonder what happened to the promised revolution in healthcare. My physician does not yet base his prescriptions on my genetic profile and has expressed no interested in sequencing my DNA, though it is clear that the availability of data on DNA sequences is no longer a limiting factor.”

He continues, “Variants that have big effects on an individual’s susceptibility to disease are rare,” adding, “Genomics is a world of probabilities and conditionalities, and unpicking cause from correlation remains a stubborn problem.”

Browne is bullish on large rich datasets like the U.K. Biobank, and approvingly quotes John Savill, former Chief Executive of the UK Medical Research Counsel, who describes of big data as “the microscope of the 21st century.” Browne also emphasizes the value of rich datasets that can be used to train AI models.

He’s far more reserved about AI itself; he applauds AI successes, like the Google algorithm which expertly plays the board game Go, but also notes, citing computer scientist Fei-Fei Li, that these achievements are based on “virtual worlds with completely perfect clear, rules.” (A similar point was made by David Epstein in his captivating new book Range, as I recently discussed.)

AI, says Browne, “is still an emerging field” that, in the words of Li, “is going through a huge hype wave, and people extrapolate overzealously.” Browne perceptively notes that “people do not trust ‘black boxes,’” and references the suggestion of Andrew Adonis, Chair of the UK National Infrastructure Commission, that “people are generally more accepting of accidents that are caused by human error than those caused by errors in engineered systems,” a resonant observation.

Readers, no doubt, will be pleased to learn from Browne that the “sheer complexity of the human body, combined with the generally conservative leadership of medical institutions, means that we are not on the verge of creating sub-species of enhanced, eternally youthful human beings.” So, there’s that.

I was struck by Browne’s repeated emphasis on the impact of the supposedly conservative medical establishment on technology adoption; apparently, when fellow oil executives worry about “first mover disadvantage” associated with early adoption of digital technologies, it’s based on reasonable concerns about unproven tech, but when physicians pause, it’s a mindset issue. (In truth, I suspect it’s a bit of both.)

Continuum From Basic to Applied

Perhaps the most significant contribution to how we think about biomedical innovation Browne offers stems from his conversation with Paul Nurse, a Nobel Laureate for his work elucidating the cell cycle, and currently head of the Francis Crick Institute in the U.K. (Browne chairs the Board).

According to Browne, “The division between what others call basic science and engineering is artificial and counter-productive.”  He deplores the “unhelpful schism that exists between science, engineering and commerce.”

Browne views engineering as inherently translational.  As noted in the review, he describes engineering as “a head with two sets of eyes: one looks to the fruits of discovery, while the other looks to the demands of commerce and customers.” A pivotal moment in Browne's career trajectory, he said, was his realization that “no solution was complete unless it resulted in something practical that humanity wanted.”

Browne cites Nurse, who, Browne says, “has no time for the arrogance of scientists who claim to be ‘pure intellects’ and refuse to be ‘sullied with dirty commerce.’ To be engaged in the process of discovery is to be alive with possibility. The routes between the laboratory bench, the factory floor, and the shop shelf are many, varied, and hard to predict….There is not and never has been an obvious or linear conveyor belt that takes fundamental research and translates it into useful products.”

“It is definitely a complex network,” Nurse says (per Browne), continuing, “[our core mission should be] understanding the world and making use of that knowledge to improve the state of humankind."

And let us say: Amen.


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