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Nurturing a Culture of Innovation

The Forsyth Institute, 140 Fenway, Boston, MA 02115-3799; ddepaola{at}forsyth.org

Quite simply, we have an unprecedented opportunity and a daunting responsibility to change the way the public and policymakers think about health and disease. In particular, it is past time for the American Association for Dental Research (AADR), the International Association for Dental Research (IADR), and its myriad Divisions to engage in innovative partnerships aimed at insisting upon and leading a "creative revolution" to transform the notion of oral health to one of simply health! The driving force behind this transformation should be the discovery of knowledge. The rapid application of that knowledge for the public good provides the basis for stimulating the nation’s and, perhaps, the world’s policymakers to action.

To be sure, we live in an era of ambiguity, uncertainty, and risk. At the same time, we live in an era of spectacular advances in science and technology and have made important strides in understanding human behavior. Yet, in the United States alone, we have over 40 million people without health insurance and more than three times that number who have no dental insurance. At the same time, we continue to experience a level of oral disease that, despite being better than it was, still poses a serious public health problem, with increasing evidence of oral-systemic health links.

On the global front, a recently released World Health Organization (WHO, 2003) Oral Health Report indicated that five billion people suffer from tooth decay, and that oral diseases in the form of tooth decay and periodontal disease(s) are an increasing threat in developing nations, including problems related to malnutrition and life-threatening systemic health problems. Indeed, the same WHO Report estimates that treatment of oral diseases accounts for up to 10% of health care costs in industrial countries and presents a significant health and economic burden with which many developing countries cannot cope. Clearly, people’s daily lives continue to be profoundly affected by oral pain, abscesses, masticatory problems, infections, and missing teeth.

But, as the noted journalist Paul Harvey points out, there is a ‘rest of the story’. The need to view health and disease as an issue without differentiation into organ categories is illustrated tellingly when one reviews the data on diabetes. For example, in the United States, about 35 million people suffer from diabetes, but only half of them are aware of it! When these data are coupled with the clear and unmistakable linkage of diabetes to oral health, the folly of this artificial separation from general health begins to illustrate the rest of the story. Without question, dental diseases belong in the same bucket as any disease that afflicts the public.

Unfortunately, as a nation, we still have a two-tiered health care system embedded in a research, academic, and clinical care system that is, on the one hand, the envy of much of the world while, on the other hand, so bogged down with bureaucracy and regulations that we are unable to address our "silent epidemic" adequately, as depicted by two Surgeons General of the United States (USDHHS, 2000, 2003). It is my considered opinion, shared by others, that if we are to take advantage of the wonders of science that are unfolding on almost a daily basis, we need to establish and/or reaffirm a culture of innovation, fueled by data and driven by passion, to resolve the apparent disparity between scientific achievements and public health.

There are two areas where nurturing a culture of innovation can be especially useful for improving the public good; in this case, the public good is served best by a unified health system. These areas include innovative leadership, and strategic, innovative partnerships.

Leadership is vital to drive performance for the public good when cultural changes, competition for resources, and technological achievements are so pervasive. The specific innovative leadership that the AADR could provide is aimed at linking science and technology with the community and the consumer. As a community of scholars, we are wonderful at the science, impressive on the technology front, but less than desirable if not downright inadequate on the community and consumer side. Let us not forget that scientists, like clinicians, also have a public trust to embrace. Perhaps a lesson from industry may be useful to consider.

According to Glen Urban at MIT’s Center for e-Business (MIT, 2004b), evidence is building that the marketing paradigm is changing from mass media and relationship marketing strategies to advocacy-based strategies essential in this era of growing consumer power. How does this relate to the AADR and to linking scientific achievements to the public good?

It seems to me that all of us are in a frenzied competition for market share similar to industry, the difference being that our "market", if you will, includes obtaining adequate physical and human resources to conduct the superb science necessary for the public good; it includes having the consumer understand that oral health and systemic health are inextricably intertwined, and that you cannot have one without the other; and it includes policymakers and insurers providing the supportive policies and reimbursements such that there is no distinction between body parts when it comes to health.

So, the innovative leadership that the AADR can help to provide—because it cannot do it alone—is to unleash its considerable talents to provide powerful advocacy with Congress, with State legislatures, with policymakers, with Foundations, with the private sector, with the community, and, particularly, with the consumer, to make the science come alive for the public good. Leadership of this type will require the AADR and its partners to take risks, to motivate people to change, and to involve individuals who are willing to put their passions, if not their souls, on the line. In their provocative book on leadership, Inspiration or Desperation: Companies Change When People Care, McPherson and Wittemann (2004) suggest that we unleash our "change ninjas" to make a difference. Without question, this is one area where it will take a village to move the national oral health agenda forward. The stakes are high, with the rewards potentially glorious!

No amount of innovative leadership can be effective on these issues without potent strategies and innovative partnerships. There are many obvious and some not so obvious partners for the AADR to consider. However, I am not suggesting that we establish a linkage or a collaboration with everyone with whom we could partner, but rather that we base innovative partnerships on mutually established objectives.

An illustration of a possible strategic and innovative partnership may be instructive. For example, the AADR could catalyze a strategic partnership with the NIDCR, the NIH, the medical and nursing communities, the American Dental Education Association (ADEA) and the academic community, pharmaceutical and biotechnology industries, and the consumer, where the objective is not to increase the potential for AADR members to obtain contract research opportunities, but where unique "paths of discovery" are nurtured, and where products aimed at prevention, diagnostics, or therapies can be created and developed. The classic "push" funding provided by the Federal Government for discovery science, where there is no proven market, and "pull" investment by companies or Venture Capitalists (VCs), that pays for development, could be cultivated and would be relatively unique to the oral health community. In this scenario, the goal of the partnership would be not only product development but also, a powerful way to move beyond traditional disciplines to illustrate that exemplary science knows no boundaries. Thus, the public good would be served by an innovative partnership, consistent with the tenets of NIH’s new Roadmap, where there is a blurring of distinctions between dental and other sciences, putting us on a closer path to health.

To ensure that the public need drives the market, the partnership could even be used to define those consumer-driven needs and the strategies and tactics to move them to a prominent place on the national research agenda. After all, as seductively as scientists can describe the genome and proteome, and as beguiling as the promises for applying the discoveries of molecular medicine are to health, the really telling and potent power needed to sway Congress or world policymakers to give up their resources and shift their priorities is the consumer. A wonderful example of how effective a strategic partnership can be is the oral cancer partnership developed and catalyzed by New York University. It would not be hyperbole to note that the NYU-led partnership is changing the awareness of oral cancer among organized dentists, other health care professionals, and the consumer. This is because the media and the consumer were early partners in the strategic alliance. The National Spit Tobacco Program (NSTEP)—a partnership among Oral Health America (OHA), the Robert Wood Johnson Foundation, Major League Baseball, and various community-based coalitions—is another sterling example of an innovative partnership for the public good. Clearly, these are home runs!

As Charles Vest, the President of MIT, has argued (MIT, 2004a), we must "...advance science and technology, but also transfer these discoveries into new products and services." To accomplish this vital goal of translating science into practice, we, as a community, need to erase the distinctions between oral diseases and other diseases and develop a national strategic plan that establishes priorities related to community needs with respect to oral diseases and allocates resources to bring expertise from whatever areas are needed to address the national agenda. In my estimation, there must be a renaissance of new ways to do business, where discovery and innovation are linked, where there is a nexus of intellectual curiosity with consumer activism, and where the distinctions fostered by a two-tiered health system are eradicated. This represents a magnificent opportunity for the AADR and its partners to lead the "creative revolution" toward the public good.

The prevention and treatment of disease, providing quality care with universal access, and a health care system that does not differentiate oral health from general health should be the raison d’être for funding discovery and for the AADR and its partners to have the will to do whatever it takes to make a difference. Driving innovation throughout the organization should be our injunction for the future.

REFERENCES

McPherson C, Wittemann JK (2004). Inspiration or desperation: companies change when people care. Augusta, GA: Summerville Books.

MIT (2004a). Program material for MIT’s 3rd Annual Innovations in Management Conference. Cambridge, MA.

MIT (2004b). Great teaching-lessons in excellence. Cambridge, MA: Spectrum.

US Department of Health and Human Services (2000). Oral health in America: a report of the Surgeon General. No. 00-4713. Rockville, MD: USDHHS, NIDCR, NIH.

US Department of Health and Human Services (2003). National call to action to promote oral health. NIH Publication No. 035303. Rockville, MD: USDHHS, NIDCR, NIH.

WHO (2003). The world oral health report 2003. Geneva: World Health Organization.

This Article Full Text (PDF) Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by DePaola, D. P. Search for Related Content PubMed PubMed Citation Articles by DePaola, D. P.