1. Disruptive versus incremental innovation in healthcare … twitter/medicalfutures Andy Goldberg MD FRCS(Tr&Orth) Consultant Orthopaedic Surgeon Royal National Orthopaedic Hospital NHS Trust Deputy Director R&D UCL Institute of Orthopaedics & Musculoskeletal Science

4. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

7. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

8. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

9. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

10. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

11. ?Better?

12. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

13. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk Market cap $340Bn Largest company in the world T/o - $65Bn, $14Bn Profits Making it 111 th company in size

14. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk Market cap $340Bn Largest company in the world T/o - $65Bn, $14Bn Profits Making it 111 th company in size T/o $350Bn with $30Bn Profits

15. Disruptive Technology Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

16. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

17. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

18. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

19. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

20. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

21. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk Everett Rogers, Professor of Rural Sociology, Iowa (Rogers, Everett M. (1962) Diffusion of Innovations) Adoption of Innovation

22. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk Everett Rogers, Professor of Rural Sociology, Iowa (Rogers, Everett M. (1962) Diffusion of Innovations) Adoption of Innovation

23. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk Everett Rogers, Professor of Rural Sociology, Iowa (Rogers, Everett M. (1962) Diffusion of Innovations) JVC VHS Sony’s BetaCam Adoption of Innovation

24. Adopter’s willingness to participate Awareness Interest Evaluation (evidence base) Tendency to risk Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

25. Adopter’s willingness to participate Awareness Interest Evaluation (evidence base) Tendency to risk Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

26. Uncemented Hips Meyer Burutaran L.S Barouk Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

27. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk Uncemented Hips

28. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk Uncemented Hips

29. Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk Uncemented Hips

30. Stepwise Introduction of Technology* Preclinical Testing First In Man Clinical Trials Post Market Surveillance Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk * Malchau 1995 (modified)

31. Stepwise Introduction of Technology* Preclinical Testing First In Man Clinical Trials Post Market Surveillance Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk * Malchau 1995 (modified) – FDA & MHRA

32. Are we joined up? FDA/MHRA Clinical Groups NICE Insurers/Commissioners Industry Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk * Malchau 1995 (modified)

33. New Proposal Industry has commercial pressures NHS funds research (circa £1Bn) Quid Pro Quo Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk * Malchau 1995 (modified)

34. New Proposal New Technology Panel (composed of stakeholders (ie regulators, clinicians, commissioners, industry and patients) Identify what evidence could be developed at the outset Joint funding of research (NHS & Industry) Limited marketing authorisation granted to industry (to trial centres who pay for product) Full marketing authorisation granted after agreed time period Andy Goldberg MD FRCS(Tr&Orth) www.medicalfutures.co.uk

38. Q&A Session andy@medicalfutures.co.uk