multidimensional design and a fresh start

I found out this week I'm switching teams.

For those with a background on the medical side of things, I'm leaving the Vascular Interventions team to head over to Critical Care / Renal Function. From a purely clinical perspective, this is a huge opportunity. Bard's big business is in Foley catheters (this link may or may not be SFW... depending on where you work), and more than 10% of its annual revenues as a corporation comes from the critical care Foley business. I'm going to be leading a huge project involving core body temperature and diagnostics, and I'm tremendously excited to get started.

Of course, I'm sad to leave my team behind. If you are one of the people that enjoys my gchat status updates during the week, I regret to inform you that the days of ambiguously hilarious updates about "PWOMs" and "LBigs" are numbered (or at least, will be reduced). Over the past two years, we've become not only subject-matter experts in venous infusion, but also good friends in the process.

Last week, I sat down with my new boss to discuss human-centered design. It was interesting, in that the conversation was happening between two engineers who see their craft as a balance of logical facts and human misgivings. We are consummate systems thinkers, trying to find where people fit into process.

Not to knock engineers (after all, I am one), but part of our problem in product design is that we try to systemize everything. We want an orderly and repeatable process to come up with orderly and repeatable innovations. Life is messy. It doesn't flow gracefully in neat, logical form. Instead, it flits its way from idea to idea, lumping together things that have no business being put together.

I'm trying to find my place in between designers and engineers. I think, then, it's important to build our lives richly, to cultivate experiences that can show us different dimensions of the problems we're trying to solve. It's the officially-unofficial first weekend of summer, and as I get ready for a fresh start on Tuesday morning learning about sepsis and kidney function and multiple-organ failure in the ICU, I'm trying to commit myself to an exploration of multi-dimensional design as well.

1. Two-dimensional design. I'm a lousy artist, so I take photographs instead. Here's a photo that sums up the weekend in Atlanta:

It's only May...

2. Three-dimensional design. I've decided to build a desk. Well, sort of. I wanted to build a desk. Then I realized that there are desks out there that are almost what I want. So I decided to find a desk to repurpose and refinish. But that's proving to be more difficult than I thought.

Four furniture stores and two hardware stores later, this is the best imitation of butcherblock I could find :-/.

3. Four-dimensional design. A new dance class that reminds me of why I started dancing in the first place. This weekend we're finishing up Ciara's Gimmie Dat, one of my favorite songs-of-the-moment (the video's choreography isn't as good as Vera's). I'm always impressed with the ability of good choreography to translate energy, emotion, and passion from individual movement and isolations to an entire crowd of people.

Since I didn't get to wear Ciara's awesome A-town hat in our video, I'll post this picture instead.

Our brains aren't wired to work in logical systems. Design is just as disorderly as life. Composing photos, creating a desk, and a choreographing a hip-hop class can teach us something about uniting human needs with systems capabilities.

channel strategy in the developing world

Effective channel strategy makes sure devices get used on patients.

Our Vascular Care group constantly talks about channel strategy (that is, how our devices make it to the bedside and ultimately to patient use). We know that designing the right product is not enough - we have really strong clinical efficacy evidence and a proven value proposition. Our products work, and clinicians that you talk to know the benefits. And yet we still have trouble driving compliance across a hospital. If a nurse knows that this device provides better clinical outcomes for patients and saves complication costs for the hospital, why do they neglect to use it with every IV insertion?

A usable device discarded by a hospital (at MedShare International).

Channel strategy is not just a medical device challenge. I'm currently rereading Prahalad's The Fortune at the Bottom of the Pyramid. In it, he argues that the poor - the consumers at the base of the pyramid - pay a "poverty penalty"that causes goods and services to be more expensive than they would be in corresponding areas of town that are more developed. The interest rates on credit in Dharavi are between 600 - 1000%, whereas on Warden Road it's a more reasonable 12 - 18% -- 53 times more expensive. Municipal grade water is 37 times more expensive, medications are 10 times more expensive, and rice is 1.2 times more expensive (see chapter 1).

Access and distribution channels in the developing world are just as complex as they are in a field like developed world healthcare. No one strategy will work. In poor areas, inadequate infrastructure makes it even more difficult (and even more expensive) to grant access to technologies and services by people who cannot afford to pay more for them.

Prahalad is not the only one who talks about access and distribution. There's a book by Frost & Reich available for free online called Access: How do good health technologies get to poor people in poor countries? It's sort of an interesting framework for why some technologies gain a foothold and some don't, from a distribution perspective (sort of similar to my own research).

So how do we lower the poverty premium? It's not necessarily by designing products for poor people (although that helps). It's by doing the basic, unglamorous things. System design. Capacity building. Effective training. These things are so needed and neglected in the developing world, but doing them can increase bandwidth and innovation in the developed world as well. As Prahalad liked to say, "If you build it for the poor, the rich will come. If you build it for the rich, the poor can't come."

the new rules for design & science

A bit ago, Tim Brown from IDEO wrote a post called "Design Renews its Relationship With Science."

My own view is that the latter half of the twentieth century saw a steady decline in designs interest toward science and technology as engineering inserted itself between the two. This is not a criticism of engineers who, in places like silicon valley, performed wonders with the new technologies of micro-processors, storage, networking and software to create the products and services we rely on today. The same is true in other fields such as aeronautics and bio-medicine. No, my criticism is of the designers and scientists who have relied on engineers to provide the translation between their two fields. My concern is that in this translation much is lost that could benefit scientists, designers and the end user.

I think "design" has gotten clique-ish. We hear the term designer and we think artsy, creative types who hang out in art museums and doodle in their margins. We've mistaken creativity for quirky stereotypes.

I saw a friend of mine last week at the Cherokee Club who is a designer by training, and he remarked that he didn't know I "design." And it's true: I have no background in graphic design, I've never taken a course on fabrication, I like my margins neat and doodle-free, and although I like museums of all sorts, I have no appreciable ability in sketching or drawing (well, I can draw a mean stick figure). I am more science than I am art.

Working on one of the first designs I created - on the apex of a pig heart.

... and then eating said pig heart after the experiment (I kid, I kid).

I try not to feel bad about calling myself a designer. But no matter what you call it - design, ethnography, imagineering - design is about how people interact with things. How we can create products and systems that interact with people the way people need to be interacted with. And that's what I'm interested in.

The lines are blurring between design, science, and engineering. Here are some new rules about navigating the gap.

1. Function first, form to follow. The world is full of designs that beautiful, but not useful. Don't just sell products. Solve problems. In a world full of "stuff", it's irresponsible to create something beautiful that isn't also useful...

2. Form does not have to be sacrificed in a functional device. ... and it's ignorant to create a highly useful device that people aren't attracted to. As our lives get more complex and our experiences richer, we tend to seek out services, systems, and products that engage us and satisfy us on many levels. We are trained to seek beauty in our lives.

3. Good design doesn't cost more than bad design. Good design just takes perspective and presence to observe how people behave in the world, and to listen to their experiences with the things that they use.

4. Listening is underrated. As a design tool, as an ethnographic method, as an engineering talent. The best way to understand what it is that people need is by asking the question and then shutting up long enough to actually hear the answer.

5. Designing a product is just as important as designing a procedure and a system of use. What good is a medical device if you can't get it to the bedside? If you don't have an appropriate channel strategy, distribution network, or carrier, no matter how clever the science or useful the product.

the hospital doesn't have to be a place where they go to die

If you want to understand a culture, listen to the stories that it tells.

MedShare is an organization that turns stories of despair into stories of hope. They donate discarded or surplus medical supplies from hospitals and companies to hospitals that have requested them in the developing world.

During our volunteer session this evening, Lindsey told a story of a hospital in Nigeria that was able, for the first time, to perform a c-section on a woman in labor due to the supplies that they had obtained from MedShare. Afterwards, the mayor of the town threw a party for all the surrounding villages to celebrate the milestone:

"It wasn't just that this one woman's life got saved. It was hope for the entire village. If something ever went wrong, there was a place they could go for help. And the hospital doesn't have to be a place where they go to die."

Sometimes, it's amazing how one small thing, can change the stories of a people forever.

a few statistics in global health

Last Friday Massachusetts General Hospital's Center for Global Health had its first annual symposium. It was an incredible turnout - at least 300 or so were in attendance. Lots of good thoughts as I try and wrap up my research paper, but one in particular:

(photo courtesy of MedShare - if you live in Atlanta and don't know about MedShare, you need to volunteer)

I posed a question to Kris Olson, who is a pediatrician and doctor of internal medicine at Mass Gen, and also the Director of the Global Health Initiative for CIMIT, about public-private partnerships and how we make innovation for the developing world a sustainable venture for the developed world. He didn't have an answer (no one does, and even now, only a few people are trying to figure that out), but he did bring up some interesting statistics and the need for healthcare innovation:

~ 40% of needles used to vaccinate children in developing countries have been used in another child before

95% of medical equipment (what we call "durable medical equipment", or DME) in resource-limited areas is donated equipment

90% of those devices fail in the first five years

Dr. Larson, while acknowledging the need for innovation in the space, made a great point: "A need does not necessarily equal a market." Not sure if we can find a way around that, or create a market, or develop a nontraditional market, but answering that question and monetizing that market goes a long way to improving global health in all regions of the world.

how information moves to create empowerment

Late last year I met with some folks in Boston who are working on some neat emerging technologies for diagnostics in the developing world. Since then, we've all been trying to brainstorm ways to engage others who are interested in this topic into the conversation. Recently, Aaron posed a really interesting series of questions to me in thinking about the world after their diagnostic technology becomes widespread:

(photo courtesy of... )

"How does the data move; what is done with the data when it gets there? How does it influence caregivers, governments, funding sources, etc? Can we predict what we might learn?"

I have an endless curiosity for questions like these (as Thomas Friedman calls it, this is my "inner fire truck"). Although my design skills are still in their infancy, and I hopefully have a long road in global health and technology ahead of me, these are the best kinds of questions to ask to move further down that path. Essentially, development is about empowerment, and empowerment comes from information. When you design for the developing world, and with the developing world, the primary concern is access to information. What information do these people need to make appropriate decisions (and how does that differ from the information that we provide for traditional devices in domestic hospital settings)? How can we deliver that information in a usable and readily accessible format? What will happen to that information once we obtain it? What other things can we couple it with to make the most of it?

Of course, you have to optimize your physical design for the environment that it will be used in, but these are questions of design intent, and they're far more interesting than questions of form or function.

the best place to start when you're struggling is anywhere at all

Today was a good day.

I've been working on a big design project for just under one full year. It's a two-part project with a lot of visibility in the company, and involves a change from our current paradigm that falls outside of our "core competence." For the past year, we've gone back and forth on designs and iterations, on concepts and user needs, on market segmentation. The topics are always interesting, and the insight is always good, but month after month, the song remained the same. It was starting to remind me of the Einstein quote about the definition of insanity: doing the same thing over and over and expecting a different result.

We were struggling.

just get the ball rolling. (photo courtesy of... )

But two weeks ago, something important happened. We brought in a new industrial designer, one with a totally different paradigm on medical devices than anyone we had on our staff. Almost immediately, he started on one piece of our design problem, and had a working concept in four days.

For anyone that works in design or manufacturing, four days is not a long time. Four days in the entire development lifecycle is a blink of an eye. It takes months, and sometimes years, to take a new product from idea to shelves. For medical devices, time to market is typically even further exaggerated, with regulatory requirements, clinical trials, and extensive documentation standing in the way. It's not uncommon for an implant or heart valve to take more than eight years of development time before seeing commercial use. For a kinesthetic person, it takes an enormous amount of discipline to work on something for that long without seeing the physical output.

The best part, though, was not that we had a design in front of us that met our design criteria, or that changed the way users interacted with IV lines. We had a design that gave us momentum. We got moving on part one of that two part design. And today, that spilled over into part two. I had been searching for a new material since February. I had drowned myself in the research, looked at material properties, made tables of peel / shear / tack values. I had tested for moisture vapor transmission rate and looked at every vendor this side of the Mississippi. But late last week, after seeing Howard's excitement and new designs, I got excited. I picked one. Today, the material arrived, and it works wonderfully. The excitement is contagious. Howard's designs get better with my excitement, and my designs get better with his input.

Momentum is a funny thing. When you get stuck in the inertia of the day-to-day, it's hard to visualize the end of the road (especially when the end of the road is 18 months down the line for a medical device to launch). But as a new friend of mine told me a few weeks ago, the important thing when you're dreaming up something new is not to come up with one really good idea; it's to come up with lots of ideas, period. Ideas lead to more ideas, and more ideas lead to action. And that's all you need to get the ball rolling.

the first sense a human fetus develops is the sense of touch

The first sense we rely on as adults is typically sight. But the first sense that God (or nature, or insert other terminology consistent with your belief or nonbelief here) gave us was the sense of touch. The first sense that children trust is their sense of touch (followed closely by their sense of taste, it seems). So why do we lose sight of that as we get older?

(a little time in PowerPoint and a few stock images later... )

Or does it? We tend to believe things that we see, but I don’t think we take into account how touching something shapes our thoughts. This is true with people we encounter – there is research showing that supportive, nonsexual touching makes people more productive, comfortable, and secure with their teams (in a workplace context). From Peter Bregman:

In a study led by Mathew Herstein, an associate professor of psychology at DePauw University, pairs of students who didn't know each other took turns using touch to try to convey a specific emotion like gratitude or sympathy. The person touched was blindfolded and yet accurately identified which emotion the touch intended to communicate between 50 and 78 percent of the time.

With objects, things that we touch can change our internal response - people who hold hot beverages feel more generous than those who hold cold ones. People who sit in hard chairs drive a harder bargain than those in soft chairs. And the more you touch something, the more valuable it becomes in your eyes.

When I think about it, this should affect the design choices in the project that I’m currently leading. My new device has to interact with both a nurse (for placement and removal), and a patient (as it dwells on their skin for days at a time). We have to choose materials that convey strength to a nurse, but comfort to a patient... two very conflicting emotions. It’s nontrivial, even for medical devices. Although the push is for evidence-based medicine and clinical research, nurse and patient perception are hugely important elements of quality of care. Our perceptions impact us more than our realities.

nonobviousness in device design

I always have reservations when I open an email on a Sunday from my work address. That being said, this FDA presentation showed up in my inbox today from our VP of R&D about medical devices being connected to the wrong attachment, resulting in some pretty nasty consequences:

(as a product of the US Government, none of this material is copyrighted - its use and reproduction is encouraged)

At first glance, as a medical device engineer with a significant clinical background, this seems ridiculous. Connecting a nasogastric tube (used to feed patients when they aren't capable of eating and need significant nutrition) to a Foley catheter (used to drain the bladder of urine)? A feeding tube connected to a tracheostomy port? By a trained nurse?


But as I look closer, some of these aren't obvious to me (are they obvious to you?). And if they're not obvious to someone who makes the stuff, I can't imagine anyone that would have an easy time with knowing how to place each and every component that surrounds a patient in a hospital bed. In the hubbub of a hospital room, with patients, doctors, family, and the scores of other people that are involved in healing, it's not always easy for someone to glance at something and know exactly where it goes and how it connects. And that is terrifying. Some of these actions have killed patients (well, when you're pumping milk into an infant's lungs...). Others have led to gross deformity and reduced quality of life.


The onus is on us, as designers, to make things as obvious as possible. Don't assume that a nurse is trained on your device. Don't assume that a doctor has read the Instructions for Use. They might have been trained on a different procedure, or be familiar with a different device. Assume nothing, and make it as difficult as possible for someone to use your device incorrectly. Don't make standardized luer connections on the end of everything just because it's cheaper to manufacture - it's also easy to connect a standard luer to pretty much anything... including things you don't want to connect to. A second molded component is worth the cost if you can save a patient's life.


In general, it's a good idea as a designer to never rely on your instruction manual. Most people (myself being the exception as I am a user's manual disciple) don't take a second look at the instructions that came with a product. And why should they? Instruction manuals are famous for being wordy, detailing features that we'll never use (but cited in our decision to buy the product), and overly complicated. They're written in technical (and legally manipulated) language. If you're in a developing or foreign country, the translations may not be perfect, and nor do you really care about reading through them. And when you have a critical patient in front of you, an instruction manual is about the last thing you have time for.


A design should limit people from doing what they shouldn't do - "designed incompatibility." It should be difficult to do things with a device that lead to nondesired outcomes. It should be damn well near impossible to do things that would cause someone harm.


Oh, and don't go walking around the hospital connecting random tubes together.

the fallacy of the empty vessel

(photo courtesy of... )

“In the Yucatan peninsula, it is the local collectivity of Mayan women who hold authoritative knowledge about birth; that is to say, the knowledge that is considered consequential for making decisions about and managing the event. Childbirth takes place either in the woman’s own house or that of her mother and technologies are familiar household objects. There are unquestionably experts involved: a midwife, with extensive experience of many births, supported by other women of the family, each of whom has her own experience on which to draw. But moment by moment knowledge of the event is produced collectively by the participants and draws centrally on the authority of knowledge of her own body granted to the woman herself. 

Into this system, designers of development programs to promoted Western biomedicine introduce new technologies developed in the context of the high technology hospital. A case in point is the sterile scissors, introduced as an alternative to the local practice of burning the umbilical stump with a candle to prevent infection. The gap between the context of its design and the local conditions of its use (in particular, an absence of stoves) led to a reinterpretation of the technology from a sterile scissors to a pair of scissors dipped briefly into a bowl of hot water. Observation by traditional birth attendants of a subsequent increase in infant tetanus resulted ultimately in their rejection of the scissors in favor of the former, clearly more effective practice of cauterization.”   - Chapter 7: Computerization and Women’s Knowledge | Suchman & Jordan, 1988

The gap between the context of its design and the local conditions of use – there isn’t a more powerful statement in the eyes of a designer. The single most important answer one can seek when developing a new technology is answering the question of use case – where will this technology be used? By whom? In what environment?

Suchman and Jordan go on to describe the “fallacy of the empty vessel – the belief by those who design new technologies that there is nothing there in advance of their arrival.” It's an interesting point - we aren't designing for an environment which has nothing. We are designing for an environment that has something different than what we have.

These two thoughts together define the crux of the difficulty of designing for the developing world – determination of the use case by people who aren’t well-versed in the context and circumstance of the users they are designing for. In other words, how do I, with my middle-class, relatively healthy, immigrant-turned-US-citizen background, translate my background in engineering into meaningful designs for people who need it most? There has been criticism among the larger NGO community of the “helicopter designer” – those who come in without understanding the use case and drop in a technology that isn’t well-received and doesn’t build trust or collaboration between the parties, and then leave. But there’s also the reality of both an inadequate critical mass of native designers and engineers coupled with Brain Drain of those who do specialize in those fields. With every failed innovation that gets transplanted from a disparate use case to one in the developing world, we lose credibility and trust in the eyes of those who we meant to help.

The world has a long way to go to address all the health challenges that we face, and we have a collective responsibility to improve the quality of life of people everywhere. In the short term, that means developing technologies that cater to the populations who need them. In the long run, we need to empower people to develop those solutions on their own. As we develop, then, it becomes crucial to do so in a way that builds trust and fosters partnership between those who design and those who use.

inventing for the future consumer

“Think one hundred years in the future, and ask ‘what will people wish we had done?’ ”

I first read that quote when I was waiting for a meeting at the Centers for Disease Control in Atlanta. It’s posted on the wall behind the Smallpox Eradication exhibit, and attributed to William Foege (who is something of a legend in the global health world). Reading that statement, it’s hard not to be excited about the work that lies ahead for me. In fact, that exhibit and the ensuing conversation inspired my research during my last year at Tech (for those that are interested, since I allude to this a good bit, the title of my working paper is “Defining The Process of Innovation: Common Themes in the Development of Biomedical Technologies for the Developing World”, advised by Thomas Barker in the Coulter department of BME at Georgia Tech).

As many of you know, I design. Specifically, I design medical devices, and although my work doesn’t yet cater to the developing world, it is nonetheless challenging and often frustrating to design for future consumers. For one, current consumers don’t know what they want or need. Henry Ford once said, “If I had listened to my customers, I would have built a faster horse.” Market research has a place, don’t get me wrong, but as I’m finding out now, the feedback you get from the market is more a blur of mumbled whispers than it is a conclusive cry of need.

Given the confusion of customer opinion, it’s frustrating to balance the need of the current user with the pressures of the future marketplace. The more removed you are from your user, the more difficult this gets. When you’re dealing with consumer goods, you’re designing for an everyday person not dissimilar from yourself, and your release cycles are typically short (less than a year) – and your feedback is still mixed. When you get into more complex markets, such as healthcare or aerospace, you’re designing for more than one user, and often a purchaser that’s entirely separate. For example, when I design a device, I consider the user (a clinician or nurse), the object of use (the patient), and the purchaser (a hospital GPO or contract manager). Add that to a release cycle of 18 to 24 months minimum (without clinical trials), and you can see how challenging this gets – trying to predict the preferences and needs of three distinct use profiles at least two years in the future in the face of rapidly changing technology.

I wish I had more insightful commentary on how to do this. It’s been a focus of mine for a while, as a young engineer trying to learn all that I can about customer preferences and how to meet needs through design. Designing for people in the future is something I’m struggling with – heck, designing for people in the present is challenging enough right now. Tim Brown of IDEO suggests “structured brainstorming”, but I think that it also requires a leap of faith, and in some ways, younger designers who better relate to future consumers are at an advantage, especially those that are scripted in systems thinking.

Maybe I should have been an imaginary engineer after all.

(and sorry Shan, for a post without a picture)

art & science

  (image: Nikki Graziano)

I’m fascinated with things at the intersection of art and science. Jonah Lehrer has a great book called Proust Was A Neuroscientist. The High in Atlanta just sponsored a Da Vinci exhibit about the intersection between Da Vinci’s sculpture and his understanding of the physical world. The new Le Laboratoire in Paris is dedicated to exploring that space.

The image above is by Nikki Graziano, and currently serves as the background on my laptop. Lots of my coworkers come closer to take a second look, and most dismiss it as one of my nerdy hobbies (of which I apparently have plenty). And maybe it is nerdy. But it’s art. And it’s science. And it’s beautiful.

Design lies at the intersection of art and science. Maybe that's why I like it so much. Designing things – whether that’s objects, systems, shoes, or medical devices (shameless plug) – is most successful when the functional (the science) is married with the beautiful (the art). One can’t exist without the other. It makes perfect sense for engineers and scientists to pursue art as well, because engineering and science are inherently creative pursuits.

Medical devices, then, make for an interesting creative exercise. As Lehrer says about the human body, “We are such stuff as dreams are made on, but we are also just stuff.” We have to be creative in how we address the body’s science (by, say, generating electrical signals to keep the heart beating through a pacemaker), but we also have to protect and nurture its art (regulating that rhythm to fluctuate with the body during exercise).

The beautiful part of Nikki's photograph is that the function isn't a simple harmonic oscillator with whole number boundary conditions. Her equations are complex because life is complex, and her photography is beautiful because the world is so.

"Like a work of art, we exceed our materials." (Lehrer 8)

how we create and how we consume

When I was younger, Dad would constantly remind me that we were "entering the new knowledge economy." The new knowledge economy, it seemed, was going to change everything, and all that could prepare you was getting the best education you could. The old rules, he said, weren't going to apply. And so it is, nearly a decade later. If you have any doubts that that reality hasn't played out, watch this and this.

The world has expanded and matured alongside my own generation, and because of that, the ways that we as young people interact with knowledge are vastly different than ever before. Part of this relates to our personalities, and part of this is dictated by the maturity of the platforms available. We've lived our entire intelligible lives bombarded with more information than any generation in history (and no doubt, this number will only continue to compound). Case in point: UC Berkeley researchers estimated that the amount of new content in the world grew at about 30% a year between 1999 and 2002, meaning that the amount of information in the world nearly doubled in that time. The past several years have afforded us the opportunity to experiment with various media, to see how creative we can be, to expand the amount and the type of content that we consume. We have progressed from a society where information was tightly controlled, disseminated by the media, the government, and a few prized creators, to a society where nearly everyone can create and share their content. This is a profound shift, with monumental implications.

In January 2010, 3 of the top 10 sites in terms of worldwide unique views were user-generated content (and 7 of the top 15). Facebook takes the cake among these user-generated sites with its 133+ million visitors, successful no doubt because it allows contributors to create conversation around what they know best - themselves. Facebook allows you to push content at your own pace, on your own terms, with your own interests. This makes a hugely attractive platform for the general user to connect with others. Somewhere further down the list is Twitter, less recognized but just as talked about. Twitter's contributors are valued less for their insightful or creative content and more for their speed (an attribute that I have never been able to master, and hence, why I don't have a Twitter account). Even those who solely consume (as in, those who don't publish any new content of their own) look first for the quickest way to learn what's relevant to them. Facebook and Twitter are successful because they are able to filter sources that you choose as important to your conversation stream, something that Google Buzz is trying to capitalize on. Blogs, on the other hand, are like more conventional news sources - it takes some searching, some trial-and-error, to find the right newspaper, television channel, radio station to enrich your conversations. My own Google Reader feed is evidence of the frustration of trying to maintain the balance between relevance and chatter. But on the upside, blogs, like traditional media sources, allow consumers and creators to engage in deeper conversations, and help identify and develop subject-matter experts in a way that other sources just can't. So where does the sweet spot lie? In being able to create deep conversations in a platform that makes it easier to identify who's relevant and who you want to listen to (thanks Karan, for the link).

In a lot of arenas (medical devices being one of them), the market still rewards those who follow traditional, conventional forms of creation. The regulatory structure, the quality control needed to make medical technology, means that creation is limited to a select few. But I imagine that in my lifetime I will see a paradigm shift in the way we create something as rigid as medical devices. The advantage, then, will go to those who understand that it's not the how we create, but the why we create - those who can correctly assess the markets, the disease states, and the patients, both in traditional markets and in the developing world.

I'm not the first to comment on the nature of creation and consumption in the internet age (as I said, speed is not my forte). But I've matured enough in my content consumption to be ready to become a meaningful contributor, and I'm excited to participate in the conversations that hopefully will follow.