(2022-10-31) Johnson The Simple Cure

Steven Johnson: The Simple Cure. I saw a brief allusion on Twitter to the sad news that Dilip Mahalanabis had died. Mahalanabis was one of the key figures—arguably the key figure—behind Oral Rehydration Therapy, a revolutionary and surprisingly simple technique that has prevented millions of people, particularly children, from dying of diarrheal diseases like cholera over the past few decades

The Lancet called ORT “potentially the most important medical advance of the 20th century.”

The investigation into ORT’s history ended up teaching me something about innovation itself, something I had previously neglected in books like Where Good Ideas Come From and How We Got To Now. What made ORT so powerful was not that it was a more sophisticated response to a health threat. In fact, it was ignored by many because it actually looked like a step backwards in complexity. But that simplicity turned out to be crucial to its success. (Worse is Better)

By at least the 1920s, it had become standard practice in Western hospitals to treat cholera and other diseases that involved catastrophic dehydration by hooking the patients up to an IV and administering fluids to them intravenously. But setting up an IV for patients and administering fluids was not a viable intervention during a cholera outbreak affecting hundreds of thousands of people in places like Mumbai

He quickly realized that the existing IV protocols were not going to work

he and his team abandoned the slow and technical IV approach, and instead delivered boiled water supplemented with a mix of sugar and salts directly to the patients. Under Mahalanabis’s supervision, more than three thousand patients in the refugee camps received ORT therapy.

Inspired by the success, Mahalanabis demonstrated to field‑workers how easy it was for nonspecialists to administer the therapy themselves. “We prepared pamphlets describing how to mix salt and glucose and distributed them along the border,”

What’s not recognized is there is an equal need for innovation in not just the discovery that this kind of thing works, but then in delivering it and seeing it drive to scale.

Sometimes the best approach is to innovate by making the solution less technically advanced. (cf Adoption Life Cycle)