Lessons from Transformational Medical Advances (Harvard Business School Elective, Spring 2021)

Just completed (December 27 2020) syllabus.

Clearly I gave the holiday, not to mention my LXV passage, a miss!

Previously recorded infomercial is just below.

The course seeks to encourage and guide innovators in health care and other industries using case-histories of transformational advances, supported by a framework of productive knowledge. After describing these basic ‘ends and means,’ this syllabus summarizes the required pre-class submissions, final paper, and grading methodology.  (A downloadable version also includes the provisional schedule and assignments)

Ends and Means.

Popular media routinely tout imminent breakthroughs that often fizzle. Our case histories of treatments and tests that actually revolutionized medical practice in the last quarter of the 20th century, reveal patterns still common in medical innovation today. They show how protracted, multiplayer innovations – not solitary breakthroughs – typically produce transformational results. Yet venturesome individuals who won’t follow the crowd remains crucial.

The case histories present a vast number of facts through engaging stories which make the facts more memorable and easier to recall. Yet the course treats learning new facts mainly as a valuable byproduct. Rather we use the case histories to support innovators in two more subtle ways, namely:

Developing skills and judgment, particularly in recognizing opportunities and anticipating problems, adapting ideas from other domains, evaluating alternatives and so on. Learning by personally doing – or by personally watching – is often crucial for developing ‘skills of the hand,’ such as changing a car tire. But for many ‘skills of the mind and heart,’ learning from past instances is more practical and feasible. Studying historical wars and battles has long been an important part of training military leaders for example. Moreover, the skills and judgment emphasized go beyond particular techniques (which may become obsolete) and support more than just medical innovations.

Sharpening goals and aspirations. The case histories include stirring stories that showcase the romance of human progress. But they do not preach or sugarcoat: they include controversies about the marketing of antidepressants and the overuse of expensive procedures. Great adventures, they remind us, require great risks and difficulties and succeeding in what’s safe and easy – or just financially rewarding — is not always uplifting. In the coronary bypass case for example we encounter a German researcher who fails to “meet the scientific expectations” of his boss, loses his job, switches from surgery to urology, joins the military, and becomes a prisoner of war. Eventually he gets a Nobel prize, but can never secure a professorship because he had not finished his PhD. Another surgeon who performs the first successful bypass is forbidden from doing another. An Argentinian who then does many bypasses at the Cleveland Clinic and comes to be known as the ‘father’ of the surgery, ends up committing suicide after the institute he starts in his homeland cannot pay its bills.

The case histories may therefore discourage some from attempting risky leaps, but they should nevertheless inspire even those with cautious natures. Unlike hagiographies of larger-than-life innovators, the stories have ‘ensemble’ casts. Stars appear but don’t dominate. Rather the stories show how innovation accommodates a wide range of talents and temperaments. Prudent contributions we will see can make a difference. Therefore, the course should help stimulate your aspirations – for any kind of accomplishment — but not past your personal breaking points.

The course’s emphasis on skills, aspirations, and stories reflects my experience of teaching and researching entrepreneurship for more than thirty years. Conversations with former students suggest that the emotional and visceral aspects and stories of startups leave a more profound and lasting impression than the analytical aspects. When I surveyed self-employed graduates of HBS’s MBA program (Links to an external site.) I asked what they wished they had better learned. Most responses related to skill development (learning to sell, for example) and exposure to the stresses of starting a business.[a]  Similarly, my research on high-growth companies (Links to an external site.) suggests that a startup’s success depends more on the founder’s skill and determination than on creative business ideas and models.[b]

That said, we will use a framework I previously developed for a seminar on practical knowledge as a “simple walking stick.”  The framework, described in detail in my Note on Productive Knowledge, treats innovation as a multiplayer process undertaken by and for the many, rather than as an elite or exclusive activity. The Note also classifies the common tasks of multiplayer innovation (into categories such as goals setting, evaluation and testing, codification, and communication). Like tags and playlists in a music collection, the categories can help us sharpen, order, and retrieve observations and inferences made from the case histories. The categories should also continue to support your learning and development long after the particulars of this course are forgotten.

The analytical framework (like the skill and attitudinal development targeted in this course) is designed to be useful in a wide range of domains. As the readings show, broad based, multiplayer (rather than ‘star-centric’) advances have become a crucial feature of innovation, as have its common tasks and challenges. Similarly, although the specific case histories we analyze are medical, class discussions will include broader conversations about the general challenges of multi-player innovation. For instance, we may (as time permits) discuss goal setting and problem specification tasks along with the Tamoxifen case history. A few additional readings (see the daily assignments section of this syllabus) and a more extensive optional reading list will stimulate these broader discussions.

Pre-class submissions.

The case histories contain specific questions after each section and at the end. Students are required to enter very brief answers (less than ten words) to the questions on an online form by 9 am of the day of each class. I will create power point slides from the submissions which I will use to start the class (instead of the traditional student ‘opening’) and to continue the class discussion.

The submissions require less than an hour of additional work over the course of the term.

My experience since 1991 (when I first started requiring such submissions at HBS) suggests that this modest additional effort provides attractive returns, including: 1) Practice in confronting the uncertainties that innovators typically face. 2). Classes with fewer superficial comments because students are better prepared and, more importantly, have a point of view. 3). Broader participation:  I can draw in the quieter, well-prepared students with prior knowledge of their perspective on the case. 4) The elimination of anxiety about being asked to open a class.

If you do not submit a response, I will assume you have also not prepared the material. However, if you have a technical problem, do not waste too much time trying to submit your response. Just send me an email telling me that you tried but could not; I will take you at your word. Likewise, if you cannot submit because of a personal emergency, please let me know.

(As with traditional case courses, the assignments for each class include questions raised by the case histories that will provide the basis for discussions about the broad ‘takeaways.’)

Final Paper.

Instead of a final exam, self-selected groups (of up to 3 students) will write papers describing and analyzing the development of a noteworthy (medical or non-medical) advance that has already proven its practical value. Like the final papers written for my entrepreneurship class (see the compilation, Tales from Successful Entrepreneurs) the papers should include: a description of what happened (the “story”); analysis of specific choices (that reflects what you learned in this); and general reflections and takeaways. (A companion memo describes detailed guidelines, non-negotiable rules, and the criteria I will use to evaluate the papers).


My grading favors regular and conscientious contribution over occasional brilliance and values learning over sharply “objective” grading. Thus, for example, I would not use a “difficult” exam instead of a final paper, merely to produce more “defensible” grades. I also have greater confidence in my ability to evaluate final papers than class participation but recognize that participation contributes more to the “common good.”

Accordingly, I will divide class participation and final papers into five roughly equal “buckets”, A through E. I will then use the sequence of bucket combinations shown below to assign Category Is and IIIs to reach the maximum Is permissible and the minimum IIIs required.

Sequence for assigning Category Is and IIIs (going from the top down)

Category Is Category IIIs
‘A’ paper + ‘A’ participation

‘A’ paper + ‘B’ participation

‘B’ paper + ‘A’ participation

‘B’ paper + ‘B’ participation

‘B’ paper + ‘C’ participation


‘E’ paper + ‘E’ participation

‘E’ paper + ‘D’ participation

‘E’ paper + ‘C’ participation

‘D’ paper + ‘E’ participation

‘D’ paper + ‘D’ participation


Note: Failure to meet requirements will lead to an automatic Category III, or in extreme cases, a Category IV.  Specifically, more than two absences or missed pre-class submissions (out of the 12 classes remaining after the add-drop period ends) without good cause, as defined by the MBA program, (Links to an external site.) constitute a failure to meet requirements. If you choose to miss class for other reasons, your absence will be counted towards your “quota” of two classes.


[a] Bhidé. 1996. “The Road Well Traveled: A Note on the Journeys of HBS Entrepreneurs.” HBS Case 396-277 (Links to an external site.).

[b] Bhidé 2000. The Origin and Evolution of New Businesses. New York, NY: Oxford University Press, 2000 (Links to an external site.).