Governors and Throttles in Innovation
Momentum
In healthcare innovation, success is determined by the delicate balance between risk-taking and risk mitigation. Borrowing from engineering concepts, I like to think of these forces as throttles and governors. Throttles push innovation forward—encouraging speed and risk, while governors temper that speed—imposing limits to ensure safety, compliance, and reliability.
But here’s the catch: the setting of a governor is a design choice, not a fixed constraint. And it’s this design choice that I find particularly fascinating because it directly impacts how much progress we can make before risk becomes untenable. So, who sets these limits, and how do they evolve?
Throttles: The Drivers of Innovation
Throttles in healthcare innovation are mechanisms that encourage risk-taking and speed up progress. These might include:
- Technology breakthroughs: New AI-driven diagnostic tools or personalized medicine approaches that open up unexplored avenues.
- Market opportunities: Unmet medical needs create commercial pressure to move fast and capture value.
- Policy incentives: Fast-track approval programs like the FDA’s Breakthrough Devices Program allow certain innovations to bypass standard regulatory timelines.
In essence, throttles are anything that accelerates innovation by reducing the barriers to entry or speeding up the time-to-market.
Governors: The Limits on Innovation
Governors, on the other hand, impose limits to prevent excessive risk. In engineering, governors are designed to prevent mechanical systems from exceeding safe operating limits. In healthcare, governors take the form of regulations, ethical standards, and institutional policies.
Critically, these limits are often set in response to past failures. Take the case of thalidomide in the 1960s: a drug initially marketed as a safe treatment for morning sickness that led to severe birth defects. The tragedy spurred stricter drug approval regulations worldwide. This is a clear example of a governor being set in reaction to an event.
Governors ensure that innovation doesn’t outpace our ability to ensure safety and efficacy, but they can also stifle progress if set too conservatively. That leads to an important question: how do we reverse or adapt governors when they’re too restrictive?
Adaptive Governors: A Dynamic Approach
Over the past few years, I’ve really gotten into Formula 1. Amazing engineering.
In these high-performance racing cars, engine management systems are adaptive, meaning they adjust parameters based on real-time data and driver input. For example, an F1 car’s engine management system might modify fuel flow or energy recovery settings based on telemetry data about tire wear, fuel levels, or temperature conditions to optimize performance and reliability.
In healthcare innovation, adaptive governance could work similarly:
Regulatory Flexibility: Regulatory bodies could employ adaptive approval processes that evolve based on real-world evidence. Early approvals could be granted with conditions for ongoing data collection and adaptive revisions.
Example: The FDA’s conditional approvals for certain cancer drugs allow faster market entry with the requirement of post-market surveillance.
Institutional Risk Appetite: Hospitals and universities could adopt adaptive policies for piloting new technologies. Instead of a binary “approved” or “not approved” stance, they might allow phased trials with dynamic risk thresholds.
Final Thoughts
Innovation, especially in healthcare, thrives at the intersection of throttles and governors. While throttles drive us forward, governors ensure we don’t lose control. The challenge lies in designing governors that don’t just react to failure, but adapt to success.
By embracing adaptive governance, we can create a future where innovation accelerates responsibly—delivering better healthcare solutions without compromising safety.