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Review Article
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OMICS A Journal of Integrative Biology
Volume 21, Number 11, 2017
ª Mary Ann Liebert, Inc.
DOI: 10.1089/omi.2017.0148
David Bowie and the Art of Slow Innovation:
A Fast-Second Winner Strategy for Biotechnology
and Precision Medicine Global Development
Vural Özdemir1,2 and George P. Patrinos3,4
Abstract
Original ideas and innovation cannot always be ordered like a courier service and delivered fresh to our desk
at 9 am. Yet, most creativity-based organizations, careers, and professions, science and biotechnology innovation included, emphasize the speed as the prevailing ideology. But a narrow focus on speed has several
and overlooked shortcomings. For example, it does not offer the opportunity to draw from, and stitch together
disparate concepts and practices for truly disruptive innovation. Preventing false starts, learning from others’
or our own mistakes, and customizing innovations for local community needs are difficult in a speed-hungry
innovation ecosystem. We introduce a new strategy, the Fast-Second Winner, specifically in relation to global
development of biotechnologies and precision medicine. This à la carte global development strategy envisions a midstream entry into the innovation ecosystem. Moreover, we draw from the works of the late David
Bowie who defied rigid classifications as an artist and prolific innovator, and introduce the concept and
practice of slow innovation that bodes well with the Fast-Second Winner strategy. A type of slow innovation,
the Fast-Second Winner is actually fast and sustainable in the long term, and efficient by reducing false starts
in new precision medicine application contexts and geographies, learning from other innovators’ failures, and
shaping innovations for the local community needs. The establishment of Centers for Fast-Second Innovation
(CFSIs), and their funding, for example, by crowdfunding and other innovative mechanisms, could be timely
for omics and precision medicine global development. If precision medicine is about tailoring drug treatments
and various health interventions to individuals, we suggest to start from tailoring new ideas, and focus not
only on how much we innovate but also what and how we innovate. In principle, the Fast-Second Winner can
be applied to omics and other biotechnology responsible development in medical practice or any field of
applied innovation.
Keywords: slow innovation, the fast-second winner, precision medicine, technology foresight, biomarkers and
diagnostics, David Bowie
analysis article offers a broader context and coins a new
strategy, the Fast-Second Winner, in relation to global
development and responsible innovation in precision medicine. Additionally, we introduce the concept and practice of
slow innovation that bodes well with the Fast-Second Winner
strategy.
We explain that the Fast-Second Winner, a type of slow
innovation, is actually fast in the long term, efficient, and
responsible, by reducing false starts in new precision
medicine application contexts and geographies, learning
Innovators don’t do things that have never been tried; they do
things that have never been done.
- Kevin Ashton (Gabbal, 2015)
Introduction
W
ith what strategies developing countries should
invest in biotechnology and precision medicine? This
is a timely and important question posed by Mitropoulos et al.
(2017) in the present issue of the journal. This innovation
1
Independent Writer, Innovation in Global Governance for Science, Technology and Health, Toronto, Ontario, Canada.
School of Biotechnology, Amrita Vishwa Vidyapeetham (Amrita University), Kollam, India.
Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece.
4
Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
2
3
1
2
from other innovators’ failures, and shaping innovations for
the local community needs. In principle, the Fast-Second
Winner strategy can be applied to omics and other biotechnology applications in medical practice or any field of
applied innovation.
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Time for a ‘‘Slow Innovation’’ Moment?
Original ideas and innovation cannot always be ordered
like a courier service and delivered fresh to our desk at 9 am.
Yet, most creativity-based organizations, careers and professions, science and biotechnology innovation included,
emphasize the speed as the prevailing ideology. If the new oil
and currency of the 21st century are data economy, as suggested by The Economist (2017) recently, this might perhaps
make sense.
But a narrow focus on speed has three, and often overlooked, problems.
First, it does not always offer the opportunity to draw from,
and stitch together disparate concepts and practices for truly
disruptive innovation. David Bowie, who defied classification as a singer and musician, transformed pop culture indelibly. Some claim that if innovation had a face, s/he would
look like David Bowie (Chakravorti, 2016). From his early
works with Space Oddity and Ziggy Stardust, he kept on
reinventing himself and drawing from fields and literatures
that do not always come together such as the Japanese theater, cinema, art, software and William Burroughs. Bowie
was an artist in every imaginable and unimaginable way,
creating brand new genres and transcending them. Had
Bowie been under pressure for speed to innovate and report
progress every quarter, he likely would not be able to bring
together the ideas he borrowed from multiple fields. Bowie’s
innovation was one of ‘‘compositional innovation,’’ a term
we introduce here, for the idea that ordinary objects,
processes, or established knowledge can create something
unusually disruptive and innovative if put together and
composed in novel ways.
Second, speed does not permit opportunity for reflection,
contextualization, and ultimately, learning from mistakes
of others or of our own. Kevin Ashton, who coined the
term ‘‘The Internet of Things’’ (IoT), has commented that
innovators do things that are never done before (Gabbal,
2015). Indeed, by definition, innovation is an unprecedented process, product, or knowledge. Thus, innovators do
fail many times as they navigate their way in unchartered
territory before (and if) they succeed. Thomas Alva Edison,
too, has failed numerous times before his discovery of
the light bulb. Yet, for every Edison we are aware of, there
are likely innovators in the order of millions in obscurity,
who have tried two times, failed, ran out of resources and
were unable to continue. Most do not get a second chance,
or the biology and its materiality rear their head on experimental constraints such as limited sample size, tissue
availability, among others. In sum, in developing countries
and resource-limited settings of the developed world, one
often has a single opportunity to experiment and succeed for
innovation.
Third, speed can make us forget to tailor innovations
for the needs of the user communities or think about the
opportunity costs of a given technology. Scientific and
other development aid can quickly turn into an authori-
ÖZDEMIR AND PATRINOS
tarian aid, if the pressing health needs and priorities of the
recipient countries and local communities are not considered. Lack of appreciation of the opportunity costs
and alternative technologies create further missed opportunities to innovate in a targeted, relevant, and efficient
manner.
These are important enough and yet little debated
shortcomings of the speed-hungry 21st century innovation
ecosystem that slow innovation is worth considering, as an
alternative concept and practice.
The Fast-Second Winner Strategy
An ‘‘à la carte’’ slow innovation approach
for global development
An astutely global, and yet customized strategy for responsible diffusion and diversification of omics and other
biotechnology innovations across the nation state borders
is sorely missing. Such globalization of science cannot be
‘‘one-size-fits-all-countries,’’ however, in much the same way
drug treatments ought to be customized through precision
medicine.
Returning to the question posed by Mitropoulos et al.
(2017) in the Introduction section, it is noteworthy that the
two common reflex responses to assist global development of
precision medicine have been the method of implementation
consortia and/or full-scale infrastructure investments, often
commencing upstream, from discovery science onward to
translational research and implementation science. This
cascade of science progression has long been known as the
linear model of innovation. While such full-scale investment
might be desirable, there are also opportunity costs when
resources are limited. For every full-scale investment in a
given geography, investments in another resource-limited
setting may become not tenable. Beginning the innovation
process invariably from discovery science prepares the innovators for possible failures and setbacks that cannot be
offset easily in developing countries in the event of failure. If
one does not have much ammunition, little reserves and
insufficient buffer systems to absorb economic and other
shocks, it is prudent to choose and target the innovation investments with a sound strategy and foresight, rather than a
full speed dive into the innovation ecosystem. Speed is not
invariably an advantageous strategy when it comes to innovations as noted earlier.
Transplanting innovations from developed countries to
the developing world may not always work or be responsible. They need to be customized for each country.
For example, in a bibliometric analysis of all human
genetics studies that used Cameroonian DNA samples
from 1989 to 2009, 52% of the publications were devoted
to population genetics (variation/migration patterns)
whereas only 10% of the studies involved the hemoglobinopathies such as sickle cell anemia that greatly impacts
Cameroon (Mnika et al., 2016; Wonkam et al., 2011). The
same is true for the plethora of discovery studies in the field
of genotype-to-phenotype correlations that are often tested
for replication in different population groups, as compared
to studies that address the applications of these findings in
the clinic, the latter being disproportionally fewer than the
former. Tailoring scientific aid and knowledge-based innovation for country-specific needs means that research and
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ART OF SLOW INNOVATION
FIG. 1. The Fast-Second Winner midstream innovation
model to tailor omics and precision medicine global development strategy in a country-specific manner. GWAS: Genome Wide Association Studies.
innovation agenda ought to be shaped earlier than implementation science. Yet, such agenda setting need not always be at the very beginning when discovery science is in
force either.
We propose a ‘‘Fast-Second Winner’’ strategy for global
development of precision medicine and omics technologies
(Fig. 1). This à la carte strategy envisions a midstream entry
into the innovation ecosystem, and offers the following
advantages:
An opportunity to identify the emerging biomarker
leads from the end of the discovery pipeline and early
translational research worldwide, and harness those
that are most appealing, for example, from genome
wide association studies for the individual country
pressing public health needs (Fig. 1). In this scenario,
one can move forward with translational research or
scale up for implementation in the relevant country.
Alternatively, the identified promising biomarker discoveries are finessed further with targeted discovery,
for example, characterization of population-specific
genomic variants in the relevant country before further translation and implementation (Chikowore
et al., 2015). The existence of well-curated population genetic databases for clinically relevant genomic variants’ allele frequencies (e.g., FINDbase: www
.findbase.org) (Viennas et al., 2017) would also help
significantly to achieve this goal. Midstream entry
to the innovation ecosystem offers the flexibility
(hence, à la carte strategy) to move bi-directionally
upstream or downstream and yet, permits investments
only on the biomarker leads that have stood the initial
test of discovery science, and addressing a health
burden of unique fit for a given country. Reducing the
odds for false starts and poorly targeted innovations
empowers the resource-limited regions and developing countries.
Midstream innovation through a Fast-Second Winner
approach capitalizes on the lessons learned from
3
other innovators’ failures. Some of these ‘‘Fast-First’’
and failed innovation actors can be from academia,
funding agencies and philanthropies, governments and
industry. Moreover, what is considered a failure in
one context and country may represent a unique niche
for another country’s innovation needs. For this learning and ‘‘match-making’’ among biomarker leads,
countries, local disease burdens, drugs, and other
health interventions to materialize, we propose the
establishment of Centers for Fast-Second Innovation
(CFSIs), and so as to assist global omics and precision medicine development and deployment responsibly.
These centers can steer Fast-Second Winner midstream
innovation for precision medicine across nations and
borders.
Finally, midstream innovation leaves ample room to
shape and tailor the development of a diagnostic candidate consistent with the local community needs, thus
contributing to responsible innovation.
In resource-limited settings and in the course of seeking
hope to overcome poverty, the allure of new biotechnology and full-scale investment in all aspects of the innovation ecosystem may be seductively appealing. Yet, this
may inadvertently forbid sound development strategies
necessary to prevent false starts, learn from other innovators, and customize an innovation for a given country
and local community. The Fast-Second Winner strategy and the accompanying CFSIs warrant further consideration as one of the new approaches to innovate the
innovation processes as omics and precision medicine
continue to diffuse and receive demands for capacity
building in various geographies and countries (Rehman
et al., 2016).
Whether one is a staunch subscriber to the linear model of
innovation or not, midstream innovation and entry into the
innovation ecosystem, in our view, should be explored further and might offer an appealing global development strategy for biotechnology and precision medicine in ways that
are also country-tailored.
The Fast-Second, as a term, has been used in the business
literature for companies to enter and capitalize on new
markets successfully, and with emphasis primarily on
scale-up for products and innovations created by others
(Markides and Geroski, 2004). Our proposal is different,
and does not focus on market capitalization but instead on
responsible innovation, and empowerment of developing
countries and underrepresented innovators with limited
resources (Fisher, 2017; Nowotny et al., 2001; van Oudheusden, 2014; von Schomberg, 2013). The Fast-Second
Winner has not been previously conceptualized in ways
that also cultivate responsible innovation in health to address the local community needs, not to mention of developing countries. The Fast-Second Winner can include
scale up but can also extend into upstream or downstream
science so as to shape and customize an innovation responsibly for people and countries.
How can such an initiative be funded? As it is the case
with many new ideas, it is often hard to fund them with the
traditional mechanisms, as previously mentioned. A conceivable and independent solution could be the adoption
of an innovative crowdfunding model. There are different
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4
types of crowdfunding methods available. Crowdfunding
2.0 builds on an initial kick-off donation by one or few
angel investors that is then scaled up by smaller donations
from many citizens and stakeholders (Özdemir et al.,
2015). Citizens are also invited to offer their ideas for
potential applications of a given technology that would be
of use to them. This increases publics’ participation in
innovation upstream at the design stage, correct innovators’ blind spots, and helps to ‘‘think the unthinkable’’ in
relation to user and local community needs (Özdemir et al.,
2015). Because crowdfunding is open to contributions
globally, it is not limited to the nation state borders, and
thus, can help reach out numerous local communities in the
spirit of precision medicine without borders. It might also
serve as a multidisciplinary forum for various stakeholders
to learn from each other and calibrate their interests and
expectations.
We support speedy innovation whenever possible, but
without forgetting that speed is only one dimension of
innovation, has several overlooked shortcomings, and that
quantity also needs to have a quality dimension. The ends
to which innovations serve, quality, and relevance of
an innovation for individuals and populations, and responsibility also do matter. When we expand our own
horizons as well as the time scale of an innovation, we
might be pleasantly surprised that what appears to be slow
innovation initially may actually be the fast and sustainable one in the long term, with fewer false starts and responsible returns on investments for knowledge-based
innovation.
ÖZDEMIR AND PATRINOS
(although one of us is a fan), but we can learn from how
Bowie and others who courageously took time to learn from
seemingly unrelated knowledge and objects, and seamlessly
composed them to works of truly innovative music and
art. Many like Bowie exist around the globe who are idea
seamsters. The creative art of science, including postgenomic medicine and its branching arms such as precision medicine can usefully learn from Bowie and slow
innovation.
If precision medicine is about tailoring drug treatments,
nutrition, vaccines, and various health interventions to individuals, perhaps we can start from tailoring new ideas and
focus not only on how much we innovate but also what and
how we innovate. The Fast-Second Winner and slow innovation are only some of the many quality possibilities that
exist.
Acknowledgments
No funding was received in support of this innovation foresight and science policy analysis. The views expressed are the personal opinions of the authors only and
do not necessarily represent the views of their affiliated
institutions.
Author Disclosure Statement
The authors declare that no conflicting financial interests
exist.
References
Conclusions and the Ways Forward
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to talk to strangers and listen to them. We may not be fond
of David Bowie and do not need to listen to his music
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ART OF SLOW INNOVATION
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5
Address correspondence to:
Vural Özdemir, MD, PhD, DABCP
Professor of Science Communications, and
Independent Writer on Innovation in Global Governance
for Science, Technology and Health
Toronto, Ontario, Canada, and
School of Biotechnology,
Amrita University
Kerala, India
E-mail: vural.ozdemir@alumni.utoronto.ca
AND
Professor George P. Patrinos, PhD
University of Patras, School of Health Sciences
Department of Pharmacy, University Campus
Rion, GR-26504, Patras, Greece, and
College of Medicine and Health Sciences
United Arab Emirates University
Al-Ain, United Arab Emirates
E-mail: gpatrinos@upatras.gr
Abbreviation Used
CFSIs ¼ Centers for Fast-Second Innovation
GWAS ¼ Genome Wide Association Studies
IoT ¼ Internet of Things
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