Josephine Knight Dickson was always getting minor nicks and burns while working in the kitchen. And while this may seem like no big deal these days, back when Knight Dickson was prepping her family's meals in 1920, “there were no good options for bandaging such small injuries hygienically,” says Margaret Gurowitz, Johnson & Johnson’s in-house historian. “And this was before antibiotics, so infections posed a serious risk.”

Knight Dickson likely resorted to what many did at the time: winding a strip of fabric around her wound and tying a knot on the end to secure it — a hack that was neither sterile nor likely to withstand hand-washing. Her husband, Earle, was employed as a cotton buyer for Johnson & Johnson; he noticed that the gauze and adhesive tape she used would soon fall off her active fingers, so he decided to invent something that would stay in place and protect small wounds better.

He took a piece of gauze and attached it to the center of a piece of tape then covered the product with crinoline to keep it sterile. This ready-to-go product allowed his wife to dress her wounds without assistance, and when Earle's boss James Johnson saw the invention, he decided to manufacture band-aids to the public and make Earle a vice-president of the company.

This invention has remained relatively unchanged in its nearly 100-year history.

Band-Aid was a new technology born from someone who sought a better, practical solution to an everyday "healthcare" problem, resulting in the first commercial dressing for small wounds that consumers could apply with ease. BAND-AID® Brand Adhesive Bandages have become a staple in first-aid kits and bathroom cabinets throughout the world, are available over-the-counter at retail and community pharmacies, and through smart brand curation, J&J created a market that continues to thrive today (the global market for medical tapes and bandages in terms of revenue is worth around $7 billion).

Earle was inducted into the National Inventor's Hall of Fame in 2017.

Doctor Walmart Will See You Now

The Economist last week published an article (“Doctor Walmart Will See You Now”) exploring one of the accelerated evolutions underway in healthcare in the United States: big box retailers like Walmart and Costco, retail pharmacies like Walgreen’s and CVS Health, and variety stores like Dollar General, positioning themselves for new growth in the $312 billion market for primary care, which includes becoming care providers themselves. From The Economist’s reporting:

"Since 2019, Walmart has opened 32 of these “health centres” in five states; by the end of next year it plans to more than double that number, and expand into two more states.
Walmart is not the only big company expanding its medical offerings. Earlier this year Amazon acquired One Medical, a concierge practice (meaning clients pay an annual membership fee) with offices in cities across America. Dollar General, a discount retailer, has set up a partnership with DocGo, which runs mobile health clinics, and has launched a pilot programme at three shops in Tennessee. Walgreens and CVS Health, both retail pharmacies, have robust primary-care offerings; last year more than 5.5m patients visited a CVS MinuteClinic, making it one of the biggest providers in the country, and earlier this year CVS completed its acquisition of Oak Street Health, an elderly-focused primary-care provider with offices in 21 states. What do these companies see in the medical business?
The simple answer is money.
Americans spend a stunning amount of it on health: roughly 18 percent of GDP in 2021, far exceeding the rich-country average of about 10 percent and more than double the ratio of some, such as South Korea, with healthier and longer-lived populations. Americans’ spending is forecast to rise by 5.4 percent per year over the next eight years, outpacing economic growth and accounting for almost 20 percent of GDP by 2031."

I posted the article in my LinkedIn feed, with this accompanying commentary:

"Patients" visit a pharmacy an average of 35 times a year, compared to just four visits to see a medical provider. And as the image used here in this article shows, those "patients" are probably women, who make 80 percent of healthcare decisions in the home, and the "patient visits" are in fact "family visits".
The next healthcare works with new economic flows powered by market innovation and new storylines of "value" centered on 'continuous health engagement'.
And there's nobody better positioned to shape this evolution than retail pharmacies.
"Those that get it right will increase their share of the immense tide of money sloshing around America's bloated and inefficient healthcare system, and may also, incidentally, keep people healthier."

This brief burst of business writing sparked a number of comments and criticisms and contending perspectives, all professional and respectful, all necessary, and all still available in my feed. They fell into four general categories, although they were bound with a common thread:

Expert knowledge (doctors, surgeons and nurses) who reacted to the threat and/or encroachment of “Doctor Walmart” into their scope of services (and, presumably business interests) — this is, in fact, a legislative platform for the American Medical Association. “The AMA is opposing legislation introduced in the U.S. House of Representatives that would inappropriately allow pharmacists to furnish services that would otherwise be covered if they had been provided by a physician, despite pharmacists not having the same extensive education and training as physicians.”
Expert knowledge (doctors, surgeons and nurses) who challenged the “scientific merit” of the data I used comparing the annual flow of “patient” visits into a retail pharmacy vs. into the office of a medical provider. The real head-scratcher, though, was the published data deployed to challenge mine — here and here — only reinforced the central argument: patients visit their retail/community pharmacies a lot more than they visit their physicians. (For more “science” into the system value of retail clinics, here’s research from RAND Corporation.)
Expert knowledge (doctors, surgeons and nurses) who positioned retail pharmacies as the place “I go when I need to have a better selection of snacks while on a road trip than a convenience store.”
Expert knowledge (doctors, surgeons and nurses) who challenged my definitions of “healthcare”

"No A Band-Aid Is Not Healthcare"

There was one exchange, though, that struck me as, well, a little weird. But it was also revealing because it illuminated the three-body problem in healthcare, the nature of “expert failure” and the language of control, and what happens when common sense leaves the room: the notion that Band-Aids are not “healthcare”. Here is the exchange:

Poster:

“If a family is seeking medications at 9x the rate they are seeking medical advice then we have a serious problem with how we are approaching illness.”

Me:

“Why do you assume they’re “seeking medications”?

Reply:

“Thought we were talking about pharmacies in the context of healthcare, if we are just talking about where people visit most frequently we should be calling these grocery stores what they are.” [Note: the comment about band-aids has since been deleted by the poster]

Me:

Are Band-Aids not healthcare?

Reply:

“No, medical dressings are not healthcare visits when the comparison is a doctors visit, those are vastly different needs and very poor comparators. Maybe we are talking about two different things and I’ve completely missed your comparison. When I read your comparison, my interpretation was that you were saying “people visit pharmacies for healthcare related issues at a rate 9x compared to visiting medical professionals”, but it seems more like you’re just stating absolute visits regardless of indication. So you would look to add 4 visits or roughly 10% traffic to a retail pharmacy by adding medical providers, assuming those are non-specialist visits.”

Which another healthcare professional was quick to underscore:

“John G. Singer No, a band-aid is not healthcare. “

And my question in response, which was (and is) left unanswered:

Why not?

Retail Pharmacies Are Evolution Accelerated

We have been slow to learn that systems -- all systems -- generate their own momentum.

However you define “healthcare” (and whether you choose to get sucked into the “patient-centered” vs. “consumer-centered” argument), its essence does not reside in the ‘clinical setting’ and under the control of any one board-certified healthcare professional, but in the community as a whole, where the $1.7 trillion pharmacy market is best positioned to serve and sustain a ‘patient-to-consumer loop’ of continuous health engagement. The basis of competition and differentiation is neither “patient” or “consumer” but family health experience.

And this slingshot to a new health economy starts with new words to think new thoughts.

“Language accelerates learning and creation by permitting communication and coordination,” writes Kevin Kelly in What Technology Wants, his provocative book that turns the conversation about technology on its head by viewing technology as a natural system, an extension of biological evolution. “The chief advantage of language is not communication but autogeneration. Language is a trick that allows the mind to question itself; a magic mirror that reveals to the mind what the mind thinks; a handle that turns a mind into a tool. Until we tame the mind with an organization tool capable of communicating to itself, we have stray thoughts without a narrative. We have a feral mind. We have smartness without a tool.”

Healthcare has normalized cliche. It has stray thoughts without a narrative.

And it should be clear to everyone that new concepts, more than new technologies, are the real tools for “transformation” in healthcare. It is the words themselves that are the source of structural stalemate, but also the source material for novel strategic thinking and market access innovation, the kind of creative leadership to invent with purpose and to position outcomes as the economic objective upon which to compete.

I do agree with the poster that we (i.e., the world) have a “serious problem with how we are approaching illness.” But “fixing” strategic atrophy starts with new positioning and flipping the script, including thinking about healthcare within the context of pharmacies, rather than “pharmacies in the context of healthcare.” 🤘

/ jgs

John G. Singer is Executive Director of Blue Spoon Consulting, a global leader in strategy and innovation at a system level. Blue Spoon specializes in constructing new industry ecosystems.

Are Band-Aids "Healthcare"?

Doctor Walmart Will See You Now

"No A Band-Aid Is Not Healthcare"

Retail Pharmacies Are Evolution Accelerated

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