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From the essay 'How Our "Stuff" Has Redefined Our World' by Clifton Leaf, Deputy Editor of Fortune (published February 21, 2017)

Nature was once a "separate and wild province" from human civilization, as Bill McKibben wrote in his famous 1989 call-to-arms, The End of Nature: It was "a world apart from man to which he adapted and under whose rules he was born and died."

But, claimed McKibben, we have effectively killed off this independent sphere -- that wondrous, self-sustaining, life-generating realm which existed for eons before us.

"There's still something out there," he said, but "in the place of the old nature rears up a new 'nature' of our own devising" -- a construct where "each cubic yard of air, each square foot of soil is stamped indelibly with our crude imprint, our X."

Some now call this evolved world (or new layer of the planet) the "technosphere," a term coined by Duke University geologist Peter Haff. And it is filled to the brim with stuff. Indeed, there is so much of this human-made stuff -- machinery, skyscrapers, packaging, waste, Ikea furnishings -- that it's almost impossible to fathom, let alone measure. And yet -- gotta love science! -- that is precisely what a team of researchers has tried to do in a recent academic paper.

Their conclusion? Our stuff weighs approximately 30 trillion metric tons. (Yes, the authors used the word "approximately.") That works out to a mass of over 50 kilos per every square meter of earth's surface, and one that's an order of five magnitudes larger than that of the human beings who created it. Or so they estimate.

The diversity of stuff -- the manufactured flotsam and jetsam of our daily lives -- may even exceed the total diversity of biology throughout Earth's history, the same research team asserts. This endless assembly of things and devices, moreover, interacts and evolves in its own dynamic, emergent way: "In this sense," writes Haff (in another paper) "one might say that technology is the next biology." 

It's a thought-provoking thought.

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Healthcare is really one 'nested market' -- it is big business comprised of an ever-expanding zoo of market segments and micro-services, an endless parade of bright and shiny digital objects, all with data that demonstrate promise to improve our health and well being. The reproductive cycle of stuff is an additive process, rather than subtractive. The old media forms endure; the new are layered on top of them (for evidence: the fax machine is still the predominant means of communications by the lion's share of physicians). Our world is not multi-channel, it is infinite channel.

There are islands of features everywhere. The challenge is pulling it all together in a way that a whole system is born and becomes focused on generative value.

Or to put it another way, competing on outcomes means solving for fragmentation and continuous consumer engagement, at scale. This is about harnessing a wide-open space to make things out of ceaseless change, where the next growth curve is based on dissolving boundaries, harnessing flow and connecting the adjacent possible.

Sir Martin Sorrell, Chief Executive Officer of WPP, calls this 'horizontality'.

Paul Romer, an economist at New York University who specializes in the theory of economic growth, says real sustainable economic growth does not come from new resources, but from existing resources that are rearranged to make them more valuable.

"Recombination is really the only source of innovation. Economic growth occurs whenever people take resources and rearrange them in new ways." -- Paul Romer

More succinctly, new growth comes from remixing pieces and parts into novel combinations.

Last week marked the latest failed trial of an experimental Alzheimer's drug when Merck announced results for verubecestat. Eli Lilly's solanezumab flunked a clinical trial last November, the third failed late-stage trial for the drug. But these are just the latest failures in a long-running trend: nearly all of the 400 Alzheimer's 'drug' trials in the last decade have failed. Not one of these, however, looked at outcomes when you combine drug + music + meditation as a new ecosystem, even though there is lots of data on the benefits of both in Alzheimer's (e.g., improving cognition, reducing agitation).

For a 'drug' company to see opportunity from this adjacency, however, means looking with a lens well beyond 'drug.' A new species is needed.

The bigger context, though, is the emerging market transition to outcomes-based competition. Essentially everyone in healthcare -- payers, providers, pharmaceutical and medical device companies -- is groping their way through the white space.

And if you buy into the logic that it's not just one thing that improves outcomes, but many things simultaneously and interactively, then advantage goes to those who are best at creating and managing unique systems of health engagement. The data that flows from this system, and then refined into specialized cognition, is the thing that generates new business value, supports population health and guarantees performance (see: "Big Pharma's Offer to Trump: Discounts When Drugs Don't Work"). Population health is an emerging form of market strategy.

Outcomes-based competition is a strategic transformation. It is not a rigid creed. Rather, it is a spectrum of attitudes, techniques, and tools that promote collaboration, sharing, coordination and unique aggregations. This is a new frontier for design, and a particularly fertile space for innovation.

This is a race with machines, not against them. More like freestyle chess, where the partnership is between man and machine. For better perspective on creating and competing in the cognitive age, here's Ginni Rometty, CEO of IBM, yesterday at HIMSS17: