Discovering User Solutions: Positive Deviance in Substance Abuse

Professor Eric von Hippel, a leading figure in user innovation and a supporter of MIT boot camps, presented his insights on how to leverage user-developed innovations, particularly in the context of substance abuse. He emphasized that while traditional approaches focus on identifying unmet user needs, a more effective strategy involves finding prototype solutions already developed by "lead users" – individuals who innovate to solve their own problems.

The Flaw in Conventional Wisdom: Producer-Centric Innovation

Conventional wisdom, largely influenced by Schumpeter's century-old ideas, posits that producers are the primary innovators, and consumers are merely educated by them. This leads to a "producer innovation and diffusion model" where:

1. Market Research: Producers identify user problems.
2. Solution Development: Producers invent solutions to these unmet needs.
3. R&D and Production: Solutions are developed and manufactured.
4. Market Diffusion: Solutions are sold to users.

However, Professor von Hippel argues that this model overlooks a significant source of innovation: users themselves.

The Ubiquity of User Innovation

National innovation surveys across various countries, including the UK, reveal that a substantial portion of the population innovates to solve their own problems. For instance, in the UK, 6.1% of the population developed something for themselves, totaling 2.9 million user innovators, compared to only 23,000 product developers working for commercial firms. This means user innovators outnumber producer innovators by over 100 to 1.

Historical and Modern Examples of User Hacking

User innovation, often termed "user hacking," has a long history:

• Model T Conversions (1908): Immediately after its introduction, customers began modifying the Model T into farm tractors, sawmills, pickup trucks, and even snowmobiles and race cars. Ford's only response was to warn about voiding warranties, yet these user innovations laid the groundwork for entirely new market segments, like pickup trucks.
• Modern Hacking: Examples include individuals putting jet engines in VW Bugs or creating custom car designs from LEGOs or Rolls-Royce parts. These demonstrate a continuous trend of users modifying products to suit their specific needs, often exceeding commercial R&D investments in volume.

User Innovation in Substance Abuse: A Double-Edged Sword

In the realm of substance abuse, user innovation is prevalent, often manifesting in negative ways:

• Defeating Control Measures: Users display immense inventiveness in circumventing substance abuse controls. Examples include developing methods to adulterate, substitute, or dilute urine samples using common household chemicals or carrying drug-free urine. These are user-driven solutions to a direct, desperate need.

However, Professor von Hippel emphasizes the importance of identifying positive innovations developed by users. These are field-tested ideas that can be commercialized.

Finding Positive Deviants: The Sternin Approach

Traditional approaches to addressing substance abuse often involve interviewing users about their problems and attempting to develop solutions for them. However, many users who have successfully overcome substance abuse may not be found through random interviews, as they have moved beyond that category.

A more effective method is inspired by Monique and Jerry Sternin, aid workers in Vietnam, who developed the "positive deviance" approach:

1. Identify the Problem: A population faces a common challenge (e.g., child malnutrition).
2. Find Positive Deviants: Identify individuals within that population who are successfully overcoming the challenge despite similar circumstances.
3. Learn from Them: Discover what these positive deviants are doing differently to achieve better outcomes.
4. Diffuse Solutions: Share and apply these locally developed solutions more broadly.

Example: In a Vietnamese village, Sternin found that mothers whose children were healthier were adding crawfish and insects from rice paddies to their soup, providing a protein source that others ignored as "trash." These mothers didn't advertise their methods due to social stigma, but their children thrived. This discovery allowed for the development of local, sustainable nutritional solutions.

The Value of User-Developed Solutions

User innovations are often more successful because:

• Real-World Experimentation: Users experiment on themselves in real-use conditions, leading to practical and effective solutions.
• Non-Advertised Solutions: Successful user innovators, especially in sensitive areas like substance abuse, often do not advertise their solutions due to social stigma or lack of incentive. This means entrepreneurs often miss these valuable insights.
• Commercial Potential: By systematically finding these non-advertised solutions, entrepreneurs can recognize their commercial potential and be first to market with user-prototyped innovations.

Methodologies for Systematically Finding User Innovations

The challenge lies in finding these scattered, often unadvertised, innovations. New methodologies are emerging to address this:

• Big Data Analysis: Researchers are developing methods to identify user innovations using big data, allowing for rapid identification of promising solutions.
• Web Content Scanning: This involves massively scanning web content for phrases like "I had a problem, and I solved it" to identify user-generated solutions.
• Innovation Diffusion Analysis: Tracking how many people are talking about or searching for a particular user-developed solution can indicate its potential for wider adoption and commercialization.

User Prototypes vs. Commercial Products

It's important to note that user-developed solutions are often "cruder" than commercial products. They are prototypes that test a principle at zero or low cost.

Example: A colleague, experiencing back pain, created an instant standing desk by placing his chair on a table. This "hack" tested the principle that a standing desk would alleviate his pain. While not a finished product, it demonstrated a need and a viable solution, which could then be refined and commercialized into a more sophisticated product.

The critical insight is that these quick and dirty user solutions prove that something works, justifying the investment in developing a more reliable, safe, and commercially viable product.

The Free Innovation Paradigm

Professor von Hippel describes a "free innovation paradigm" where:

• Self-Rewarded Users: Users innovate for themselves, driven by personal need (e.g., avoiding withdrawal symptoms).
• Peer-to-Peer Diffusion: Successful solutions are often shared and improved upon by peers, leading to free diffusion.
• Producer Adoption: Commercial entities can then pick up these user designs, refine them, and commercialize them.

A key advantage in medicine is that users can innovate and share without FDA intervention as long as it's for free and for personal use. This leads to extensive medical experimentation among users, particularly for chronic diseases, where patients innovate to improve drug administration, ease pain, and manage their conditions. These innovations are often not protected by intellectual property rights and are freely shared.

Lead Users as Pioneers

Lead users are pioneers for functionally novel innovations because, at the outset, there's no clear market evidence to motivate producers.

Example: The Heart-Lung Machine: Developed by surgeon John Heysham Gibbons, who needed to temporarily stop the heart to repair defects in children with rheumatic fever. Manufacturers initially refused to develop it due to lack of perceived market demand. Gibbons spent 10 years developing it with charitable help. Only after other surgeons began adopting his design and building their own versions did enough market evidence emerge for producers to enter the market.

This pattern highlights that users are motivated by personal benefit, even if it's a cheap hack, while manufacturers require evidence of a market to justify significant investments. This means many valuable innovations exist in the "down curve" of adoption, waiting to be discovered and commercialized.

Audience Contributions and Discussion

During the presentation, attendees shared their observations and questions:

• Self-Medication with Other Substances: An audience member noted that individuals withdrawing from opioids often self-medicate with psychostimulants, and vice versa. While dangerous, this highlights user-driven attempts to alleviate severe withdrawal symptoms, offering insights into potential treatment approaches.
• Abuse of Non-Controlled Substances: Another attendee mentioned the abuse of medications like gabapentin or quetiapine for their sedative effects, leading to addiction. This again demonstrates user innovation, albeit with negative consequences.
• The Role of Adversity: A data scientist inquired about the role of adversity or intensity of need in driving successful user innovation. Professor von Hippel confirmed that higher intensity of need correlates with greater struggle for solutions, leading to more impactful user innovations.
• Defining "User": A psychiatrist raised a crucial point about the definition of "user." While many examples focused on negative innovations by individuals with addiction, the heart-lung machine example showed a physician as the user innovator. Professor von Hippel clarified that "user" refers to anyone who uses a product or service, and while negative innovations are prevalent in substance abuse, the goal is to find the few, scattered positive innovations, like Alcoholics Anonymous, that are truly beneficial and diffusible.
• Positive Deviance in Recovery: An entrepreneur shared examples of positive deviance in recovery, such as individuals using motivational videos, tangible reminders (pebbles), or extensive motivational quotes in their cars to stay sober. He also highlighted the potential for treatment centers to have developed effective, unshared techniques.

Patient Innovation Website

Professor von Hippel introduced "patient-innovation.com," a website supported by the UN, which hosts thousands of user-developed innovations by patients and caregivers. This platform aims to overcome the issue of successful patient innovations not being diffused due to lack of incentive for patients to advertise them.

Example: A hydraulic engineer with Marfan syndrome, facing a life-threatening aortic condition, innovated a Dacron support system to wrap around the aorta, a novel approach to treating the condition that surgeons initially dismissed.

Conclusion

The core message is that a vast, often untapped, source of innovation lies with users who develop solutions to their own problems. By focusing on "positive deviants" and employing systematic methods to identify and analyze these user innovations, particularly in challenging areas like substance abuse, entrepreneurs and researchers can discover field-tested solutions with significant commercial and societal potential.