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Observations Out of Hours

A lesson from Lapland

BMJ 2010; 341 doi: (Published 24 November 2010) Cite this as: BMJ 2010;341:c6366
  1. Christopher Martyn, associate editor, BMJ
  1. cmartyn{at}

What the snowmobile did to one Lapland community illustrates what medicine is doing to us. Why don’t we take notice?

I’m not sure whether the sociologist Everett Rogers actually coined the terms opinion leader, early adopter, and change agent, but it was certainly his famous book The Diffusion of Innovations that shifted them into the vocabulary of people keen to promote new ideas and new products. The book explores the reasons why some innovations are rapidly adopted while others, on the face of it equally good ideas, never get off the ground. It carries no torch for change as an end in itself. Indeed one of Rogers’s central themes is that it’s usually impossible to manage the effects of an innovation in a way that separates the desirable from the undesirable consequences. He gives several examples where the initial advantages of new ways of doing things were far outweighed by the long term harms they caused.

One of these is an account of what happened when the snowmobile was introduced to an isolated community of Skolt Sami (Skolt Lapps) in …

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