Delivering cost effective healthcare through reverse innovationBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6205 (Published 14 November 2019) Cite this as: BMJ 2019;367:l6205
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We thank Skopec, Issa and Harris(1) for their fascinating essay on reverse innovation and note that it could herald an age of increased cultural humility for the global north and assist with dissipating prejudices towards innovations from the global south. Bringing in new ideas from ‘outside’ requires disrupting entrenched power and value systems around knowledge. This process of disruption is essential to the process of decolonising medicines and devices. Indeed, it chimes with Timms and Mearns book New Power: Why Outsiders are Winning, Institutions are Failing, and how the Rest of Us Can Keep up in the Age of Mass Participation,(2) which refers to bottom up power surges (like #MeToo) that are overturning old power hierarchies and protectionism around institutions.
The authors rightly raise the possibility of the term “reverse” being problematic. We agree. Linguistic interaction — the words and terms we use — conveys and reproduces social, cultural and political structures. By labelling innovation as reverse, or indeed other incentives like “reverse” mentoring, we may be reinstating the power dynamic we are seeking to undo. Could there be a new term for this type of collaboration? We also believe that the pitfalls of cultural appropriation should be avoided whereby aspects of an oppressed culture are taken out of context by a historically dominant people, who lack the cultural context to properly understand, respect, or utilise these elements.(3)
1 Skopec Mark, Issa Hamdi, Harris Matthew. Delivering cost effective healthcare through reverse innovation BMJ 2019; 367 :l6205
2 Heimans J, Timms H. New Power: Why outsiders are winning, institutions are failing, and how the rest of us can keep up in the age of mass participation. Macmillan; Main Market edition (19 April 2018). ISBN-13: 978-1509814183
3 Connecting up the curriculum – Decolonising the Medical Curriculum [Internet]. [cited 2019 Nov 28]. Available from: https://decolonisingthemedicalcurriculum.wordpress.com/connecting-up-the...
Competing interests: All co-authors have worked on an educational project regarding decolonisation and medical education. MF is in the same Department as MS & MH (authors of the article we are responding to). CD is a member of the Patient Liaison Group at the BMA