Written by Elvin Geng, director of the Center for Dissemination & Implementation at the Institute for Public Health
Vaclav Smil’s new book is a must read for implementation researchers. Smil walks us through the last century, highlighting examples of inventions that were widely heralded and even implemented at scale, but which actually had unanticipated and harmful effects. Leaded gasoline is one example: it solved the relatively small problems of inefficiency and annoying knocking in car engines, but created a far larger problem by poisoning millions around the world.
The stories also include poignant tales of public health crusaders who foresaw bad effects, but were brushed aside by market imperatives and politicians. Smil’s book is a reminder that “even after we have succeeded by introducing an invention, its future may be marked by underperformance, disappointment, demise, or outright harm.”
My takeaway for implementation scientists is that our efforts to solve problems through implementation should be humble and alert to interventions and strategies having different effects in different contexts; the things that we know about them should be taken in context with the things that we don’t yet know. The unknown unknowns can never be dismissed.