Great ideas don't fail in the lab – they die in the last mile
In 1747, Scottish naval surgeon James Lind conducted what is widely recognised as the first controlled clinical trial in history. His work carefully evaluating different treatments for scurvy – a sickness that routinely killed more sailors than combat – showed that citrus fruit was by far the best treatment.
Despite this, it famously took the British Navy nearly 50 years to actually issue lemon juice to its fleet.
The delay was not caused by a failure of responsibility or any dereliction of duty. Lemons were expensive and rotted quickly at sea. To make the juice transportable and shelf-stable, naval authorities boiled it down – a process that inadvertently wiped out the heat-sensitive Vitamin C. When the Navy finally deployed the miracle cure, it failed.
While the science was unassailable, the execution killed it.
Nearly 300 years later, we still assume that if an idea is proven it will automatically land. But ideas only break through when you understand and can work collaboratively to address the frictions that can disrupt timing, translation, and traction across sectors and disciplines.
So often, we don't need to deliver more innovations, we need to innovate delivery. Put another way, if you don’t tackle the gaps that exist between discovery and distribution, you are not preparing for a breakthrough – you’re just boiling lemons.
I encountered this challenge early in my career as an eye surgeon, where proven, cost-effective treatments exist for the vast majority of people who need eye care, yet a billion people worldwide still can’t see clearly.
I could help the patients who reached my clinic, but I became increasingly concerned about those who never did, were unable to cover the cost of treatment, or didn’t even believe that a cure was possible. The question was how to reach them, not simply how to improve the treatment they were missing out on.
At Peek Vision, we began by looking beyond the clinic and asking what was already reaching the communities we needed to serve. Mobile connectivity offered an opportunity. Mobile networks reach billions of people, including communities poorly served by traditional healthcare infrastructure. Rather than building an entirely new network, we saw the potential to use existing connectivity to bring eye screening closer to people.
We developed technology that enables trained community workers to use smartphones to screen vision, identify people who need treatment and track their progress through care. Peek technology has screened more than 23 million people across 13 countries and now reaches around 150,000 people every week. It took us 10 years to reach our first million people; today, we reach that many in 10 weeks or less.
Screening is only the first step. People must still be able to access treatment, and technology cannot replace clinicians or functioning health systems. But our approach demonstrates how infrastructure originally built for another purpose can help address a longstanding healthcare challenge. We did not need to recreate the networks connecting these communities; we needed to find a way to put them to work for people missing out on care.
The challenge of delivery extends well beyond healthcare. Massive capital is deployed into next-generation carbon capture and fusion, while existing grid infrastructure cannot handle the queues for proven solar and wind energy. Enterprises are spending vast amounts on frontier AI, only to see adoption stall because data architectures, middle management, and compliance pipelines cannot operationalise them. And predictive software has limited utility in supply chains because warehouse hardware and dock logistics run on legacy systems that cannot ingest the data.
Across industries, effective technologies and services can struggle to make an impact because the infrastructure, skills or processes needed to put them into practice are missing. Engineers optimise for performance, legal teams optimise for liability, and supply chains optimise for margin. When these functions operate in silos, breakthroughs gather dust on shelves while companies burn capital trying to reinvent wheels they never learned to roll.
Looking beyond our own disciplines can help uncover these possibilities. Specialisation is valuable, but it can also limit the range of approaches we consider. Infrastructure built for one purpose, or expertise developed in another sector, may offer a way to overcome barriers that have proved difficult to address from within our own field.
This is one reason cross-sector conversations, including those at Future Forum, can be useful. The real value of bringing technologists, CEOs, investors, academics, and public leaders into the same room is the friction it creates. It forces the scientist to confront distribution economics, pushes the business leader to reckon with regulatory lags, and challenges the policymaker to understand technical reality.
In a world defined by compounding crises – economic volatility, fragmented supply chains, and escalating health and environmental burdens – we can no longer afford the luxury of a 50-year lag between invention and execution.
True progress cannot be measured by what gets invented in the vacuum of a lab. It must be measured by what actually survives deployment into the real world. Where do we have proven solutions ready to make an impact, and where are we just boiling lemons?
