The word “disruptive” gets applied to almost everything now. Every startup is disruptive. Every new app is disruptive. The word has been so overused that it risks meaning nothing.
This platform has used it since 2008 to mean something specific: a willingness to challenge the assumptions, institutions, and power arrangements that keep health care from working for everyone — and particularly for women.
Why Health Care Needs Disrupting
Health care in the United States is a system that produces extraordinary outcomes for some people and catastrophic failures for others. It spends more per capita than any health system in the world while delivering worse results on most major health indicators than its peer nations. It is structured to reward volume over value, acute intervention over prevention, and treatment of the diagnosed over care of the at-risk.
Women navigate this system carrying a specific set of disadvantages. They have been systematically excluded from clinical research that generated the evidence base practitioners rely on. Their symptoms are more frequently dismissed, their pain more consistently undertreated, their conditions more often misdiagnosed. They are more likely to be primary caregivers for children, aging parents, and disabled family members — which means they carry the burden of a poorly functioning system at both ends: as patients and as unpaid system participants.
The policies that could address these failures exist. The political will to implement them has been inconsistent at best.
What Disruption Actually Requires
It requires asking uncomfortable questions. Not rhetorically — specifically. Which assumptions embedded in clinical training are wrong? Which policies are perpetuating disparities we claim to care about? Which institutions are resisting change because change would cost them money or power?
It requires diverse voices. The perspectives that are least represented in health policy conversations are often those with the most to contribute. Patients who have navigated a broken system know things about it that administrators and policymakers do not. Community health workers who serve underserved populations understand barriers that randomized trials never capture. Women of color who have experienced discrimination in clinical settings have evidence that matters.
It requires sustained attention. Health policy is not a news cycle. Changes to the research enterprise, to clinical practice guidelines, to insurance coverage structures, to public health infrastructure — these unfold over years and decades. Disruption that dissipates after six months accomplishes little.
Fifteen Years of Asking
This platform has been asking since September 2008. The questions have evolved as the landscape has changed: from the debates over the Affordable Care Act to the COVID-19 pandemic’s illumination of health inequities that had always been there, to the current moment of federal retrenchment from public health infrastructure.
Some things have improved. Women’s inclusion in clinical trials has increased. The sex-as-biological-variable policy at NIH represents genuine progress. Menopause has become a topic that clinicians and employers are finally willing to name. Maternal mortality is on national policy agendas in ways it was not a decade ago.
Other things have gotten worse. Health disparities by race and income widened during the pandemic and have not fully recovered. Access to reproductive health care is more restricted in more states than at any time in the past fifty years. Proposed cuts to the NIH and NIMHD would undo decades of investment in the research infrastructure that understanding and treating women’s health requires.
The case for disruption is not abstract. It is built from the gap between the care women should receive and the care they actually get.
The Invitation
This platform has always been an invitation — to think differently, to challenge the consensus, to bring evidence and experience into uncomfortable conversations. The voices that have contributed here over the years have shaped how we understand what disruption in health care actually means.
If you have a perspective that challenges the dominant narrative, a finding that complicates the conventional wisdom, a story that illustrates what the statistics miss — this is the place for it.
The health care machine does not disrupt itself. That is our job.
