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What health care can learn from Mike Mulligan and his steam shovel

Susannah Fox
Feb 13, 2015 · 4 min read

Google is …again.

In 2010, I was inspired by Animal Farm to that Google saw some health sites as more equal than others. This time I turned to Mike Mulligan and His Steam Shovel, by Virginia Lee Burton.

If you don’t know the story, Mike boasts that he and his steam shovel, Mary Anne, can dig the foundation for a new town hall in just one day. He says that if they fail, the town won’t have to pay him at all. A crafty town selectman, Henry B. Swap, sees an opportunity to get part of the job done for free and “smiles in a rather mean way” as they seal the deal.

Mike and Mary Anne set to work, digging as if for their lives, gaining strength from the support of the crowd that gathers to watch.

My favorite illustration shows the swirl of dirt, dust, and steam as Mary Anne bites away at the earth:

Illustration by Virginia Lee Burton

The dust settles at sundown and Mike is at first triumphant: They did it! They dug the foundation in just one day.

But Mike had failed to plan for a way to get Mary Anne out of the hole. Again the crafty Henry B. Swap smiles in a rather mean way, savoring his victory over the upstart. It’s a disheartening turn of events.

But wait! The cynics don’t win! A little boy suggests that Mary Anne’s powerful steam engine could become the furnace of the new town hall if they build it around her.

‘Why not?’ said Henry B. Swap, and smiled in a way that was not quite so mean.

Relief floods through me even now, reading that line.

Why am I telling you all this?

Because, at their very best, I see technology companies (even a behemoth like Google) playing the roles of Mike and Mary Anne: bold, brash, and not afraid to take on audacious goals. We need that in health care.

I see establishment health care, at its worst, playing the role of Henry B. Swap — arms crossed, as if to say, “oh, you think you’re so smart,” and smiling in a rather mean way as the techies fail.

Consumers play the role of the community that comes out to watch. Some are there to cheer, some just to gawk at the spectacle, but we all hope that somehow, some day, the problems will get solved.

Note that the story is not a perfect analogy. Mike and his steam shovel, Mary Anne, represent a dying form of technology, as other bloggers point out and .

But try to see what I see:

Yes, Dr. Google can dump you into a .

Yes, Apple’s HealthKit can be .

Yes, it is easy to in wearables.

Yes, IBM Watson is being fed (scare quotes intentional).

But these companies are TRYING.

How might we help them?

Think about it: Who offers the innovative solution that saves the day in the storybook? A child. Someone outside the “we know best” adult world.

Who plays that outsider role in health care? Patients and caregivers.

For example:

More broadly:

What other examples do you see of quixotic quests in health and health care? Where do you see glimmers of hope? Where can we gather as a community to cheer on a team that needs a boost? How might we get people to smile in a not so mean way when people dream and ask, How might we get more people to say, “Why not?”


I’m an advisor to Iodine and Stanford Medicine X, which I mention or link to in the post.

Too good not to share:

When I searched online for images of Henry B. Swap I stumbled on a , such as:

Glas wen (Welsh): Literally, a “blue smile” — a smile that is insincere or mocking.

Henry B. Swap was the illustration.

I also found a of someone reading the storybook out loud and someone who it, line by line. I love the internet.

Originally published at on February 13, 2015.

Susannah Fox

Written by

I help people navigate health and technology.

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