New Horizons in InterVentional Cardiology.

represented at IAGS, I would like to remind you that about three quarters of all medical device industry players have 100 employees, or less. It is also well recognized that over the years many of the true innovations have originated in small, less structured and less risk averse environments. I would like to thank Dr. Myler for recognizing that dynamic and for giving me the opportunity to participate in this open forum. Whether change is evolutionary or revolutionary, it is the driving force of progress. Without change innovation is by definition unachievable (Figure 1). It is an unpopular thought — and you may choose to acknowledge it or not — but, the days when you as a physician could have the clinical benefit of patients as your sole consideration are waning. In the future, the healthcare system itself will become an equivalent component of the medical progress formula. In this new model (Figure 2), technique and technology will continue to drive clinical progress, but costs, outcomes and regulation will determine the pace of the convoy. Since any convoy advances at the speed of its slowest vehicle, you can expect regulatory pressures to add greatly to your frustration in the USA, both in terms of reduced scientific study opportunities and in terms of product non–availability. I wouldn’t be an entrepreneur if I didn’t spend most of my time on the clinical change components — for that is where the real excitement and satisfaction is for all of us — but, I will give healthcare delivery change its due by letting it dominate my conclusion. Another way to present Dr. Myler’s phenomenal interventional growth slides, is to project the New Horizons in InterVentional Cardiology