A research project with Accuracy Incorporated, a medical robotics company, lead me to an 18month assignment as Chief Technical Officer. Accuracy’s product, the Cyberknife, uses X-ray triangulation and precision robot positioning to target and remove brain tumors. This is a remarkable engineering achievement, yet the business struggled due to the economic structure of medical radiation treatment. As the inventor Stanford neurosurgeon John Adler said in frustration “curing cancer does not generate a recurring revenue stream.” Undeterred, he and Accuracy set out to remake the business of radiation treatment. In comparison, my reorganization of engineering to shift its focus from research and development to customer satisfaction was easy. Though obvious to some, it was a hard lesson for me to see the extent that a business environment can dictate the success of engineering design.

Consider another example but from the...

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