BOX 2.2 Controlling Scurvy In the British Navy: Innovations Do Not Sell Themselves

In 1601, an English sea captain James Lancaster, conducted an experiment to evaluate the effectiveness of lemon juice in preventing scurvy. The beneficial effect of lemon juice was so clear that one would have expected the British Navy to adopt citrus juice for scurvy prevention on all its ships. But it was not until 1747, about 150 years later, that James Lind, a British Navy physician who knew of Lancaster's results, carried out another scurvy experiment on the HWS Salisbury . The scurvy patients who got the citrus fruit were cured in a few days.

Certainly, with this further solid evidence of the ability of citrus fruits to combat scurvy, one would have expected the British Navy to adopt this technological innovation for all ship's crew on long sea voyages. And, in fact it did so. But not until 1795, 48 years later. Scurvy on Navy ship was immediately wiped out. And after only 75 more years, in 1865, the British Board of Trade adopted a similar policy, and eradicated scurvy in the merchant marine.

SOURCE: Condensed from a case illustration in Rogers (1995), originally based on a 1981 article by Frederick Mosteller.

nizations, they must justify their existence to their community, payers, and constituency. Concern with survival naturally diverts attention from the development and expansion of the treatment program. Under these circumstances, involvement in research or adoption of new treatments cannot compete with more immediate concerns.

The typical treatment organization is small, employing less than 30 workers. Resource constraints limit the type and range of services the organization can provide, and it often lacks the financial and human resources to participate in research. Even the introduction of new treatment modalities may be impossible for many CBOs without significant external financial support

The core staff will likely include a mix of counselors in recovery and those who were introduced to the field through graduate training. The number and mix of practitioners are sufficient to support a specific treatment program and achieve a sufficient revenue base. However, implementing new psychopharmacological therapies generally requires adding medical staff, and new behavioral interventions may require trained psychologists who are not a part of current staff (Stitzer and Higgins, 1995). CBOs are frequently unable to afford the additional professional time to implement new treatments (Naranjo and Bremmer, 1996). Even those with enough resources may be reluctant to spend the amounts required.

Managers play an important role in implementing organizational



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