The underlying theme of this year's Phoenix meeting was the need to carefully manage through times of rapid change and discontinuity and select appropriate corporate cultures. The medical device industry is, in large measure, built on the notion that small companies deliver the lion's share of innovative technology. But the critical role large companies play in bringing those products to market undermines, to a degree, the power small companies have as innovators. Thus, side by side with the value that innovative or disruptive technology brings is the power of incumbency and entrenched interests. And as the e-health revolution hits the skids, no segment better illustrates the ability of incumbency to take control over the discontinuity that disruptive technology brings than the Internet. There are, in fact, several reasons why even the most innovative devices fall short of being truly disruptive, including the long clinical and regulatory paths they must travel, the aversion most physicians have to products that make them change the way they practice medicine, and the critical role of big companies in marketing.