that was highly decentralized with respect to choices about treatment, but had developed some capacity to accumulate actual experience in treating patients very quickly. Doctors, like teachers, do not have scientific answers to all questions that arise in their practice. There are some conditions that we know can be treated effectively by some particular interventions. We know this on the basis of both cumulative practical knowledge, and scientific processes of reviewing the safety and effectiveness of the treatment. But there are always those individuals for whom the standard treatment is not feasible, or those who do not seem to respond to the recommended treatment. There are also many, many conditions for no treatment has been proven to be effective, but there are some that are recommended on the basis of some logic, reasoning, or demonstrated effect. In the background, of course, is the idea that the choices about how to treat patients should be decided between doctor and patient – not dictated by a centrally mandated practice. My mother suffered from leukemia for which there was no certain ideas about the best possible treatment. Neither my mother, nor her doctor, was required to choose a particular treatment. Nor were they required to report to any central capacity what they chose. But what did exist was a small number of recommended protocols – a set of treatments judged to be more likely to be successful with fewer bad side effects than others, but at that stage, not established as methods that were scientifically proven to deliver valuable results at an acceptable cost. And, there was the professional expectation that if the doctor and my mother chose to use one of the recommended protocols, they would report what happened to a central registry design to collect that actual experience. This system for collective experience with medical interventions is obviously not as powerful as the use of randomized trials to demonstrate impact, and search for important side effects. But it was an efficient way of taking advantage of a large amount of experience with a given treatment even when that experience was not structured as a controlled experiment.

######## Social Entrepreneurship and Large Scale Philanthropy

A fourth idea that has had significant influence in the educational world is the concept of social entrepreneurship. This idea is very closely linked to the Schumpeter, decentralized market model of social innovation and learning. This model, like the Schumpeter model, depends on the existence of a group of individuals with ideas about how to improve the educational system. That group can include professionals with lots of experience in education, or technologists with ideas about how to use digital technology to improve learning, or …………… just about anyone with an idea. Their motivation can be primarily to improve “educational outcomes”, and or some financial return to them if they develop an idea that can be sold at a profit to some buyer. This group of educational entrepreneurs has found an interested and resourceful financier among a group of philanthropists who have seen the power of entrepreneurship in the commercial sector, and hope that the power of new ideas might produce the same kind of productivity gains in education that have been produced in other economic and social sectors. Significant contributions from these philanthropists have supported ed entrepreneurs not only to develop the ideas into working models, but also to support the development of networks of schools that employ the educational ideas of the ed entrepreneurs. Under changes in governmental policies that allowed public funds to pay for “chartered” private schools, they have begun to compete for public funds to maintain and expand their market share in the overall ed sector.