Opinion: What are the barriers to innovation in medicine? Thomas J. Webster, PhD provides a firsthand account of the obstacles hindering innovation in medicine, covering publishing, conferences, politics, funding, universities, and industry. Innovation is hard. Such a simple word, but so many obstacles exist to innovate and, more importantly, to turn your innovation into a medical product that actually improves human health for ultimate technology validation. As I look back at my almost 25-year career innovating in medicine, I find myself continuously reflecting on how I was able to develop innovative solutions for improving medicine despite constant obstacles. One particular innovation that I am extremely proud of involves my efforts to integrate nanotechnology into orthopedic implants. How did my team and I develop nanotextured orthopedic devices now in over 30,000 patients in which zero implants have failed to date (no infection, no chronic inflammation, and no implant loosening) when the industry average shows orthopedic implant failure rates over 10%, increasing daily (Figure 1)?(1, 2)