a thoughtful web.
Good ideas and conversation. No ads, no tracking.   Login or Take a Tour!
comment by b_b
b_b  ·  2085 days ago  ·  link  ·    ·  parent  ·  post: Trial wipes out more than 80 per cent of disease-spreading mozzie

I'm in the business of making medicine. Specifically, medicine for brain injuries. We (mk and I, along with a few other colleagues) have invented a medicine that we think may help brain injury victims heal more efficiently (stroke, traumatic injuries, etc). There's a significant problem with this medicine in that we don't really understand how it works (hence my favorite history of science fact about IC engines and the ideal gas law), at least not in any granular detail. This is difficult, because (a) it's hard to get funding to support it, and (b) the FDA has certain requirements that will be hard to meet some we can't explain exactly what e think we're doing. The whole medical system is set up around a reductive approach to biology. However, it has been proven by such geniuses as Wittgenstein and Koestler that reductionism is a fool's errand with regard to biology. There are things that cannot in principle be explained at the molecular level. Descriptivism fell out of favor in psychology long ago, but it still has a long way to fall in molecular biology.





johnnyFive  ·  2085 days ago  ·  link  ·  

That's an interesting comparison, particularly in terms of psychology. I'm thinking about the fact that I have two meds on my desk as I type this whose mechanisms of action are at best partially understood. But they do wonders, target the symptoms we want them to target, and (so far, at least) have not caused any side-effects. Granted, it took a couple tries to get the right ones, but the proof is in the pudding.

As I recall, there have been some pushes to both reform the FDA's approval processes, and IIRC a bill passed recently allowing people at the end of life to try experimental treatment (and why this is controversial is beyond me). I've also been encouraged by some things I've seen about using modified viruses to attack cancer cells and/or edit their genes so they attack each other. Here too there may be some unintended side-effects, but when the alternative is death, I have to imagine it'd be hard for those effects to be worse than the disease.

But more generally, your point about the approach to biology is an interesting one. I know it was always my least favorite subject in school, and looking back, what you describe may be a good deal of why. I am attracted to systems, and biology always felt like a bunch of pieces, especially when compared to chemistry (which was my passion when it came to science). Of course, I do wonder to what extent this is more how it's taught than how it's researched.

b_b  ·  2085 days ago  ·  link  ·  

There is a mechanism to get your hands on an experimental drug ("compassionate use" in America and something like "named person use" (can't remember the term of art exactly) in Europe), in which a person with no other options's doctor can request a specific experimental drug. This reasonable sounding alternative is less cut-and-dry as it might seem on face, because the thing you really, really don't want in evaluating a drug's effectiveness is anecdotal evidence.

E.g., Patient A takes miracledrug and get better against all odds. Patient B hears about patient A's experience on the internet and also demands miracledrug. Patient B dies horribly because the drug is actually quite toxic and Patient A would have gotten better anyway but falsely attributed their recovery to miracledrug. Something like that. Or on the other side Patient A dies and all of a sudden miracledrug's manufacturer has a PR storm on their hands that threatens to sink the drug even though Patient A would have died anyway and miracledrug played no role.

There are also many issues relating to informed consent that are too long and boring to write about. For these reasons compassionate use is an ethical and business minefield that the FDA and drug companies shy away from. One patient isn't a study, and the efficacy and safety of any drug should always be evaluated within the confines of an appropriately powered double blind clinical study unless there's a really compelling reason not to do that.

To your other point, I think that biology as a school subject is really boring because of how it's taught, but it's taught that way because that's how many biologists think. I think that biologists think that way, because the type of people who are attracted to that style of learning are boring people (rote memorization). I and mk and our mutual mentor were all trained in physics, so that's how we look at the world. We fortunately have the ability to ask "why not?"

johnnyFive  ·  2084 days ago  ·  link  ·  

Those are all fair points. Still, after a certain point, I feel like it stops mattering.

b_b  ·  2084 days ago  ·  link  ·  

For real. Any person in that situation would want the latest treatment, because they have nothing to lose, myself included. Just trying to highlight why it's a more complicated issue than a lot of the public probably realizes.

user-inactivated  ·  2085 days ago  ·  link  ·  

Do you feel like, in general, we're starting to get better at considering the idea looking things on a more interconnected level? I ask, because it seems like in the past decade, the number of conversations around our health and its connections to our diet and nutrition, environmental factors, psychology, and such have not only increased in quantity, but also in nuance and amount of information available.