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comment by johnnyFive
johnnyFive  ·  132 days ago  ·  link  ·    ·  parent  ·  post: Trial wipes out more than 80 per cent of disease-spreading mozzie

Yep. It's like every time I hear someone waxing pretentious about how the human brain works X way, or how the universe is structured like Y.

It takes a special kind of hubris to believe we have any clue.




user-inactivated  ·  130 days ago  ·  link  ·  

In one of the books I'm currently reading, it talks for a brief moment about paradigm shifts. The example the author used was eventually, people will regard our current form of medicine the way we regarded the Paradigm of Humours. With new technologies, new bodies of knowledge, and ever evolving social philosophies, paradigm shifts are probably inevitable in a lot of various fields. Who knows? Maybe we'll see a major one in our lifetimes (if we haven't already).

johnnyFive  ·  130 days ago  ·  link  ·  

That's probably true, but I think large-scale changes are dangerous more often than not.

Side note on this point. I met up with my undergrad intro Greek professor a few months back. Her area of research is ancient medicine. She mentioned being at a conference or talk or something, and was asked what medical procedure we do now will be looked on in the future the way we look at things like humors now. Her answer was cancer treatment.

user-inactivated  ·  130 days ago  ·  link  ·  

    That's probably true, but I think large-scale changes are dangerous more often than not.

I'd agree. I think when it comes to discoveries and inventions and the introductions of ideas, we need healthy doses of restraint, caution, wisdom, and inspection. Just because something is possible and easy, doesn't necessarily mean it should be done.

    Her answer was cancer treatment.

That's not the first time I've heard that and understandably so. The amount chemicals and/or radiation we expose a person to in an attempt to treat cancer does seem extremely harsh when looked at from a certain angle.

b_b  ·  130 days ago  ·  link  ·  

We're at a stage in the maturity of cancer treatment that can only be described as barbaric. I think it's less humor-like, and more bleeding-of-the-patient-like (which of course itself was a vestige of the theory of humors). Blood letting actually does some good in some circumstances, so they thought, "Let's do more of this." Cancer is sometimes similar. Some chemo and some radiation can work some of the time, so we just do more, often to the point where the patient can't tolerate it. It's very sad, but it's the best we can do most of the time.

Just like with blood letting, we're missing something about the theory of life that will go a long way to explaining how to better treat cancers of all kinds, and I don't think it's going to come from the sort of piecemeal approach taken by most cancer researchers (e.g., gene X is deleted here, so we need to target its target, or gene Y is multiplied, so we need to limit its expression, etc.).

Biology suffers from a lack of a theoretical framework in which to think about experimental biology. In physics, by contrast, there are lots of theorists, and they continually propose new ideas that can be tested by the experimentalists. In biology there are basically only experimentalists who are charged with devising hypotheses, testing them, and then convincing their colleagues that their hypothesis confirmation is credible. It's neither, in my opinion, a very efficient nor a very credible way to do science. It ends up being hyper descriptive, with very little predictive power (hence all the "omics," which make me want to puke).

user-inactivated  ·  130 days ago  ·  link  ·  

    barbaric

That was the word I was originally gonna use, but opted against, for fear of sounding like I'm being critical of scientists and medical professionals.

As to the rest of what you said, that same book also touches on that a bit as well, but in a different way. It seems in science, we have a desire to break down concepts to granular, almost elemental levels, in hopes that in understanding the parts, we'll have a better understanding of the whole. To which, there is some good deal of logic behind that. The point the author brought up though, is that sometimes when the parts interact with each other, the result is often completely different from what we would expect. The example he used was that hydrogen and oxygen, on their own, act in a very certain way, combined though, water has completely different properties. So while granular understanding is important, a wider, more holistic understanding is also important.

b_b  ·  130 days ago  ·  link  ·  

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  ·  130 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  ·  130 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  ·  129 days ago  ·  link  ·  

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

b_b  ·  129 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  ·  130 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.