[Link] An argument for Low-hanging fruit in Medicine

by [anonymous]2 min read22nd Feb 201228 comments

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Those of us who have found the arguments for stagnation in our near future by Peter Thiel and Tyler Cowen pretty convincing, usually look only to the information and computer industries as something that is and perhaps even can keep us afloat. On the excellent West Hunters blog (which he shares with Henry Harpending) Gregory Cochran speculates that there might be room for progress in a seemingly unlikely field.

Low-hanging fruit

In The Great Stagnation, Tyler Cowen discusses a real problem – a slowdown in technical innovation,  with slow economic growth as a consequence..   I think his perspective is limited, since he doesn’t know much about the inward nature of innovation. He is kind enough to make absolutely clear how little he knows by mentioning Tang and Teflon as spinoffs of the space program, which is  of course wrong. It is unfair to emphasize this too strongly, since hardly anybody in public life knows jack shit about technology and invention. Try to think of a pundit with a patent.

Anyhow, it strikes me that a certain amount of knowledge  may lead to useful insights. In particular, it may help us find low-hanging-fruit, technical innovations that are tasty and relatively easy – the sort of thing that seems obvious after someone thinks of it.

If we look at cases where an innovation or discovery was possible – even easy – for a long time before it was actually developed, we might be able to find patterns that would help us detect the low-hanging fruit  dangling right in front of us today.

For now, one example.  We know that gastric and duodenal ulcer, and most cases of stomach cancer, are caused by an infectious organism, helicobacter pylori.  It apparently causes amnesia as well. This organism was first seen in 1875 – nobody paid any attention.

Letulle showed that it induced gastritis in guinea pigs, 1888. Walery Jaworski rediscovered it in 1889, and suspected that it might cause gastric disease. Nobody paid any attention.  Krienitz associated it with gastric cancer in 1906.  Who cares?

Around 1940, some American researchers rediscovered it, found it more common in ulcerated stomachs,  and published their results.  Some of them thought that this might be the cause of ulcers – but Palmer, a famous pathologist,  couldn’t find it when he looked in the early 50s, so it officially disappeared again. He had used the wrong stain.  John Lykoudis, a Greek country doctor noticed that a heavy dose of antibiotics coincided with his ulcer’s disappearance, and started treating patients with antibiotics – successfully.   He tried to interest pharmaceutical companies – wrote to Geigy, Hoechst, Bayer, etc.  No joy.   JAMA rejected his article. The local medical society referred him for disciplinary action and fined him

The Chinese noticed that antibiotics could cure ulcers in the early 70s, but they were Commies, so it didn’t count.

Think about it: peptic and duodenal ulcer were fairly common, and so were effective antibiotics, starting in the mid-40s. . Every internist in the world – every surgeon – every GP was accidentally curing ulcers  – not just one or twice,  but again and again.  For decades. Almost none of them noticed it, even though it was happening over and over, right in front of their eyes.  Those who did notice were ignored until the mid-80s, when Robin Warren and Barry Marshall finally made the discovery stick. Even then,  it took something like 10 years for antibiotic treatment of ulcers to become common, even though it was cheap and effective. Or perhaps because it was cheap and effective.

This illustrates an important point: doctors are lousy scientists, lousy researchers.  They’re memorizers, not puzzle solvers.  Considering that Western medicine was an ineffective pseudoscience – actually, closer to a malignant pseudoscience  – for its first two thousand years, we shouldn’t be surprised.    Since we’re looking for low-hanging fruit,  this is good news.  It means that the great discoveries in medicine are probably not mined out. From our point of view, past incompetence predicts future progress.  The worse, the better!

Link to post.

I think Greg is underestimating the slight problems of massive over-regulation and guild-like rent seeking that limits medical research and providing medical advice quite severely. He does however make a compelling case for there to still be low hanging fruit there which with a more scientific and rational approach could easily be plucked. I also can't help but wonder if investigating older, supposedly disproved, treatments and theories together with novel research might bring up a few interesting things.

Many on LessWrong share Greg's estimation of the incompetence of the medical establishment, but how many share his optimism that our lack of recent progress isn't just the result of dealing with a really difficult problem set? It may be hard to tell if he is right.

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