- Critical of certitude in science? Distillation is needed for life to proceed
- When science-driven business is led by leaders who stick to simplified science, you risk ignorant decisions
- It's critically important for key decision makers to have at least some sense of underlying scientific complexity
Even as a med student, I was struck by the discrepancy between how much the junior doctors (particularly the interns and second-year residents) seemed to know, and how much the more experienced doctors knew: with few exceptions, the junior doctors seemed to know a lot more. Or at least, they would always have a definitive answer at their fingertips. Such was their apparent understanding of human pathophysiology that they were usually able to offer plausible, immediate explanations of anything, make a rapid assessment, and move on.
"While it’s essential for junior physicians and biopharma researchers to be able to reduce inherently complex situation to understandable and actionable questions, it’s critically important for key decision makers–in both medicine and biopharma–to have at least some sense of the underlying scientific complexity, and to at least recognize that it exists."
In contrast, the expert physicians – the doctors who had spent decades of their lives treating particular types of patients, and studying a specific disease – tended to be far less definitive, and much more likely to say, “to tell you the truth, we really don’t know.” If a patient responded in a certain way to a new treatment, the experienced doctor is more likely to say “well, that happens sometimes,” while the second-year resident would more likely say, “of course we expect that, it’s because ….”
I did most of my clinical training after completing my PhD, which focused on the relationship between several proteins involved in intracellular transport, and I was struck by how difficult it was to define with precision how a handful of proteins interacted, even when I was able to study these proteins essentially in isolation in a test-tube – an extremely reduced system. It was a struggle to say with certainty exactly what was going on (though the results – here, for instance – seem durable, at least to this point).
Given the difficulty of understanding a few proteins in a test-tube, I was immediately skeptical of the certitude expressed by the junior physicians I first encountered on the wards, and in turn, they didn’t universally appreciate questions that challenged their mastery of the medical universe.
I was reminded of this experience by an excellent op-ed in yesterday’s WSJ, critical of certitude in science. The author’s point, captured by the headline, is that “absolute certainty is not scientific.” (This op-ed is not to be confused with a different excellent article in yesterday’s Journal, focused on lack of reproducibility in science, discussed in my previous post.)
I’m also reminded of this dichotomy every time I hear a discussion of science in a business context – not surprisingly, in translating a complex scientific concept into a digestible powerpoint slide, key subtleties can get lost.
Here’s the problem: it’s easy to critique these simplified powerpoint summaries as failing to capture the essential complexities of science, just as it’s easy to critique junior doctors for their excessively precise world view. But the catch is that without some sort of distillation, you can’t make the many essential decisions that are required on a daily basis for life to proceed.
Take the case of the medical residents – they were (as I learned when it was my turn to do this job) responsible for the care of a large number of extremely complex and sick patients; they needed a way to be able to evaluate a patient, make a reasonable decision about care, and then move on to the next crisis. I came to see their explanations less as robust understanding of disease and more as convenient rationalizations, perhaps a framework for them to remember the key facts, and to understand what you’re supposed to do in a particular situation. (To be sure, I think many of them believed they were truly practicing applied science – e.g. they’d ask questions such as “what do you think causes atrial fibrillation,” as if the list they memorized was derived from first principles, rather than received wisdom.) (Some of these issues discussed here [abstract only]).
Importantly, these junior physicians were generally supervised by a senior (attending) physician, who could listen efficiently to a stylized, simplified presentation of a patient, recognize the underlying complexity involved, and guide the team appropriately.
Similarly in business, if a senior biopharma executive was forced every day to step through even of fraction of the actual complexity of the science associated with every product, it would be overwhelming, and make decision-making all but impossible.
While it’s essential for junior physicians and biopharma researchers to be able to reduce inherently complex situation to understandable and actionable questions, it’s critically important for key decision makers – in both medicine and biopharma – to have at least some sense of the underlying scientific complexity, and to at least recognize that it exists.
(I’ve argued in other contexts that this pattern can also be seen in the historical failure of Silicon Valley to make a dent in the health space – most tech-savvy entrepreneurs lack an in-depth appreciation for the complexity of medicine in general, and the nuances of the doctor-patient dynamic they are confidently trying to influence or replace).
When a science-driven business is led by leaders who don’t even know what they don’t know, and who actually believe that the crisp powerpoint slides that bubble up for their review actually and adequately represent the science involved – then you risk making some very ignorant decisions, and you are also more likely (as seems to be happening) to jettison what you never really felt comfortable with to begin with. Arguably, there are similar risks for health systems led by executives lacking clinical experience.
It’s been said that war is too important to be left to the generals; I’m not sure whether this is true, but I’m increasingly convinced that the oversight of healthcare delivery and medical product development are certainly too important to be led by those who have never treated a patient nor picked up a test-tube.
David Shaywitz, M.D., is an adjunct scholar at AEI