Clash of civilizations: Medical versus the World edition
During this Covid-19 pandemic, I have been staying home and putting a lot of trust in medicine assured that they will find a way to get us through this. What else can I do? I don't know about the domain, so I defer to the experts.
But, several months in to the quarantine, with the deluge of disheartening news about lack of progress on this problem, I am getting more and more worried, anxious, and restless. I am sensing I am not alone. There is a clash of civilizations brewing between medical and lay people, and maybe more relevant for my domain, between medical and IT people.
OK, this is how we will do this. I will first give you off-the-cuffs comments from the Cynical Murat. I know that Cynical Murat is wrong in many places, because I don't know anything about medicine and he is a caricaturized version of myself to voice my insecurities/worries about the situation. (Oh God, this is getting weird.) So I can't just leave you with his rant. I follow that up with a response from another IT researcher/practitioner, but someone who had collaborated with medical people a lot in the last 10+ years.
My impression about the medical people is that they are failing this test. They have been very slow to disseminate best practices and act on them. The invasive ventilators do not seem effective (very low survival rates) but they are being used, because it is the "procedure". The proning technique was still not practiced even after months. They are slow to act on re-purposing existing drugs. We still don't have a good understanding of the illness. Antibody and vaccine development has uncertain time horizons.
If the entire world, 7 billion people, the governments, the economies, were holding their breaths waiting for an "IT problem" to be resolved, regardless of how difficult that problem is, we would see much better progress in the IT domain. For example, the Y2K problem was resolved without any fuss. People came together, best practices were openly shared, and things got straightened out quickly.
Why don't we see a similar coordinated quick response from Medical side?
1. Is it because IT/tech people have better tools and networking? Then we should try to help by giving the medical people better tools and networking support for collaboration.
2. Is it because the IT domain problems are intrinsically easier? (If we had 1% crash rate in servers in a cluster, we wouldn't even care. We would just replace crashed servers periodically, as it is not a big deal. Nobody dies.)
3. Or is it because of the intrinsic "slow" culture in medicine? The culture in IT/tech is innovate and disrupt. Try many different attacks on a problem, including peripheral attacks from left field. When the prize is this big, IT/tech would have been crushing things. Maybe there is also an incentive problem in medicine? The scientists don't see enough of the prize, which prevents the hordes of scientists working on the problem.
I think we need some of that IT chutzpah to attack this problem. For example, take Paul Buchheit. He doesn't know shit about the problem domain, but he is trying and he is ambitious.
Well, that is my rant. I realize the domains are very different, and I don't know anything about medicine. But there seems to be a big mismatch between the effort/results out there compared to what this crisis requires. And this is not even a very potent bug, I am afraid of worse things to come.
“There is much more to health care than algorithms.”
(Got this quote, by a doctor at Iowa, in an MIT Tech Review article about Google's AI)
Second, the physician I work with, an infectious disease specialist, says we have known about and been using proning for twenty years.
Third, the common cold is a coronavirus but it is so mild it is not a catastrophic epidemic. Why hasn't medicine been able to cure or have a vaccine against common cold? Why don't we have vaccines for malaria, for AIDS, etc? Maybe some things are hard, maybe the coronavirus family (in general) is one of those, but now more money and intensive efforts are being thrown at it than ever before, because SARS-CoV-2 is a leading cause of death, for now.
Fourth, about being slow, it is true that medical research is deliberate. Two famous events (and there are more) have cause medicine to be deliberate. One was thalidomide which tempered the free-wheeling pharmacy attitudes; another was the Tuskegee study. Because of these and other examples, the formal system of ethics impedes progress in medicine. And in the US, we have this horrible public/private, insurance/profit bureaucracy. More recently, there is a call for even more careful and deliberate research due to the replication crisis, p-value hacking, and the like.
Fifth, you (like countless VC types) have observed that software people are super smart and could solve these things quickly if given the chance. So why don't you? You are much smarter than Elizabeth Holmes :)
(Murat's remark: I am still unclear if this was written to be sarcastic or super sarcastic.)
Also, you might want to take a look at this, which, I think, indicates some in the medical community think quite a lot about their mission and methods.
We the IT people should first make sure we do all we can to help, before we start to criticize Medical research. For example, we still couldn't get our shit together solving the disinformation warfare problem, which is a critical problem during these trying and challenging times. (Yes, I used this in a sentence finally without being sarcastic.) It seems hypocritical to criticize the medical people about being slow, before we could do that.
There might also be several other important problems we can and should help with.
But, several months in to the quarantine, with the deluge of disheartening news about lack of progress on this problem, I am getting more and more worried, anxious, and restless. I am sensing I am not alone. There is a clash of civilizations brewing between medical and lay people, and maybe more relevant for my domain, between medical and IT people.
OK, this is how we will do this. I will first give you off-the-cuffs comments from the Cynical Murat. I know that Cynical Murat is wrong in many places, because I don't know anything about medicine and he is a caricaturized version of myself to voice my insecurities/worries about the situation. (Oh God, this is getting weird.) So I can't just leave you with his rant. I follow that up with a response from another IT researcher/practitioner, but someone who had collaborated with medical people a lot in the last 10+ years.
Rants from the Cynical Murat
Let me start by saying that I applaud the ER doctors/nurses for their bravery and selfless sacrifices. I doubt that I would be able to raise to that level, if I were in their place. (I am cynical, but I am not a jerk.)My impression about the medical people is that they are failing this test. They have been very slow to disseminate best practices and act on them. The invasive ventilators do not seem effective (very low survival rates) but they are being used, because it is the "procedure". The proning technique was still not practiced even after months. They are slow to act on re-purposing existing drugs. We still don't have a good understanding of the illness. Antibody and vaccine development has uncertain time horizons.
If the entire world, 7 billion people, the governments, the economies, were holding their breaths waiting for an "IT problem" to be resolved, regardless of how difficult that problem is, we would see much better progress in the IT domain. For example, the Y2K problem was resolved without any fuss. People came together, best practices were openly shared, and things got straightened out quickly.
Why don't we see a similar coordinated quick response from Medical side?
1. Is it because IT/tech people have better tools and networking? Then we should try to help by giving the medical people better tools and networking support for collaboration.
2. Is it because the IT domain problems are intrinsically easier? (If we had 1% crash rate in servers in a cluster, we wouldn't even care. We would just replace crashed servers periodically, as it is not a big deal. Nobody dies.)
3. Or is it because of the intrinsic "slow" culture in medicine? The culture in IT/tech is innovate and disrupt. Try many different attacks on a problem, including peripheral attacks from left field. When the prize is this big, IT/tech would have been crushing things. Maybe there is also an incentive problem in medicine? The scientists don't see enough of the prize, which prevents the hordes of scientists working on the problem.
I think we need some of that IT chutzpah to attack this problem. For example, take Paul Buchheit. He doesn't know shit about the problem domain, but he is trying and he is ambitious.
Well, that is my rant. I realize the domains are very different, and I don't know anything about medicine. But there seems to be a big mismatch between the effort/results out there compared to what this crisis requires. And this is not even a very potent bug, I am afraid of worse things to come.
Response from my wise friend
First, realize this:“There is much more to health care than algorithms.”
(Got this quote, by a doctor at Iowa, in an MIT Tech Review article about Google's AI)
Second, the physician I work with, an infectious disease specialist, says we have known about and been using proning for twenty years.
Third, the common cold is a coronavirus but it is so mild it is not a catastrophic epidemic. Why hasn't medicine been able to cure or have a vaccine against common cold? Why don't we have vaccines for malaria, for AIDS, etc? Maybe some things are hard, maybe the coronavirus family (in general) is one of those, but now more money and intensive efforts are being thrown at it than ever before, because SARS-CoV-2 is a leading cause of death, for now.
Fourth, about being slow, it is true that medical research is deliberate. Two famous events (and there are more) have cause medicine to be deliberate. One was thalidomide which tempered the free-wheeling pharmacy attitudes; another was the Tuskegee study. Because of these and other examples, the formal system of ethics impedes progress in medicine. And in the US, we have this horrible public/private, insurance/profit bureaucracy. More recently, there is a call for even more careful and deliberate research due to the replication crisis, p-value hacking, and the like.
Fifth, you (like countless VC types) have observed that software people are super smart and could solve these things quickly if given the chance. So why don't you? You are much smarter than Elizabeth Holmes :)
(Murat's remark: I am still unclear if this was written to be sarcastic or super sarcastic.)
Also, you might want to take a look at this, which, I think, indicates some in the medical community think quite a lot about their mission and methods.
Conclusions
Well, the medical people, they think differently, they work differently, but they are very smart people. So the Cynical Murat is jumping to conclusions prematurely.We the IT people should first make sure we do all we can to help, before we start to criticize Medical research. For example, we still couldn't get our shit together solving the disinformation warfare problem, which is a critical problem during these trying and challenging times. (Yes, I used this in a sentence finally without being sarcastic.) It seems hypocritical to criticize the medical people about being slow, before we could do that.
There might also be several other important problems we can and should help with.
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