Friday, May 20, 2011

Flat Earth

We experience our nearby environment as a plane.  Seems pretty flat.  And the objects within our senses seem relatively familiar and the behavior around us is fairly predictable.  That means that I don't expect the tree outside my office to suddenly become an ostrich nor the car driving by to turn 90 degrees suddenly and come through my office. But they some time to exactly that.  Even when the exceptions are seen, we note them for precisely what they are, exceptions.  Anomalies.  Once in a blue moon.  Black swans.  We have a large and distinctive vocabulary for these kinds of events.  The words are even specialized, in that anomalies can have context specific 'names,' like the 'six sigma' of manufacturing or the "outlier" in medical research.  
The notion that there is a linear organization to the world belies the fact that this is untrue.  But it is not an inconvenient myth, mostly.  When it becomes inconvenient is when the belief either persists in being supported despite the evidence (think about modeling risk in banking) or in organizing consequential activity, and specifically, medicine.  I think I'll turn to specific topics in a few pieces next, but wanted to lay the ground work first.  The simplest observation is that having a flat earth for the context, then thinking is built within the context, so it 'fits.'  Anything that doesn't 'fit' is either unobserved or ignored.  There is a grand artifice, but without a strategy or even designer, that holds reign over most of our efforts to improve the human condition and certainly the physical condition in medicine.  Virtual all the therapeutics we have today are derived from the context of that flat earth.  To build a therapeutic today the first order of business is to demonstrate your commitment to the flat earth system.  As long as that is done, you are allowed to proceed.  
Of course, that means failure is virtually a foregone conclusion, presuming therapeutic success was the goal.  But, as Kuhn taught, the first order of business in science is the reproduction of the artifice, the method.  So that done, we have collectively settled for marginal advances in therapeutics, as if that is the natural order of things.Natural order.  The natural order is non-linear, complex, fractal, self-organizing and networked, among other attributes.  It is unpredictable, but understandable.  And it is possible to improve the human condition by know all of this.  So let's pierce a veil or two together.