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Is Donald Knuth's approach the complete opposite of the lean startup methodology? Are too many people just trying to follow the latest trends?

His advice was to follow your instinct rather than the herd. I don't see how that's related to learn startup methodology.

because the lean startup methodology is currently the herd favorite...

The lean startup methodology is a process for following either the herd (coupons!) or your instinct (something useful).

I think concentrating on any methodology and thinking success will come is irrational.

In the end, it comes down to blood sweat and actual work put into something.

Too many people are definitely trying to follow the trends, but that is by definition since they wouldn't be be trends otherwise.

But yeah, people need to learn to think independently.