Comment by larrys | Hacker News Reader

Comment by larrys | Hacker News Reader

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"I think the field of medicine is extremely prone to disruption by clever, process-focused laymen, whether they are 15 or 30-years of age."

But isn't that really, as you said, "man bites dog" thinking? How many "clever, process-focused laymen" are there out there exactly? Do people really think that scientists involved in research with their training are at some kind of disadvantage in solving medical mysteries? That someone with no training whatsoever is just going to have some thought that others haven't explored in anything other than outlier situations?

I mean if you take enough people of any age attempting enough things something is going to stick. This particular kid ignored his school work to work on this idea. How advisable is that in general? (We've seen that happen with people dropping out of Harvard as well who hit it big).

So the problem I have with this is the way the media portrays it which plays down what happens to the vast majority of people who either ignore their school work to pursue a passion (with a slim chance of success) or drop out of college and later wished they had finished.

Remembering Ron Kovic who was portrayed by Tom Cruise in "Born on the 4th of July". Wanted to go off and fight for his country like dad did based on all those romantic movies from WW2. Came back in a wheel chair.

Let's not get jelly. I think this sort of advancement, if actually true and not just sensational journalism, is really promising for the future of humanity. He's not working on getting people to click ads.

"He's not working on getting people to click ads."

A great point. I didn't think of it from a role model point of view.

I completely agree. Even if it is a completely false and fabricated story, if it inspires other kids to go into STEM and do great things, solve real problems of humanity, I still think it is a great story.

> Do people really think that scientists involved in research with their training are at some kind of disadvantage in solving medical mysteries?

I'll be brash and say "Yes"

Not because these particular researchers/experts are dumber than those in any other field. But this is a natural psychological state for anyone working within a specialized, intellectually demanding field: to not be aware of (or not want to care about) any other machinations that happen peripherally to what they're focused on.

So, I don't mean that a layperson can walk in and say, "Hey, I have a hunch if you combine this protein with this chemical and run this lab routine I developed on my own, you'll come up with the cure for cancer." But a layperson can notice that there may be an information gap between a researcher and a practitioner that results in groundbreaking work being ignored/not implemented correctly, and suggest a process that in itself is groundbreaking. Because a scientific breakthrough is not really useful if it's not actually used.

To refer to the "Checklist" again, there is nothing on that list that a high schooler could not have thought up him/herself. But do you think its implementation would've been accepted anywhere if someone who was not a doctor had pushed it? Even though a doctor did devise it, it faced considerable resistance.

So this is my wild speculation: The medicine field is especially susceptible to the detrimental effects of having blinders. Its practitioners are hard-working geniuses who have well-justified confidence in their processes and insights...but because of that confidence, may be unable to notice blind spots. Moreover, laypeople are unwilling to put in the effort to challenge medicine professionals, because doctors have traditionally such a reputation of being near-all-knowing, and so it's easy to sitback and say, "Who am I to question them? I didn't go to medical school for 8 years"

And this is how the implementation of a sensible checklist that includes steps as simple as "Wash your hands" can have a huge impact in modern medicine.

Hey Dan.

This is what I don't like about your frame: this kid isn't actually a layman in the sense of layman vs specialist. He's probably a proto-doctor of some kind.

There certainly is a tension within academic fields between specialists and interdisciplinarians, but i would argue the layperson/specialist dichotomy, when it comes to contributions like this one, is a special case of the specialism/interdisciplinary dichotomy.

Medicine is a particularly interesting case, because there divisions are further fractured into basic research, applied research (say medical devices), and actual implementation of research findings, and between each of these are holes and pitfalls, where only a special few bridge the gaps, and help to transfer knowledge.

I would bet that this kid is, in actuality, the kind of person who makes up those bridges, as opposed to just someone who doesn't have the blinders a specialist has developed.

Further to blinders: A layperson is more likely to try many avenues for the reason that they don't know it "won't work" or has "already been tried".

I had numerous "genius but not quite" moments around the time I started university: I'd come up with something that seemed fantastic, only to move on to the next chapter in the textbook to either find that the same method was invented 30 years ago by someone who didn't have the benefit of having all the pre-requisite knowledge lined up for them.

Or I might find researchers had spent years lining up by now well known problems with would-be spark of genius. I'm sure that's not a unique thing - once you have a certain foundation of knowledge, a lot of things suddenly become obvious to try.

As I learned more about my field, the "genius moments" became more and more rare: I knew better. For more and more things I can instantly give reasons why an approach is highly likely to fail. Far more options are closed off from the outset because I "know" they will be fruitless.

Most of the time this is sensible pruning of obviously meaningless avenues of research.

But sometimes, through chance and sheer volume of attempts or by coming at things from slightly different angles, someone will try a slight variation that has very different implications, or stumble upon flaws in the accepted "truth" because they don't "know better" than to try something that someone well versed in the field would immediately dismiss.

" to not be aware of (or not want to care about) any other machinations that happen peripherally to what they're focused on."

I don't disagree and it sounds like the proverbial urban legend about the kid who said "just let the air out of the tires" when the truck was stuck under the bridge.

I guess the question really is then how do you make an atmosphere where you can make people with blinders aware of other possible solutions in other disciplines or entertain wild thoughts from normals. (Not normals but I believe the success of Bell Labs stemmed from having all sorts of disciplines in close proxmity to each other to solve problems. But of course the "respect" factor was very important in that working.)

That's the billion dollar question...as hackers, we've take a spirit of openness and free exchange for granted. I don't think that exists as much in many areas of medical research...even research done in academia is mostly sponsored by industry. The fact of it is, the overhead/investment needed to introduce a new innovation in medicine is extremely high, in terms of time and in millions of dollars. So sharing is not going to be actively encouraged.

In terms of how to reduce the blinders in the practice of medicine in general...also, a tough question. Practitioners are resistant to change not only (or even perhaps mostly) because of intellectual elitism, but out of disincentives in the system. A formal implementation of a checklist that is as simple as "wash your hands" and "mark the limb to be operated upon with an 'X'" can be seen as a liability. Every ER surgeon has had some kind of experience when procedure is broken because of the pandaemonium involved in any given operation...it's not that they are too dumb to wash their hands, it's just an easy step to overlook when chaos breaks out. If a surgeon does forget to wash her hands and a patient suffers (either because of it or from an unrelated thing), that checklist is going to be seized on by the malpractice lawyer.

Malpractice is a very real, common thing in the medical industry...and so even common sense innovations with be held back out of well-intentioned concerns. This goes for electronic medical keeping and many other kinds of improvements that are still in limbo.

"Malpractice"

Another woman (that I dated for many years not my wife) was a radiologist. She wouldn't even go on the record in reviewing another docs interpretation of a study. Didn't want to get on the chart lest get sued.

Otoh others in her group took malpractice as a necessary cost of doing business to churning out a top number of studies per day. It was expected that you would get sued and almost was a marker that you produced a lot of work.

The other thing that happened quite frequently that I personally experienced was the signing of study reports. If she didn't get her studies signed (electronically she did this from home so much for hipaa) someone else would sign them for her. They would just do "y" "y" "y" never reading and never catching errors in her dictation. Just approving so it could move to a final state. (You know the same way customer service people want to "close out" a support ticket).

".as hackers, we've take a spirit of openness and free exchange for granted. "

I think that stems from being a member of the "non it" group originally and finding acceptance among a group of people that appreciate and reinforce someone's willingness to share with others.

"that checklist is going to be seized on by the malpractice lawyer."

It's worse than that. My wife is a Physician. Not a week goes by when she tells me a hospital story where I think up something that a lawyer could use against them for something they don't do correctly or could have prevented.

An example, from just this morning:

The hospital that she works at has physicians that are on call to cover if there is an overload of patients. But they also have Physicians that will ask another to cover them if they can't make it in or have some other obligation. But there is no system in place to prevent the person who is "on call" from agreeing to help someone even though they are backup for the other situation. It's entirely up to the Physician to not do the wrong thing. And it happens since that is why I am telling this story and how the discussion came up.

I'm reading your comment as "Ignore your interests, passions, and ideas and just do the work that is put in front of you. Also, don't take any risks ever".

Since I'm sure that's not what you really think, would you mind explaining your position further?

I think the media is portraying it this way because there are a lot of people who get into fields and do work they way they're "supposed to", i.e., told to by peers and bosses, rather than, as this kid did, actually going through and figuring things out. Every medical breakthrough is a puzzle that's been solved, but some people aren't as interested in solving the puzzle as listening to what their boss says. Which makes sense, nobody wants to get fired, it's just suboptimal for problem solving.

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