The entire 8 billion humans alive on this planet are all a part of one single massive population. We are all nodes in a network that spans across the globe, and the only way for us to continue to maintain this population, living at the pinnacle of civilization, is to innovate. That is something we are not doing. Specifically, if our healthcare system cannot innovate fast enough, it cannot adapt in a world that, according to Science Direct, “takes all the running you can do, to keep in the same place.”
Stagnant innovation
When I teach others the concept of innovation-stagnation in the biomedical sciences, I often first start out by asking if one can tell me what penicillin is, and then I ask them if they can tell me what the IBM5100 is. To this day, I’ve never met someone who couldn’t answer the former and someone who could answer the latter. While there are decades of time in between the two, one of these has been made irrelevant by constant human innovation, and the other is being made irrelevant by the innovation developed by natural selection, i.e., antibiotic resistance.
While there are many actions that we must take to innovate, or “keep in the same place,” I am astonished at how little value our healthcare system places on understanding the nature of scientific inquiry and the scientific method, as this has been the foundation of every major innovation over the past two centuries.
Science is non-authoritarian.
Often, innovation does not come from within authoritative agencies; it comes from the fringe. Barry Marshall was mocked for his claims that H. Pylori could cause stomach ulcers as everyone “knew” that nothing could survive in stomach acid. The Belousov-Zhabotinsky reaction was dismissed as impossible for it seemingly violated the ever-holy second law of thermodynamics. DNA could not be the genetic material of the cell because 2x Nobel Laureate, Linus Pauling decreed that the cell’s genetic material would be a protein. There are numerous other examples that I won’t go into, but the point that I am making is that as long science is done by humans who all fall short and succumb to the inherit biases of their nature, the new ideas we need to literally keep the lights on will face extreme opposition.
Over time, these issues of conformity and authoritarianism have only gotten worse, not better, as our underlying information infrastructure has become more centralized and more hierarchical. This leads to less innovation as breakthrough ideas must work harder and harder to gain acceptance and climb to the top of these hierarchies.
What happened to teaching science?
Many premed students will undoubtedly take courses that will teach them cell respiration and glycolysis. Few will take an equivalent amount of time to sit down and learn what the scientific process is like, what its strengths and weaknesses are, and how to approach these issues. While in principle, the unspoken rule regarding the essentialism of undergraduate research should teach future physicians about the nature of scientific inquiry, the hyperspecialized nature of academia has resulted in a process of “too much doing and too little thinking,” as quoted by the National Center for Biotechnology Information. An overwhelming number of students do not understand the research they are working on. Thus, research becomes a mindless procedure where they work for free, setting up agar plates and streaking solutions onto them, their names included in the publication, but little to no understanding of what was done.
There are no questions related to scientific inquiry on the Medical College Admissions Test (MCAT). Not one question for these would-be physicians about criticizing experimental methods or the nature of scientific inquiry. They are asked to memorize facts and draw conclusions from data sets assumed to have been obtained honestly, in a world with human beings who have the tendency to be dishonest.
The only set of standardized exams that we do see asking questions on the nature of scientific inquiry are the Advanced Placement exams in high school. This creates a bias in the individuals who will go on to study medicine or pharmacy because they seem to believe that because something was only prioritized at the high school level, it is somehow simple, diminutive, and irrelevant. One would never make such a claim about the biochemical reactions present in the mitochondria or its implications for understanding eukaryotic evolution and by a more distal effect, cancer.
This creates an incredibly pathological viewpoint: that scientific inquiry is somehow simple, established, unchanging, and less relevant than memorizing “facts.” Nothing could be further from the truth; I would never expect physicians to know the role that formyl-methionine plays in prokaryotic translation. I would, however, expect them to understand how science works and how to differentiate good from bad research.
We are in danger of having entire generations of physicians, mid-level providers, and pharmacists who are all apt to believe the sales pitch of pharmaceutical companies, CBD oil, and so on, providers who cannot tell the difference between scientific experiments and an advertisement. This will lead to massive stagnation, and further deaths in a system notorious for causing grave error. As new diseases emerge, we must emphasize understanding of the nature of scientific inquiry as a means to promote innovation and maintain the undeniable luxury of the modern world.
