My observation diary
It's always very hard to start a conversation without the listners' help, so
is a composition on the Internet. Today I want to share something I found on
the TED.com. TED is a wonderful tool for every students or anyone interested
in science, art, music, language, and so on. I would talk about something I
just found on TED.
Science. The very word for many of you conjures unhappy memories of boredom
in high school biology or physics class. But let me assure that what you
did there had very little to do with science. That was really the "what" of
science. It was the history of what other people had discovered. What I'm
most interested in as a scientist is the "how" of science. Because science is
knowledge in process. We make an observation, huess an explaination for that
observation, and then make a prediction that we can test with an experiment
or other observation.
A couple of examples. First of all, people noticed that the Earth was below,
the sky above, and both the Sun and the Moon seemed to go around them. Their
guessed explanation was that the Earth must be the center of the universe.
The prediction: everything should circle the Earth. This was first really
tested when Glileo got his hands on one of the first telescopes, and as he
gazed into the night sky, what he found there was a planet, Jupiter, with
four moons circling around it. He then used those moons to follow the path
of Jupiter and found that Jupiter also was not going around the Earth but
around the Sun. So the prediction test failed. And this led to the
discarding of the theory that the Earth was the center of the universe.
Another example: Sir Issac Newton noticed that things fall th the Earth.
The guessed explanation was gravity, the redition that everything should
fall to the Earth. But of course, not everything does fall to the Earth.
So did we discard gravity? No. We revised the theory and said, gravity
pulls things to the Earthunless there is an equal and opposite force in
other direction. This led us to learn something new. We began to pay more
attention to the bird and the bird's wings, and just think of all these
discoveriesthat have flown form that line of thinking. So the test failures,
the exceptions, the outliers teach us what we don't know and lead us to
something new. This is how science moves forward. This is how science learns.
Sometimes in the media, and even more rarely, but sometimes even scientists
will say that something or other has been scientificallyproven. But I hope
that you understand that science never proves anything definitively forever.
Hopefully science remains curious enough to look for and humble enough to
recognize when we have found the next outlier, the next exception, which,
like Jupiter's moons, teaches us what we don't exactly know.
We're going to change gears here for a second. The caduceus, or the symbol
of medicine, means a lot of different things to different people, but most
of our public discourse on medicine really turns it into an engineering
problem. We have the hallways of Congress, and the boardrooms of insurance
companies that try to figure out how to pay for it, The ethicists and
epidemiologists try to figure out how best to distribute medicine, and the
hospitals and physicians are absolutely obsessed with their protocols
and checklists, trying to figure out how best to safely apply medicine.
These are all good things. However, they also all assume at some level that
the textbook of medicine is closed. We start to measure the quality of our
health care by how quickly we can access it. It doesn't surprise me that in
this climate, many of our institutions for the provision of health care start
to look a heck of a lot like Jiffy Lube.
The only problem is that when I gradiated form medical school, I didn't get
one of those little doohickeys that your mechanic has to plig into your car
and find out exactly what's wrong with it, because the textbook of medicine is
not closed. Medicine is science. Medicine is knowledge in process. We make an
observation we guess an explanation of that observation, and then we make a
precition that we can test. Now , the testing ground of most predicitons in
medicine is populations tend to distribute around a mean as a Gaussian or a
normal curve. Thereofre, in medicine, after we make a prediciton form a
guessed explanation, we test it on a population, That means that what we know
in medicine, our knowledge and our know-low, comes form populations but
extends only as far as the next outlier, the next exception, which, like
Jupiter's moons, will teach us hwat don't actually know.
Now, I am a surgeon who looks after patients with sarcome. Sarcome is a very
rare form of cancer. IT's the cancer of flesh and bones. And I would tell you
that every one of my patients is an outlier, is an exception, There is no
sirgery I have ever performed for a sacroma patient that has ever been guided
by a randomized controlled clinical trial, that we consider the best kind of
population-based evidence in medicine. People talk aboit thinking outside the
boxm, but when we don't even have a box in sacroma. What we do have as we take
a bath in the uncertainty and nknowns and exceptions and outliers that
surround us in sacroma is easy access to what I think are those two most
important values for any science: himanity and curiosity. Because if I am
humble and curious, when a patient asks me a question, and I don't know the
answer,I'll ask a colleague who may have a similar albeit distinct patient
with sacroma. We'll even establish international collaborations, Those
patients will start to talk to eash other through chat rooms and support
groups. It's through this kind of humbly curious communication that we begin
to try and learn new things.
Thanks for your patience.
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