Low-hanging fruit

In The Great Stagnation, Tyler Cowen discusses a real problem – a slowdown in technical innovation,  with slow economic growth as a consequence..   I think his perspective is limited, since he doesn’t know much about the inward nature of innovation. He is kind enough to make absolutely clear how little he knows by mentioning Tang and Teflon as spinoffs of the space program, which is  of course wrong. It is unfair to emphasize this too strongly, since hardly anybody in public life knows jack shit about technology and invention. Try to think of a pundit with a patent.

Anyhow, it strikes me that a certain amount of knowledge  may lead to useful insights. In particular, it may help us find low-hanging-fruit, technical innovations that are tasty and relatively easy – the sort of thing that seems obvious after someone thinks of it.

If we look at cases where an innovation or discovery was possible – even easy – for a long time before it was actually developed, we might be able to find patterns that would help us detect the low-hanging fruit  dangling right in front of us today.

For now, one example.  We know that gastric and duodenal ulcer, and most cases of stomach cancer, are caused by an infectious organism, helicobacter pylori.  It apparently causes amnesia as well. This organism was first seen in 1875 – nobody paid any attention.

Letulle showed that it induced gastritis in guinea pigs, 1888. Walery Jaworski rediscovered it in 1889, and suspected that it might cause gastric disease. Nobody paid any attention.  Krienitz associated it with gastric cancer in 1906.  Who cares?

Around 1940, some American researchers rediscovered it, found it more common in ulcerated stomachs,  and published their results.  Some of them thought that this might be the cause of ulcers – but Palmer, a famous pathologist,  couldn’t find it when he looked in the early 50s, so it officially disappeared again. He had used the wrong stain.  John Lykoudis, a Greek country doctor noticed that a heavy dose of antibiotics coincided with his ulcer’s disappearance, and started treating patients with antibiotics – successfully.   He tried to interest pharmaceutical companies – wrote to Geigy, Hoechst, Bayer, etc.  No joy.   JAMA rejected his article. The local medical society referred him for disciplinary action and fined him

The Chinese noticed that antibiotics could cure ulcers in the early 70s, but they were Commies, so it didn’t count.

Think about it: peptic and duodenal ulcer were fairly common, and so were effective antibiotics, starting in the mid-40s. . Every internist in the world – every surgeon – every GP was accidentally curing ulcers  – not just one or twice,  but again and again.  For decades. Almost none of them noticed it, even though it was happening over and over, right in front of their eyes.  Those who did notice were ignored until the mid-80s, when Robin Warren and Barry Marshall finally made the discovery stick. Even then,  it took something like 10 years for antibiotic treatment of ulcers to become common, even though it was cheap and effective. Or perhaps because it was cheap and effective.

This illustrates an important point: doctors are lousy scientists, lousy researchers.  They’re memorizers, not puzzle solvers.  Considering that Western medicine was an ineffective pseudoscience – actually, closer to a malignant pseudoscience  – for its first two thousand years, we shouldn’t be surprised.    Since we’re looking for low-hanging fruit,  this is good news.  It means that the great discoveries in medicine are probably not mined out. From our point of view, past incompetence predicts future progress.  The worse, the better!

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33 Responses to Low-hanging fruit

  1. Dan says:

    Tyler Cowen is a no-talent hack. A total mediocrity.

  2. JayMan says:

    No kidding about doctors being horrible scientists (which is scary to think about in this day and age). I’ve heard claims that technological innovation in our society is reaching a plateau (e.g., the number of patents per capita is going down). Having read The 10,000 Year Explosion, you and Dr. Harpending have gotten me to see that civilizations plateau in their development because the population reaches their “genetic potential” for innovation. Could the same thing be happening to our civilization? This would mean that only changes in the population genetically offers hope of bringing about an age of serious innovation.

  3. dearieme says:

    It’s odd that it took so long for horsey societies to come up with the saddle, stirrups and the non-choking horse collar. It’s interesting that the Romans noted the British habit of heating with coal and took the idea no further. There must be hundreds of comparable oddities.

    • dave chamberlin says:

      I was shocked to hear how long it took for stirrups to be invented. The damned fools crippled, maimed, and knocked themselves senseless for thousands of years by falling off a horse before they figured out, gee maybe we can do better than grip this galloping beast with our legs. The list of rampant stupidity, past and present, is long and glorious. Before there was Donald Trump for President, there were two childrens crusades. The muslims thanked the kids for coming to Jerusleum, and promptly sold them into slavery, making a fat profit.

  4. Jim says:

    There is a question though of whether some medical advances may actually negatively affect economic growth. I’ve read of speculation that the reduction of cigarette smoking in the US may have been economically negative. Since lung cancer in any case tends to occur in the latter part of life the increase in the present value of additional productive years may be less than the increase in the present value of retirement costs.

  5. MikeP says:

    The vast majority of people are totally incurious. We seem mentally adapted to adhere to convention and to reject new ways. Perhaps it’s a mechanism to better transmit culture, but it’s at odds with the modern pace of innovation. I constantly get excited by other fields and crazy ideas, but usually meet with bored indifference. The good thing for innovators is that this leaves a whole lot for them to do. I am just about to file a patent in a very crowded field totally outside my own area and am just amazed that people in that field haven’t come up with this thing before.

    • billswift says:

      There was a post today on LessWrong about the importance of curiosity:

      A lot of rationalist practice is like that. Whether thinking about physics or sociology or relationships, you need to catch your intuitive judgment and think “No! Curiosity.”

      Get Curious

  6. The golden age of medical discovery was relatively brief – the mid-twentieth century – and is long since gone:

    http://qjmed.oxfordjournals.org/content/98/1/53.full

    A very important book on this topic has just been published: Pharmageddon, by David Healy

    • dearieme says:

      Try the second edition of James Le Fanu’s The Rise and Fall of Modern Medicine – it’s a tremendous read. He dates the end of the golden age to ca. 1975.

  7. Leo Szilard says:

    Why should doctors have paid attention to H. pylori when there were already perfectly good expensive treatments for ulcers? Entire practices were based on using Freudian psychotherapy to treat “stress”-induced ulcers and they were wiped out by simple and cheap antibiotic based treatments. People had been happy to give their money to these quacks for years. It was the story-book definition of a successful treatment regime: indefinite, labor-intensive, and expensive. Then the golden goose was throttled because one guy could not keep his mouth shut.

    Of course, there might be a lesson here about finding these types of low-hanging fruits by looking for choruses of concentrated human stupidity and trying to figure out what all that squawking is protecting.

    But that is no way to get rich.

    • Anonymous says:

      “looking for choruses of concentrated human stupidity and trying to figure out what all that squawking is protecting.”

      Well, we may not get rich, but it will certainly keep us busy…

  8. erica says:

    Specialization lead to periods regression in overall skill, no? Practitioners of just about everything of value today (value in an economic sense) are selected for limited skill sets.

    If I may make a sports metaphor: the NFL defensive back, say, has grown bigger, stronger, faster as a result of selection to cover bigger, stronger, faster and thus, productive, receivers. Problem is, he no longer possesses one of the most basic skills of a football player–the ability to tackle. What used to be a 15 or 20 yard catch on a slant pattern is now quite often a 60 yard touchdown catch.

    While his immediate employer, his team owner, cares that he gives up such points and causes the loss of games, his other “employer,” the NFL, is quite happy about the situation. Offense sells.

    A few good teams realize the “low-hanging” fruit of fundamentals in tackling can offer pay-offs in the form of wins, but it’s amazing how hard they have to look for such players among the pool of players at the lower levels. It’s also amazing how many players themselves don’t see the benefits of picking that low-hanging fruit.

  9. Konkvistador says:

    There have been several interesting responses to this in a thread on LessWrong:
    http://lesswrong.com/r/discussion/lw/aa5/link_an_argument_for_lowhanging_fruit_in_medicine/

  10. Gorbachev says:

    I didn’t know this about ulcers. I suggested it to my father, who had one. he said his ulcers cleared up after he took a course of antibiotics for an unrelated problem. The doctor called it a small miracle.

    Apparently, his doctor was just as ignorant as others.

    One thing that always stunned me was how we’re convinced that doctors have some sort of knowledge about biological discoveries. I’ve known more than one doctor who was a dogmatic Creationist; despite the most powerful evidence, they denied the single intellectual framework that makes the world of biology comprehensible. They did not have scientific mindsets. They, may, however, have been good doctors.

    Engineers and doctors are technicians. They are not scientists.

    Saying this to them often offends them.

    • gcochran9 says:

      I know of several cases of such accidental cures in friends of mine. When did this happen to your father?

    • Sean says:

      I wouldn’t encourage people to be too casual about coincidentally improving health with a course of antibiotics given for another reason, especially if they are in a country where people with a bit of money can go to another doctor if the current one does not give then what they want. Antibiotics are in many ways the exception that proves the rule: (medical treatment does not consist of anything that can properly be called a cure). You are going to take out a hell of a lot of bacteria in the gut flora with wide spectrum antibiotics. What that does is not really known. Lesions on the artery walls may have bugs in them, yes, But those bugs may be beneficiall for all we know. Carefully controlled experiments to find out if specific bacteria are actually doing damage are needed before calling for the nuclear bazooka.

  11. dearieme says:

    “Saying this to them often offends them”: offends them when it’s true, or offends them when it’s false?

    • Gorbachev says:

      Especially when it’s true.

      • j says:

        I am an engineer and we certainly are technicians in the sense of applying standard techniques in a mechanical way. Engineering is honest work and according to JDPeron, honest work “dignifies”. The universe follows laws, and we build things that work in that set of rules. Mechanical, banal and boring, but not everybody is built for more exciting trades like pimping or robbing banks.

  12. Rollory says:

    ” Tang and Teflon as spinoffs of the space program, which is of course wrong”

    Could you elaborate on that? It’s not “of course” when it’s one of those “everybody knows” things.

    If someone had asked me to name common civilian spinoffs of the space program, I would’ve said Tang and Velcro. I’ve never researched the matter, but if you know better, a link or three would be nice.

  13. gcochran9 says:

    Not Velcro, either, As for a link, try http://www.wikipedia.org/.

  14. Sean says:

    Be fair , it may not be because they are evolutionarily aware , but doctors were AND WILL BE right to stop antibiotics being used without A PROPER RATIONALE.
    People are already dying of diseases that antibiotics used to be able to cure.

    And there won’t be any new antibiotics – because they work, and fast. Those reaping the ‘fruit’ are the pharma business; they’re looking for a treatment that has to be given for years and years like, er, tagamite.

  15. Matt says:

    That seems like the result of there being a lot of anatomy and chemistry to remember and no real strong logical or functional relationships that give all the performance of memorisation from raw reasoning ability (that’s particularly the case for docs who would wilfully ignore evolutionary biology).

    It’s not like physics as described by Richard Feynman where he describes it as a subject where you don’t really need to remember everything at once because everything is connected by relationships to the extent that you can work out a lot of everything else just from knowing some facts (as much as he had a rather special mind). Physics is a field which seems to be remarked on for selecting people who have a very high level of general intelligence but have a rather thin knowledge base and interest in acquiring one, relative to other people of similar g (they’re the guys who, to paraphrase Steve Hsu’s lecture on his work with the BGI, want the “one equation that explains everything” without getting involved with the “nasty biological machinery”).

    General docs being selected for ability to memorise a lot of facts seems difficult to get around really, without an implosion in the number of docs (although perhaps quantity>quality)… Medical research might be better optimised for more super selected for general problem solving ability of course, but I don’t know if at the expense of memorization, just in the direction of being more highly selected.

    • Aidan Kehoe says:

      ‘General docs being selected for ability to memorise a lot of facts seems difficult to get around really, …’

      Sure, but there’s such a huge demand for medical school places that it would be trivial to g-load the process a bit more, such that you admit a higher proportion of people who have very strong general problem-solving ability as well as an excellent memory. Now, politically it would be a bit harder; I suspect it would change the sex ratio of those admitted.

      And of course the g-loading could well come at the expense of social skills, which would not actually be something that your average patient would want.

  16. Jim says:

    To Sean – I had a duodenal ulcer once and was treated with Tagamet. I went from horrible pain to feeling fine in a few days. I was on Tagamet for only a short time. That was more than 30 years ago and I have never had a recurrence.

  17. Deckin says:

    Why did you change ‘whack shit’ in the first iteration of this post to ‘jack shit’? I know the latter is more commonplace, but I really liked the former. I’d go with it.

  18. Jim says:

    To Sean – Until the day I took the Tagamet the horrible pain was getting continually worst. Even the first evening I felt much better. Than in less than 48 hours on Tagamet virtually all the pain was gone. Tagemet is an acid inhibitor so if my stomach acids killed the bug they must have done that before I began taking the Tagamet. Maybe if I had not taken the Tagamet the pain would have gradually gone away but it was the most excruciating pain I have ever had to endure so if the Tagemet saved me from one minute of it I am grateful.

  19. Anonymous says:

    I’ve never had an ulcer but I’ve had an inflamed duodenum and assure you it was not due to any bug but purely stress-driven.

  20. jamesg1103 says:

    Speaking of low-hanging fruit, consider the following facts consistent with the idea that lethal juvenile cancer functioned as evolution’s de facto quality control mechanism.

    All cancers begin in an individual somatic cell.

    Cancer initiation follows replication error a/k/a somatic mutation(s).

    As Bruce Ames — http://en.wikipedia.org/wiki/Bruce_Ames — determined, things that cause replication errors cause cancer: mutagens are carcinogens.

    All normal animal somatic cells contain cancer triggers. (See Varmus and Bishop’s 1985 Nobel Prize.)

    The genetic material of juveniles killed by cancer were eliminated from the gene pool.

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