On biomedical research (and why I no longer do it).

CaptureGetting a Ph.D. in biochemistry from Stanford is excellent preparation for two careers.  One, becoming a research professor at one of our nation’s universities, in which case you get to help mint more Ph.D.s because the workforce employed by research professors is primarily composed of doctoral candidates.  Two, conducting bioscience science research at one of our nation’s many private medical companies.

Most of my colleagues from Stanford are pursuing one of those two careers.  There are a couple who went into teaching, either high school or college students, but a Ph.D. is actually not very good training to become a teacher.  Sure, a la Michael Spence’s job-market-signaling model, their degrees indicate that they are smart people who could probably learn to teach well.  But the process of getting a Ph.D. doesn’t train people to do it, even though this is the only training that many teachers at the university level receive.  I don’t think K would be comfortable in a classroom if she hadn’t then earned a less-prestigious-sounding master’s in education, and even that quantity of training might be insufficient for someone who gets hired at a school district where teachers aren’t often observed and critiqued in their practice, i.e. the vast majority of all U.S. schools.

Needless to say, a Ph.D. is also pretty poor training for somebody who wants to be a writer.  And I knew this at the time.  I showed up, was paired with a second-year student who was supposed to show me the ropes, and he asked me:

“So what do you want to do after you finish your degree?”

“I want to be a writer.”

“Then you shouldn’t be here!  This isn’t going to help you!”

“Well, I’ll be learning, right?  And, if you’re going to write, everything you learn can help.”

As it happens, my big buddy was correct (he is, after all, a very smart guy; he now does fancy microscopy at UCSF and completed his Ph.D. under a winner of the 2014 Nobel Prize in Chemistry).  Sure, every bit of education helps, but finishing a doctorate is a very lengthy, labor-intensive, psychologically-draining way to learn something.  I do know a lot about biomedical research now… but one thing I know is that, given my philosophical stance, I definitely don’t want to do it.  It’s not just that I don’t enjoy it, it’s that I don’t believe it’s what I should be doing with my time.

A cheeky way to reason through this is to invoke illogical extremes.  This is similar to the reasoning behind Immanuel Kant’s categorical imperative (“act according to maxims that can at the same time have as their object themselves as universal laws of nature,”translated by Mary Gregor), i.e. only do something if you’d be happy to live in a world where everyone did it.

In this case, imagine a world in which the work you’re pursuing was done perfectly.  Is that a world you’d want to live in?  With both K’s current work (perfect teaching would result in knowledgeable people) and my own (honestly, I could say the same thing about writing that I did about teaching; writing is like teaching for agoraphobes), I think this is satisfied.  With biomedical research, though, I don’t think it is.  Perfect success would mean that no one would die.  And, yes, immortality sounds nice.  But immortality for all sounds like a nightmare.

CaptureAs our biomedical knowledge increases, medical care gets better.  And, sure, I take my daughter to the doctor.  I’d be devastated if anything happened to her.  One of my friend’s sons is very sick (his situation is slightly less scary than it was previously, at least as of this writing, but it’s still scary), and obviously I want him to get better.  And I myself receive excellent healthcare via cellphone from my father.

Nobody wants young people to die.

But a majority of the gains from biomedical research have always gone to extending the time remaining for the old and sick.  And this is bad in many ways.  For one, it doesn’t really help the world to prolong relatively unproductive existences.  But that’s me as a selfish young person writing.  More to the point, it doesn’t really help patients to prolong that time.  From Michael Bell’s article in Forbes:

“It seems that no matter how much money you use during that last year / month, if the person is sick enough, the effort makes things worse.  A lot of the money being spent is not only not helping, it is making that patient endure more bad experiences on a daily basis.  The patient’s quality of life is being sacrificed by increasing the cost of death.”

Or you could read Samuel Shem’s House of God.  But you’ll have to remember that his book was written in 1978.  Since then, medical care has gotten better, which means that in some ways the situation he describes has gotten worse.  Here’s a dialogue between a supervisor and the interns at the end of their first year:

“Strange.  Boys, when I was an intern, I loved my admitting days.  All of us did.  We looked forward to them, we fought for those ‘toughies’ so we could show our Chief what we could do.  And we did damn well.  What’s happened?  What’s going on?”

“Gomers,” said Howie, “gomers are what’s going on.”

“You mean old people?  We took care of old people too.”

“Gomers are different,” said Eddie.  “They didn’t exist when you were a tern, ’cause then they used to die.  Now they don’t.”

Which, right, I guess it’d help to give you a definition for Shem’s term “gomer” here: it stands for Get Out of My Emergency Room, for people with numerous medical complications, enough aches, pains and physiological turmoil to bring them repeatedly to the hospital, but a sufficiently stable condition that with sound care they might survive in that state for years.  As we pursue medical advances (like the fight to “cure cancer,” which always sounds strange to me because cancer is an inevitable corollary to cell division), we will convert more maladies from things that kill us into things that will shunt us into the peculiar stasis of gomer-hood.

Shem, or rather the actual human who writes under this pseudonym, and his protagonist both responded to this philosophical conundrum by switching to psychiatry.  Instead of treating the body so that life can be longer, he would treat the mind so that life could be better.  And that is why I write.  Good books have done that for me.  My darling Marcel was in many ways my closest friend during graduate school (of course, K disagrees with this.  But even so, Marcel probably earned second place), and without his help I’m not sure I could have finished my degree.  But although there are already many, many lovely books, there are a few things I wanted to read that did not exist.  In my ill-trained, shambling way, I’ve been trying to create them.