Always remember that no amount of specialist skill by itself gets things done. Healthcare, and everything else, depends on the vast capital structure of our global economy.
If you sent a great doctor back in time to the 15th century, she could do somewhat better than the locals (hand-washing helps a lot). But she would come nowhere near her capabilities when backed by a modern economy.
If you can make one little piece of the economy 50% more efficient, you're freeing up capital for the next highest use. In this sense, it doesn't matter that you're not directly contributing to the next cure. You're helping create a wealthier world, and a wealthier world can afford more cures.
Medicine depends on myriad materials and technologies that are affordable precisely because they're widely used in many other applications. If microprocessors were only used in IV pumps and pacemakers, they would be impractically expensive.
Even something as seemingly superficial as consumer mobile electronics is having major impact on medicine right now.
This is one of the most insightful things I've read about the interconnectedness of different professions and the overall economy in recent memory. I'm currently at a crossroads of decision, wondering much as the author about the most meaningful use of my life. This helped me, Thank You.
I get what you're saying, but I think that 'somewhat better' is an understatement. Obviously she's not going to be performing heart transplants and bi-pass surgeries, but just knowing about things like penicillin, would be huge (not to mention knowledge of things like disease vectors, etc).
I would actually say "she probably knows less than the locals and can do much less than the locals".
I studied Medicine for two years, and was surprised by how much advanced and knowledgeable our ancestors were.
Pharaons did brain surgery to remove cancer tumors a thousands years back successfully. This alone, shows the degree of sophistication and technology they had.
Now I'm not saying before is better, but today we rely a lot on technology (IRM, Radiology, Echography...) that we don't keep much of the details and don't even need to learn them.
Well, then depends on the part of the world and the period. I was assuming 15th century Europe, which is a different story. Also, things like penicillin have a much broader affect than removing a couple of brain tumors. On the other hand, advanced knowledge could be called witchcraft, and she could be burned at the stake.
The question of whether my contribution to the world and how meaningful it should be has been in my head for a long, long time. It's not an easy answer. Working on an IDE certainly isn't performing life-saving surgery on someone who's bleeding out, but it does serve its purpose in the world.
I used to criticize people working on social apps until I started training in the hospital here and noticed kids spending hours in their stretchers browsing Instagram and the like. Social apps likely help a huge number of patients get through their hospital stays. And while they're not contributing directly to a person's physiological stability, I don't think they are that less meaningful than the services being provided by the hospital. There's a patient here who listens to his iPod all day, and another who is constantly on Facebook, and another who is always watching movies on his iPad, and I'd bet a cool million that all those products and services contribute to their mental, and eventually physical health.
If your product/service is providing value, making lives easier, and you're satisfied providing it, I would try to ignore the "meaning" question, because your mind will always default to you being the Nobel piece prize winner who discovered the cure for cancer, or the doctor who just single-handedly resurrected a patient (and all the glory and status that comes with that). The point is you will always undervalue the contribution you're currently making while overvaluing the contributions you could be making. I'm not saying you shouldn't pursue stuff like cancer research, but before you do, objectively evaluate the contribution you're making.
Know there is much more to a meaningful life than health, like friends, families, hobbies, entertainment, work, etc. Helping facilitate any of that makes you a positive-contributor in my book.
> Know there is much more to a meaningful life than health
Nicely said. There seems to be a pervasive notion among my classmates (yours too, I bet) that health is the most important value. I think people should and do decide which things they value most, and that top value is not always maximizing every aspect of health. There are tradeoffs to be made. (Otherwise, ahem, nobody would do residency.)
Health, by the way, is a constellation of different, related factors. Even within the overarching concept of "health," people hold these factors in different esteem.
"Even the determination of what is healthy for your body depends on your goal, your horizon, your energies, your impulses, your errors, and above all on the ideals and phantasms of your soul. Thus there are innumerable healths of the body; and the more we allow the unique and incomparable to raise its head again, and the more we abjure the dogma of the “equality of men,” the more must the concept of a normal health, along with a normal diet and the normal course of an illness, be abandoned by medical men. Only then would the time have come to reflect on health and illness of the soul, and to find the peculiar virtue of each man in the health of the soul."
This post has some special meaning to me. I work as a developer at a cancer hospital. The work I do directly helps clinical trials. I handle everything from trial conception to actual patient accruals and the resulting deluge of data.
Every little bit of tech I get to use which has a net positive affect on my efficiency reduces the time of my deliverables/milestones. My team and I develop the tools/software/data which the doctors/nurses/practitioners rely on to provide care, solve interesting medical puzzles, etc. It is a race against the clock. I get the privilege of writing code that has the potential to help cure cancer.
I switched from TextMate to Sublime Text 2 recently. I've been monitoring Light Table and ST3 as of late. Keep up the good work.
i think your kind of testimony is really the best a developer could hope to read. We all know that in a somewhat indirect way, we are helping someone somewhere with our work, but it must feel really good to hear one say it out loud from time to time.
PS : I'm not even building an IDE, so that makes me even further away from helping anyone help someone.
No, there is no absolute "moral duty" to anything or anyone. There is a thing called "guilt", that some people try to induce (moral manipulation), when you don't do the things they want you to do. You only duty is to do things that you think are right.
> Could I have saved Kristie, or if not her, others like her?
Saving her - quite unlikely, unless you manage to find a cure for the kind of terminal cancer she has, in less than the survival expectation that were given.
Saving others - unlikely, unless you manage to find a cure for any cancer. There seems to be many people working on that.
I would say this is a battle you have <0.01% of winning. In such case, the wise thing to do is not to enter in this battle.
>if this is really the "right" thing to do
That being said, considering death is a final state, you may want to spend some time with the dying person instead of working on your project. If you don't, you may have regrets later on. You won't be able to interact with the person after death. I'd suggest stalling the IDE work, unless you have very compelling reasons to prioritize that.
Don't fight the battle, but instead, provide care and comfort to the dying person.
>I'm doing this because I believe that this is the greatest contribution I can make
Good statement. You do with the cards you are dealt with. Just make sure to take the right decisions to avoid regrets.
>> By this logic no one should ever work on really hard problems.
Maybe the key is that not just anyone should work on really hard problems, if you have an advantage or enough capital then nobody is stopping you. Someone with a PhD in clinical research has a much higher percentage "chance" of succeeding at a difficult medicinal problem than >99.999% of the rest of the population. Maybe the best approach would be to help funnel funds to specific cancer research groups.
If you start with nothing and have the goal of curing cancer, it just isn't going to happen (<0.001% chance of success or even progress).
It gets weirder too. In SF I can make substantially more money working for a random social startup than I can working as a postdoc directly on cancer-curing science. I have the capacity to work on such science at a high level, or a social startup at a pretty moderate level. But society has worked its compensation out such that being a highly trained PhD is far less compensated than someone working on the tech scene.
Last year I was with a family member in her final months... mostly spent in a hospital. Working was a sort of refuge that allowed me to focus on something else. When I returned I was a much better support. You will go crazy if you do nothing but sit at the hospital listening to beeping machines and watching basic cable. You'll want to sit there with her all the time but you need to take care of yourself as well.
It's a cold world if you try to reduce everything to logic and probability.
There's nothing about what the author wrote that struck me as though he had some tremendous guilt weighing him down. There's guilt and there's humble recognition of one's own privilege. They aren't the same thing. He strikes me as someone who understands the opportunity cost of what he's chosen to do, and not only appreciates the fact that he has a choice, but feel conviction that he made the right one.
I'm sure you intended your pep talk out of a genuine desire to help, but I think you missed the point of why the author wrote what he did, at least my perception of it. He's trying to bring a little perspective, through the lens of his own experience.
We romanticize what we do in the startup world like we're living on the edge. He's comparing one sense in which working on a startup pales in comparison to other challenges people face, versus the sense in which you truly are out there on the edge. There's truth on both sides of the coin.
I applaud your mission to try and improve lives, and I believe that every start-up should focus on just that. I would also like to give it a little perspective though.
There is generally an inverse correlation between the effectiveness of solving a problem and the directness of the approach. If you would like to cure cancer, the most effective way is to cure cancer. The next most direct approach is to help the doctors who are curing cancer. The next most direct approach is to help the medical companies who are helping the doctors who are curing cancer. And so on.
Having "a mission" is of paramount importance to succeeding, but it bothers me when we believe we're on a mission to solve a problem that we're simply not solving. A photo sharing application could say they're improving the lives of cancer patients by allowing them to see photos of their grandchildren, and yes, by the letter that is a true statement, and honestly maybe that's all the patient really wanted -- to see photos of their grandchildren, but to me it seems like an indirect drop in the bucket toward solving the real problem.
I feel like this thinking is actually poisonous to the ecosystem. It prevents us from solving the real problems we've set out to solve by deluding us to think that by building some indirect tool for people who may help people who may help people who may actually solve the problem, we've accomplished our mission. We haven't. It's a text editor, and you have to see it for what it is. If we want to cure cancer, we need to sit down, understand the problem landscape, and solve it without five layers of indirection. Otherwise, we shouldn't be stealing the thunder of those whose actual mission is to cure cancer.
I apologize if my post implies I believe we're out curing cancer - we're not and that was not my intent. If you point out to me where I've somehow stated that, I'll be happy to fix it.
That being said, I'm not sure I agree with your argument. Both indirect and direct means are ultimately necessary for any serious change or innovation. By your logic, a microscope is just an item that lets you see things up close. Now imagine a world without it. We'd certainly be hard-pressed to do much in the medical field. Tools, by definition, enable us to do something we couldn't do before or increase the efficiency of something we did have the ability to do. Without advancements in tools, we won't get very far.
If a new "text editor" ends up providing us a much more efficient means of creating things like Watson, in what way is that not just as important as curing any one disease? The argument is certainly not that one case is better than the other, just that I've decided to go down a different path, one that I believe is just as important. I can fix 100% of something or increase everything by 1% - I believe the latter is the best thing I can do at this point.
Both direct and indirect tools are absolutely equally necessary, and my apologies if that sentiment did not come through -- I would never debate the usefulness or effectiveness of these tools, but instead their fitness for achieving a specific goal.
The parallel to curing cancer was mainly drawn from this paragraph:
I could've become a doctor. All signs pointed to me likely being a very good one. In doing so, I would have gone to work and done my best to save lives every day. In that context, how is some programming environment a greater contribution to the world? Truthfully, it wouldn't be if I just set out to build an IDE. But that's not what I did - Light Table is just a vehicle for the real goal. While an IDE probably won't directly save someone's life, the things people are able to build with it could do exactly that.
To your main point:
If a new "text editor" ends up providing us a much more efficient means of creating things like Watson, in what way is that not just as important as curing any one disease?
Absolutely. I'm not arguing its importance, I'm arguing its effectiveness at achieving a mission, which I interpreted as curing cancer / saving lives. If you "increase everything by 1%", that is fantastic! And it has furthered many different missions 1% closer to their goals. This is very much important and necessary to the advancement of society, but its mission specifically should be put into context.
A microscope is a fundamental tool to help scientists do their best work. Thus, a person setting out to build one, in my opinion, has the opportunity to profoundly impact science's understanding of the human body and the world we live in. This understanding, further, can help scientists achieve their missions of curing disease, et cetera. But while the microscope plays a very important role in science, I believe it is unfair to the scientists for the microscope maker to believe that he is accomplishing his mission of curing disease by inventing one. Rather, he should be achieving his mission of helping our understanding of science, and/or furthering the missions of his users.
I get your point, I really do. It's a decent argument, but if that's his gasoline, let him use it. Motivation is a hard thing to come by and his story just illustrates how hard it can be to focus and build something when dealing with emotional issues.
I don't think it hurts anyone when he says he's helping solve cancer, he's not stealing anyone's thunder. There's plenty of evidence of tool/library developers not getting any credit in the end product. If someone directly finds a cure using Light Table as their IDE, I'm pretty damn sure not a lot of people are going to seek out Chris and congratulate him on curing cancer. But he would've helped and that's the important thing. So let him have his motivation and keep building things.
I don't know why the parent comment got down voted (other than being a bit harsh). I agree that too little is being done to cure cancer directly. Unfortunately, I see two main causes for this:
* Too many successful people (especially founders) end up having an "I've got mine" mentality. They take the money and run instead of seeing their wealth as a grant from society, in other words a kind of debt that they should pay back by applying their skills to really helping others.
* Everyone is in denial about aging and illness. So the real causes of cancer - alcohol and tobacco, too little regulation in food, pollution, and the real kicker: the inequality that causes the social ills that amplify these problems - are not being attacked by the population at large. To me, the sense that we are powerless as individuals to do something about disease is an indictment of capitalism at large.
I think the worst sin, as far as the golden rule goes, is to reach a position of privilege and power and do nothing to change the system that got you there. By that measure, the vast majority of people of influence are failing. I never see myself having a net worth of more than perhaps a few hundred thousand dollars (enough for a home and family), because I know in my heart that society has done more for me than I can every hope to pay back. So I plan to be rolling any wealth I acquire into disruptive technologies and giving grants to people who have a shot at really making life better instead of distracting us.
Insightful comment. You might be interested in checking out the book Twilight of the Elites by Chris Hayes. It talks a lot about societal inequality and the concept of "elite failure", which I think you've alluded to.
(Longtime HN participant using a throwaway account.)
I'm half of a two-person startup. I have a wife and child, and my wife is chronically ill, so I end up doing a large share of the child care. And now one of my cofounder's parents has cancer. Given our family obligations and financial constraints, we both work absurdly hard to get everything done.
This is enough adversity to make anyone run the other way and bet on our failure (one reason I'm using a throwaway account). But I don't think it's that clear-cut at all.
I don't like it when people take the "adversity is an asset" argument too far, but in our case it has only steeled my resolve. Having constraints is helpful, up to a point. We deeply believe in our product, we know it materially improves people's lives.
Working more hours is not a scalable competitive advantage. We're going to succeed because we're smarter and have more guts.
You have my full sympathies and empathies. Living at home with a sick relative (terminal or not) is a deeply emotionally taxing but personally important act.
No one person can fix / help with every problem. You can only at best better enable others to more effectively solve problems. That's what I'm doing with my tech, that's what you're doing with your tech. That's what everyone building a genuinely technological venture is trying to do.
Dennis Ritchie demonstrated the social value of tooling beyond all doubt. The Life Sciences hasn't had its Dennis Richie moment yet and it is a reason why cancer therapy hasn't advanced as far it could. Life sciences is in a crisis where a lab at Amgen with the best equipment money can buy could only replicate 11% of the results in 53 Nature published cancer papers.
The Life Sciences desperately needs computer scientists to learn their workflow and build the tooling for better more replicable science.
I work in biomedical research building software apps. We are grant funded with tiny teams. Every little thing that allows us to go from idea to reality helps. Python, Django, Postgres... Hell even Twitter bootstrap (we don't have time to screw with styling, but stuff needs to look professional) are all critical for us. The more stuff we can use off the shelf to solve ferociously hard biomedical data problems, the better.
Concrete example: there is a paper in Nature that just came out where some discoveries were made on the genetic causes of congenital heart defects. Our team did all the data integration work to create a resource those researchers could use to do their work. I'm proud of what we have done, but there is so much more we could be doing for them if we could only move faster.... If our tools were better. We haven't switched to using Light Table yet, but we will if it lets us do more with so few people.
I often wonder if the creators of the open source tools we use ever imagined their stuff being used the way we use it. Did the Postgres team ever think someone would try to shove 100's of millions of DNA variants of folks looking for a cause for their disease into their database? Did the JavaScript library teams think someone would be using their stuff to show radiology images to people studying hearing impairment? Did the Django team ever image someone would build a biomedical data integration framework on top of their web framework so biomedical researchers don't have to reinvent their particular wheel every time?
If you build great stuff that is useful, it will have an impact in ways you can't possibly imagine.
Boots on the ground are important. Tools are important. Ancillary tools are important. I've worked with doctors, researchers and software developers. We're all important.
Doctors solve problems that are occurring right now. They save lives right now. They're assisted by nurses, and the guy who resets the sheets on the beds. They're all important.
Tool builders are like nurses, or the guy who resets the sheets. They enable the boots on the ground to do their job better. They're important. I used to build healthcare software. It was focused around making Doctors spend less time filling out forms, so they can spend more time with patients. I have never saved any lives with software, but I've helped other people save lives with software. And in turn, the fine people at Atlassian (JIRA) helped us manage our bug reports, which helped us focus on building better software.
My girlfriend does biomedical research. She has also never saved a life with her work. She probably won't have anything remotely useful out of what she does for decades. But, decades later, she might be a small part in something that makes people slightly more likely to survive cancer. What she does is important.
Are any of these things more important than each other? I don't think so. Doctors and nurses save lives now. Hospital workers and people who build hospital software help make them more efficient. Researchers create understanding that allows whole new avenues of live saving to occur.
I don't disagree in principle, but as a fellow biomedical/hacker hybrid I'd like to point out that the notion of doctors and nurses saving lives is probably too simplistic for the purpose of this discussion. I see research as the sole enabling factor for saving lives and healing people in general. It's very important that there are people out there applying our knowledge, but it's also painfully clear that we still have a long, long way to go in giving doctors the tools necessary to actually save a patient from cancer.
We have managed to make some modest gains in life expectancy of cancer patients, but it bears repeating that there is no cure. Modern medicine likes to gloss over the fact that there is no cure for most serious diseases, sometimes the desire to finding a cure can even be ridiculed as "unnatural" by some practitioners. With a few notable exceptions, hospital doctors don't do a lot of scientific research - if they're researching at all it's mostly what I would call engineering research. Not that this isn't important, too, but the potential to actually save lives largely rests in the hands of other people, such as biomedical researchers, but also increasingly computer scientists.
Of course you're right in asserting that without implementers such as doctors and nurses there would be no lives saved. But let's de-emphasize the romantic notion of the life-saving doctor a bit, because scientific advances are really the force that makes all medical treatment possible.
I'd have to disagree with the "modest gains" in life expectancy for cancer patients. We have made some incredible progress in the last few years.
The best example is chronic myelogenous leukemia. Before Gleevec was launched, the 5 year survival rate was 30%. Now? It's into the mid-90s and basically the same as the general population.
And Gleevec isn't the only drug that has changed the natural progression of cancer. There are drugs in the pipeline that will basically "cure" other types of cancer as well.
Chronic myelogenous leukemia might be the best example because the improvement has been so drastic. I challenge you to look up historical average 5 year survival numbers for lung cancer, colo-rectal cancer, cervical cancer, or even breast cancer (where we maxed out in the mid nineties). Fact is, an actual cure is missing. Available treatment options tend to be palliative.
Best wishes to you and your family at this tough time, Chris. Hang in there.
At the risk of committing a social faux pas, I'd like to inject a little humor into this thread. Please watch this, and hopefully get a good laugh: http://www.youtube.com/watch?v=rTzO-_Yl4d0 — Now, in all fairness, by the standards outlined in the video, I don't think the accusation of irrelevance applies to Light Table! After all, it runs on devices which can print...
As someone who is doing a startup to try to develop cures for cancer, your project may not necessarily directly help mine, but somewhere along the line, there is someone who wrote an IDE that enabled tools that enabled what I'm about to do. I remember when I was younger, my dad stumped $500 for borland turbo pascal, and $1500 for MS visual C++, later. Now that there's competition for these things, it's to where I can afford one for development on a meager budget and, eventually for my children, too. Programming, in many ways directly influences the way that I think about things, and I'm incredibly glad to have learned how to do it, even if I haven't made anything of consequence (made an android app in the early days that netted me $300).
The adversity is an asset thing I completely understand. Although I was trained as a biologist/chemist, I always shied away from ideas like "curing cancer/AIDS" but when my "adoptive grandmother" passed from cancer, and a cancer drug development project fell into my lap, I took it as a sign and now my resolve is steeled. I also never imagined I would be running a company (or a nonprofit one, at that)... Yet, here I am.
It is easy to focus on the "glory" positions, but easy to forget all of the support required. For a doctor to save someone who comes in on an ambulance, there's the other staff in the hospital, the training for everyone, the tools, the work to get the right tools in the right place, the roads the ambulance drove in on, etc etc.
I talk specifically about being a doctor only because that was my personal path. My argument was generally meant to apply to anyone with more direct influence over someone's well-being, so nurses, EMTs, hospital staff, pharmacists, researchers, and everything in between could certainly be swapped in any time I used "doctor."
I recently went through this with somebody close to me. Don't forget that doctors, nurses, etc ... can't always save somebodies life, but can only prolong or make it better. You too, can make somebodies life better in many, many ways and that is as important as anything else.
I have great empathy for what you're facing. I've lost family members to cancer. It is a very unique form of helplessness in face of calamity. That said, I'm working for a genomics company, part of our mission is to understand each cancer as a unique disease so we can diagnose it correctly, leading to personalized treatment. In my personal opinion IDEs are not the rate-limiting step to curing cancer, and a better one won't meaningfully contribute. This doesn't mean what you're doing is not meaningful though!
Chris, thanks very much for sharing this story with us. It takes a lot of courage, and as someone who has been a caretaker (briefly) for a loved one before, I very much empathize by how difficult it is to run a company while doing laundry/cooking/feeding/bathing/entertaining another person--while at the same time trying to keep it together emotionally.
I hope that you and Kristie stay tenacious. All the best.
I had a similar dilemma. I taught high school in one of the most impoverished school districts in the country. I certainly felt (and still feel) that the work I did there was incredibly crucial, but I left to follow my heart and pursue a career studying music.
I went through a few months of logical conflict, trying to rationalize for my logical brain the commitment I'd made to do something for my own fulfillment, and arguable selfishness. This was made more stark by the fact that I was moving from a job that had a very immediate impact in an area of very obvious and dire need to something that could be viewed as recreational.
But eventually I realized that what drew me to music was the fact that it was one of the great constants in my life. It has enhanced my happiest moments, and it has helped my ride out some brutally difficult times in my life. It serves that same purpose for my former students. Music led me to doing my own startup, http://breakrs.com.
And, the fact is, I was leaving teaching anyway. It is by a long shot the most difficult and stressful thing I've ever done. It was a completely unsustainable lifestyle. Pouring my heart and soul into this undermanned startup--it's not even a comparison. We've had numerous failures, and only hints of success. We've had very tough pitches. None of it's comparable to how hard I had to work as a teacher and what it feels like to bomb four lessons in one day in front of an audience of cynical teenagers <i>and</i> feel as though you've failed to educate them.
This thing we do is a tremendous privilege, when it comes down to it. That's nothing to be ashamed of, but it should be recognized. It's <i>not</i> the hardest or most crucial job in the world "to disrupt the basketweaving market" or whatever each of us works on. In the real-world, nearly all of those kids I taught are de facto denied the opportunity to do what I'm doing today, with even a shade of my probability of success. That's a tremendous injustice.
However, I know that I can't spend my life tilting after windmills. I will never forget to find ways to give back and give a hand up to those who are less fortunate, but I'm going to enjoy this life by doing things that are fun and important to me. Innovating something that the improves the market for X is fun, challenging, multifaceted, highly rewarding, and important. It allows you to actualize a vision. There's nothing wrong with being proud of that.
I've experienced a lot of untimely loss in my life, but never in a prolonged way, and I know that is in many ways more difficult. My thoughts and prayers go out to you and your family.
In this case, the mother's partner is another woman, implying that the woman is in a lesbian relationship. So your joke about 'meant to say spouse' could be quite hurtful if they would actually like to be married but can't because of current marriage laws.
Not to mention that your comment simply sounds ignorant and/or homophobic. Just thought I'd clue you in to why you're getting downvoted, in case it wasn't obvious.
My boyfriend is my partner, but not my husband, though we've been around for longer than many marriages. For some reason, I don't think Chris would have had a problem saying wife were it so.
I respect the fight, but we don't all fit into the marriage binary either.
(And hey, maybe someday the two of us will be married too, heh.)
So I guess you could say he's your boyfriend. In the case of the original story you could say girlfriend or lesbian lover. Both terms are much better than partner.
"Partner" is seriously problematic because it really does deliberately evoke two profit seeking individuals in a venture, and that is not at all the basis of a marriage.
If you sent a great doctor back in time to the 15th century, she could do somewhat better than the locals (hand-washing helps a lot). But she would come nowhere near her capabilities when backed by a modern economy.
If you can make one little piece of the economy 50% more efficient, you're freeing up capital for the next highest use. In this sense, it doesn't matter that you're not directly contributing to the next cure. You're helping create a wealthier world, and a wealthier world can afford more cures.
Medicine depends on myriad materials and technologies that are affordable precisely because they're widely used in many other applications. If microprocessors were only used in IV pumps and pacemakers, they would be impractically expensive.
Even something as seemingly superficial as consumer mobile electronics is having major impact on medicine right now.