The Butterfly Effect

According to Sharon Begley and Mary Carmichael in their Newsweek cover story Desperately Seeking Cures, a cornucopia of cures for an infinity of diseases is (or would be) available but for (a) a culture that sets the wrong incentives for academic scientists and (b) a stodgy bureaucracy that does not prioritize urgent needs. 

Well, maybe…but posing the question that way misses important points. The article has a handful of examples, but ignores the fact that literally thousands of such examples exist. Scientists, venture capitalists, government, advocacy groups all have their own priorities, with no rational way but the marketplace to choose among them.

The article focuses on today’s Holy Grail, that a single aberrant molecule—a single target—if corrected or blocked, will reverse the course of an illness. Well, maybe that, too—if, as is unlikely, the illness results from a single gene mutation. But the chronic illnesses that I know, and possibly most cancers as well, have a better analogy: their origins are like the flap of the butterfly’s wings in Brazil that sets off a tornado in Texas. Human biology and human illnesses are so complex that it is unlikely that targeting a single molecule will “cure” any but the most narrowly-defined genetic diseases.

I am not nihilistic: I do believe that “cures” will be found. My argument is that the molecular-target-found: cure-imminent concept lacks humility. The butterfly wing concept is a better model of illness. If our goal were not to find molecular targets but rather to ameliorate those symptoms that we can recognize and measure, then we might take more pride in the progress we have made and we might direct our future research toward more attainable goals.


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