I’ve been devouring The Remedy by Thomas Goetz since it came out last week and finished it on a series of long flights this week.
It’s a lucid, accessible popular science book. It’s primarily about two men - Robert Koch and Arthur Conan Doyle - engaged in a debate over whether a tuberculosis cure was indeed a cure or not. If you’re even a little interested in the late 1800s, popular science, the origins of Sherlock Holmes, or the emergence of medicine as a science you’ll probably enjoy it.
For me though, I was most struck by the first few chapters and the remarkably clear unfolding of how certain moments in scientific time can be moments of massive and rapid change. Goetz traces how Koch, a country doctor in Germany with big dreams, integrated theoretical, methodological, and technological breakthroughs to become one of the most famous scientists in the world.
This integration of breakthroughs fascinated me. The theoretical breakthrough was germ theory, and Koch didn’t invent it. It had spent decades burbling from the fringes of science towards the mainstream but was still well on the outside. It threatened the theories of the famous, eminence-based scientific system. And it hadn’t been demonstrably proven. But it was a powerful enough theory that despite the shutout, it continued to develop, quietly, on the edges.
The methodological breakthrough was Koch’s. He figured out how to use pure cultures (the Four Postulates) to determine the cause of infectious disease. In so doing he helped cement germ theory as a cornerstone of modern science and medicine.
The technological breakthroughs laid out in the book may be my favorite part. I knew about the emergence of germ theory, I knew vaguely of the four postulates, but I had no idea of the kind of rapid, on-the-fly invention that the emergence of the culture-based methodology spurred. It is straight out of Eric Von Hippel.
The example that sticks with me from the book is such a simple one on the surface: the petri dish full of agar. But it arrived after Koch began culturing anthrax in the aqueous humor of a cow’s eye between glass, moving to gelatin on plates, moving to agar on the advice of a jam-savvy scientist’s wife, finally to round plates with upraised edges. This kind of evolution of technology to support methodology to support theory is packed onto most every page of the first few chapters and just blew me away.
I’m fairly convinced that this is a pattern we’re in the middle of right now. What struck me reading The Remedy was that I think we can identify the methods and the technologies - sequencing, causal statistical analysis, self-tracking, all the stuff that is on the bingo card of a “Big Data” conference attendee.
But I wonder what the theory is. Goetz clearly makes the point that scientific progress is only obvious in retrospect. In the moment, it’s messy, competitive, sometimes downright personally nasty (the Pasteur-Koch animosity is epic!). The methods can seem so much more obvious in the moment than the theory.
I do what I do in the belief, naive though it may be, that the breakthrough methods and technologies of the last 20 years are on the edge of allowing us to prove or disprove new theories about the causation of chronic disease, as Koch’s time did about infectious disease. And it seems obvious in retrospect that germs would emerge as the causative theory. But at the time, it wasn’t. Just like it wasn’t obvious that ulcers were caused by infection.
So what are the theories of chronic disease that are going to be embarrassingly obvious? What are even the candidates? I wonder.