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\begin{document}

\title{Thoughts on Goetz's The Remedy}



\author[1]{John Wilbanks}%
\affil[1]{DEL-FI}%


\vspace{-1em}



  
  \date{May 27, 2024}


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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.

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