This week’s research workload saw us more engaged than usual with inscrutably complex systems and the tendency of experts to bluster past their mysterious aspects. No, I am not referring to the oh, so, au courant question of Climate Change, though it is a mystery indeed how when all those generators of hot air and bad gas congregate in the Nordic regions, so much of North America is visited by record breaking cold. (Could it be a somehow endothermic extinguishment of the celebrity star power of a certain professional golfer/lothario?) This week has been very much about trying to get to the bottom of what drives demand for a promising new medical device that has been developed by one of my companies, which has meant trying to learn all I can about how the body responds to trauma. It is truly amazing how, via what is called the sympathetic nervous system, our bodies somehow “know” to respond to threats. We understand this in terms of “stress”, which triggers responses (adrenaline, endorphins, faster pulse, being “in the zone”, etc.) that facilitate fighting back and otherwise coping (“eustress”), but past a certain threshold render us less effective (muscle tension, excessive perspiration, “choking”). When the body experiences trauma that it somehow deems life threatening, this same sub-system starts down a pathway that is initially manifested by what we call shock. This mechanism seems to start out as a way of enhancing survival. For example, blood is restricted from the extremities so that it might concentrate on the brain and heart, which are most susceptible to damage in the event of oxygen deficit. However, if this chain of events persists long enough, it cascades into things like S.I.R.S (systemic inflammatory response syndrome), sepsis (S.I.R.S + a pathogen) and multiple organ dysfunction syndrome (MODS), hallmarks all of what despite all of our progress remains pretty much a path of no return. I cannot help but wonder, when I consider the lot of that vast sweep of humanity that did not exist on this apex of technologically-rendered ease and comfort that we think of as normal, if perhaps this is a system seemingly designed to hasten death and make it less difficult (akin to how shock can shut down the pain response to the sudden loss of a limb) once a certain point has been passed.
In the process of learning not only about this marvelous system and how our understanding of it has evolved in recent years, but also how clinicians and other practitioners respond to evolving knowledge, I could not help but see the similarities that arise in any field of inquiry where there is complexity shrouded in mystery. (Perhaps we should define mystery as a way of describing that part of a field of study for which our tools of inquiry remain inadequate, or perhaps do not exist at all.) The ways we go about trying to understand the system that is human physiology are not unlike how we address similarly complex and mysterious systems like climate, the economy, or the enterprises which comprise the productive portion of an economy (or the government entities which comprise the non-productive portions). In any case, we have lots of data derived from observable phenomena and subject to timely verification, but much of what we like and need to know is shrouded in mystery. In these cases, we rely on indicators where the connection between the observed phenomena and the functioning of the organism is plausible but not assured. Sometimes we find indicators that seem to have predictive value (“leading”). More typically, we get lagging indicators, which obviously are not much help in dealing with contemporaneous threats to the system, but do help us learn and so be better prepared for the future.
With this in mind, the old joke about the drunk looking for his keys under the lamp post (“because the light is better”) comes to mind. This joke is a classic because it connects with something very real in the human condition. We go where the light is, with the indicators we have and are used to. The passage of time invariably brings up new ways of looking at things, but the uptake is way slower than an idealized understanding of ‘the pursuit of knowledge” would expect. Medical practitioners understand the mysteries of physiology which they face each day with the accepted wisdom they “grew up with”. Experts in all fields find themselves similarly stuck. To the degree that reputations, academic sinecures and other forms of financial security are tied to a certain interpretation of a field of inquiry whose understanding is hindered (if not foreclosed) by mystery, resistance to reinterpretation is all the more likely to occur.
I would like to think that my experiences as an investor have provided something of an antidote to this. It is, after all, about acting on the courage of one’s convictions with respect to an ultimately inscrutable future. The Market is pretty good at instilling humility, at teaching us, if we are willing to absorb the lesson, the consequences of being dogmatic about mere data, especially when we have confected some elegant hypothesis that ends up almost but not quite bullet-proof. Spare me the pride of authorship if it psychologically locks me into an eventual capital loss! (In the aftermath of that avalanche of humility that was the Market a year ago, it was a real treat to read Mr. Buffett’s interview with the WSJ about his experience, to be reminded that we weren’t the only ones experiencing stress bordering on shock!)
Such humility seems to be lacking in fields where there is nothing like the Market doling out its corrective feedback. Indeed, any subject that relies heavily on indirect measures of what happened before there was anyone measuring is probably going to end up overrun by reckless speculation. I suspect this is a problem in any number of disciplines (paleontology, cosmology, etc.) but is especially in play in what we call climate sciences. Here, with the Climategate scandal, we have been treated to an illustration of exactly why “appeal to authority” is one of the classic logical fallacies. Scientists are human (though not all “scientists” are really scientists in the sense that they actually use that methodological set of tools that is science as classically understood). We should not be surprised to learn that there are scientists (even in the real sense) who are pretentiously and yet falsely “objective” in much the same manner that we find clergy whose facade of “holiness” turns out to be an instrument of deceit. (For some reason, something in us tends to want to hold the clergyman to a higher standard. Mysterious, no?)
Back to where my research goes on, the path that took me into the mysteries of physiology is pointing in the direction of what just could be, from the perspective of picking stocks, my biggest winner ever. The device in question appears likely to be able to replace lagging and difficult-to-do indicators of shock with something of a leading indicator (i.e., hypoperfusion of oxygen in the microcirculation as opposed to arterial or venous) of shock, or at least early enough to prompt a more timely intervention aimed at keeping the patient’s system from starting down the aforementioned path of no return. It has also been found to be useful in cutting down the likelihood of over-resuscitation, which is both expensive and damaging. In a venue where each hour of delay in recognizing the onset of sepsis (the #2 killer of the elderly) increases the likelihood of mortality by 7%, a simple to operate, noninvasive early warning would seem to be a real game changer. The financial implications of this are staggering, and will be the subject of much work by High Road Value Research in the year ahead. Stay tuned.
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