
Cancer and Startups - sentiental
http://www.chris-granger.com/2013/05/20/cancer-and-startups/
======
ef4
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.

~~~
pyre

      | she could do somewhat better than the locals
    

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).

~~~
csomar
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.

~~~
pyre
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.

------
kyro
Beautifully written.

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.

~~~
carbocation
> 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.

~~~
mbrock
There's a nice Nietzsche quote about this:

"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."

------
darkmethod
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.

~~~
bsaul
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.

------
guylhem
_> Isn't it my moral duty to do that?_

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.

~~~
rquantz
_No, there is no absolute "moral duty" to anything or anyone._

That is a very limited understanding of morality.

 _There seems to be many people working on that._

Not enough.

 _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._

By this logic no one should ever work on really hard problems.

~~~
dm2
>> 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).

~~~
toufka
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.

------
aclimatt
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.

~~~
ibdknox
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.

~~~
aclimatt
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.

~~~
Hoffenheimer
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.

------
throwaway838205
(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.

------
carterschonwald
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.

------
zmanian
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.

------
JunkDNA
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.

------
melling
A great IDE or language can add "Force multiplication":

<http://en.wikipedia.org/wiki/Force_multiplication>

Hopefully, Light Table will enable developers to many times more productive.

------
gourneau
Beautiful Chris. Thanks for the hard work, I am proud to be a backer of light
table.

If any of y'all wanna use light table to work more directly on defeating
cancer, we are looking for more hackers at Ion Torrent
[http://spectrum.ieee.org/biomedical/devices/the-gene-
machine...](http://spectrum.ieee.org/biomedical/devices/the-gene-machine-and-
me)

------
SCdF
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.

It's all important.

~~~
Udo
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.

~~~
refurb
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.

~~~
Udo
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.

------
gcv
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...

------
dnautics
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.

We're rooting for you.

------
eyeface
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.

~~~
ibdknox
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."

~~~
dtauzell
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.

------
dkural
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!

------
ebahnx
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.

------
keeptrying
Having a sick parent can make running a startup about 10 times harder. Big
props Chris. I know how hard it is.

------
porker
Thank you Chris. This is one of the best posts I have _ever_ read.

I know what that doubt is like. I don't know what helping someone through
terminal cancer is like - yet. Thinking of you all.

------
acjohnson55
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.

------
pattle
A really really powerful post. I wish you all the best, I truly mean that.

------
ffggdddd
Checkout the Life Extension Foundation.

------
dataisfun
Inspiring. Thanks Chris for sharing.

------
andrewhillman
Hang in there. Stay strong.

------
dakrisht
Powerful

------
faziol
LoL

------
13b9f227ecf0
> my mother's partner was diagnosed

What business is this mother in? An accountancy? Perhaps you meant to say
spouse?

~~~
ebiester
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.)

~~~
13b9f227ecf0
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.

