Range - David Epstein Page 0,109

performing the procedure. Being told to stop using stents was like being told to forget you are an interventional cardiologist. The instinct, often well-meaning, to use interventions that seem logical but that have not been shown to help may explain the finding of a 2015 study: patients with heart failure or cardiac arrest were less likely to die if they were admitted during a national cardiology conference, when thousands of top cardiologists were away. “At large cardiology conventions, my colleagues and I have often joked that the convention center would be the safest place in the world to have a heart attack,” cardiologist Rita F. Redberg wrote. “[The conference study] turned that analysis around.”

Similarly harrowing findings are now appearing all over medicine, wherever specialties have arisen for the use of a particular tool. One of the most common orthopedic surgeries in the world involves shaving a torn meniscus—a piece of cartilage in the knee—back to its original crescent shape. A patient reports knee pain; an MRI shows a torn meniscus; naturally, a surgeon wants to fix it. When five orthopedic clinics in Finland compared the surgery with “sham surgery”—that is, surgeons took patients with knee pain and a torn meniscus to operating rooms, made incisions, faked surgeries, and sewed them back up and sent them to physical therapy—they found that sham surgery worked just as well. Most people with a torn meniscus, it turns out, don’t have any symptoms at all and will never even know. And for those who do have a torn meniscus and knee pain, the tear may have nothing to do with the pain.

Seeing small pieces of a larger jigsaw puzzle in isolation, no matter how hi-def the picture, is insufficient to grapple with humanity’s greatest challenges. We have long known the laws of thermodynamics, but struggle to predict the spread of a forest fire. We know how cells work, but can’t predict the poetry that will be written by a human made up of them. The frog’s-eye view of individual parts is not enough. A healthy ecosystem needs biodiversity.

Even now, even in endeavors that engender specialization unprecedented in history, there are beacons of breadth. Individuals who live by historian Arnold Toynbee’s words that “no tool is omnicompetent. There is no such thing as a master-key that will unlock all doors.” Rather than wielding a single tool, they have managed to collect and protect an entire toolshed, and they show the power of range in a hyperspecialized world.

CHAPTER 12

Deliberate Amateurs

JANUARY 23, 1954, was a Saturday, and Oliver Smithies was in the lab in Toronto, as usual. “Saturday morning experiments,” he called them. Nobody was around, and he felt free from the strictures of normal work. On Saturday, he didn’t have to weigh things carefully. He could take a pinch of this, a dash of that for an experiment that during the week would be considered a waste of time and equipment. He could try something that intrigued him, but that had little to do with his primary project. One needs to let the brain think about something different from its daily work, he would say. “On Saturday,” as Smithies put it, “you don’t have to be completely rational.”

Smithies worked in a lab studying insulin, and his job was to find an insulin precursor. The work was stuck, literally. The method of separating molecules so they could be studied involved running an electric current through a special type of moist paper. The molecules moved apart as they crossed the paper. But insulin just stuck to it. Smithies had heard that the local children’s hospital had tried moist starch grains instead of paper. Starch solved the stickiness problem, but would require him to cut the grains into fifty slices and analyze each one individually to find out where the molecules ended up. That would take forever, so it was a nonstarter. Then he remembered something, from when he was twelve.

Smithies grew up in the town of Halifax in England, and would watch his mother starch his father’s work shirts to make the collars firm. She dipped each shirt in gooey hot starch, and then ironed it. To help her tidy up, Smithies disposed of the starch. He noticed that when it cooled, the starch congealed into a jelly.

Smithies had a skeleton key for the building, and went around raiding supply closets for starch grains. He cooked the grains, let them cool into a gel, and tried it in place of the paper. When he applied electrical current, the