Medicine: an engineer's perspective

Practicing physicians are much like auto mechanics. Research physicians are much like "tinkerers" who sit in the garage and take apart anything they can get their hands on.

This is not to be taken as demeaning! In fact, it should be seen as a compliment!!

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As a doc in the clinic, working with everyday patients, one must run some tests, figure out what is probably wrong, and follow standard procedures to fix it. Sometimes you need new brakes, other times your transmission is blown. Sometimes the same symptoms may result from several different, unrelated problems. It is the doctor's job to figure out what is causing it and use an appropriate solution.

Research doctors look at black boxes. Very engineering: "The Black Box." In ancient civilizations, like Greece and Rome and China, the thinkers and doctors had little idea about the inner workings of the human body, virtually no knowledge of biochemistry, and couldn't even dream about cellular and subcellular mechanisms. They cut open cadavers and criminals to learn about gross anatomy, what was connected where, which parts could do this-or-that function. A lot of guesswork. They didn't need to understand the mechanism of muscular contraction--in fact, until the 1800s it was thought that there was some sort of fluid that caused body movement--in order to see the effects of body position when certain muscles contracted. They viewed what they didn't know as a black box.

As medicine developed into the modern era, there were and are still countless black boxes. Most of these are at much lower levels than before: What causes a membrane channel protein to fold properly? We say "thermodynamics" or "chaperone proteins," but to a large degree we don't fully grasp the mechanisms, for if we did then there would be no protein-folding diseases. What is the signal that tells a cancer cell to metastasize? Again, we see correlated factors, but the underlying cause and mechanism are still hazy, and therein lies the cure.

When I want to know how my vacuum cleaner works, I'll disassemble it. I start by taking off the cover, opening the case. I see belts and gears and motors. I see cables and cords and wires. I take out the motor and disassemble that as well, going another level down to a smaller black box. The more pieces I take apart, the more I see what is going on inside. But as for what really drives it, I need to "take it on faith" the explanation about how electricity works. I can't take apart the black box of electrons in a wire to see it myself.

I applaud you, research physicians, for disassembling each level of black boxes, figuring out the micro mechanisms that cause the macro results we see as symptoms. You are truly reverse-engineering the human body.