Ask not why would you work in biology, but rather: why wouldn't you?

1.9k words, 9 minutes reading time

There’s a lot of essays that are implicitly centered around convincing people to work in biology. One consistent theme amongst them is that they all focus on how irresistibly interesting the whole subject is. Isn’t it fascinating that our mitochondria are potentially an endosymbiotic phenomenon that occurred millions of years ago? Isn’t it fascinating that the regulation of your genome can change throughout your life? Isn’t it fascinating that slime molds can solve mazes without neurons? Come and learn more about this strange and curious field!

Yes, it is all quite fascinating, and I do appreciate everyone writing about it all. But I’ll be honest with you: that reasoning never quite did it for me. Lots of things in the world are fascinating, a great deal of them easier to do and more profitable than biology is. Biology is one of those troubling fields where the economics end up mattering a great deal more than the actual science, and while there are biotech startups that are both highly profitable and save lives, there are other, much more frightening cases. Like the gene therapy company Bluebird Bio spending 30~ years doing R&D, getting 3 drugs approved, and then being acquired for a mere $30 million. Given situations like that, many talented people decide, very rationally, to go spend their precious one life working on something else.

But I’d like to offer a different take on the matter. Yes, biology is very interesting, yes, biology is very hard to do well. Yet, it remains the only field that could do something of the utmost importance: prevent a urinary catheter from being shunted inside you in the upcoming future.

Being catheterized is not a big deal. It happens to literally tens of millions of people every single year. There is nothing even mildly unique about the whole experience. And, you know, it may be some matter of privilege that you ever feel a catheter inside of you; the financially marginalized will simply soil themselves or die a very painful death from sepsis.

But when you are catheterized for the first time—since, make no mistake, there is a very high chance you will be if you hope to die of old age—you’ll almost certainly feel a sense of intense wrongness that it happens at all. The whole procedure is a few moments of blunt violence, invasiveness, that feels completely out of place in an age where we can edit genomes and send probes beyond the solar system. There may be times where you’ll be able to protect yourself from the vile mixture of pain and discomfort via general anesthesia, but a fairly high number of people undergo (repeated!) catheterization awake and aware, often gathering a slew of infections along the way. This is made far worse by the fact that the most likely time you are catheterized will be during your twilight years, when your brain has turned to soup and you’ve forgotten who your parents are and who you are and what this painful tube is doing in your urethra. If you aren’t aware of how urinary catheters work, there is a deflated balloon at the end of it, blown up once the tube is inside you. This balloon keeps the whole system uncomfortably stuck inside your bladder. So, you can fill in the details on how much violence a brain-damaged person can do to themselves in a position like this by simply yanking out the foreign material.

Optimizing for not having a urinary catheter being placed into you is quite a lofty goal. Are there any alternatives on the table? Not practical ones. Diapers don’t work if the entire bladder itself is dysfunctional, suprapubic tubes require making a hole into the bladder (and can also be torn out), and nerve stimulation devices require expensive, invasive surgery. And none of them will be relied upon for routine cases, where catheterization is the fastest, most reliable solution that exists. You won’t get the gentle alternatives because you won’t be in a position to ask for them. You’ll be post-operative, or delirious, or comatose, or simply too old and confused to advocate for something better.

This is an uncomfortable subject to discuss. But I think it’s worth level-setting with one another. Urinary catheterization is but one of the dozens of little procedures that both contributes to the nauseating amount of ambient human suffering that repeats over and over and over again across the entire medical system and is reasonably common enough that it will likely be inflicted upon you one day. And if catheterization doesn’t seem so bad, there are a range of other awful things that, statistically speaking, a reader has a decent chance of undergoing at some point: feeding tubes, pap smears, mechanical ventilation, and repeated colonoscopies are all candidates.

Moreover, keep in mind that all these are simply the solutions to help prevent something far more grotesque and painful from occurring! Worse things exist—cancer, Alzheimer’s, Crohn’s—but those have been talked about to death and feel a great deal more abstract than the relatively routine, but barbaric, medical procedures that occur millions of times per year.

How could this not be your life goal to work on? To reduce how awful maladies, and the awful solutions to those maladies, are? What else is there really? Better prediction markets? What are we talking about?

To be fair, most people go through their first few decades of life not completely cognizant how terrible modern medicine can be. But at some point you surely have to understand that you have been, thus far, lucky enough to have spent your entire life on the good side of medicine. In a very nice room, one in which every disease, condition, or malady had a very smart clinician on staff to immediately administer the cure. But one day, you’ll one day be shown glimpses of a far worse room, the bad side of medicine, ushered into an area of healthcare where nobody actually understands what is going on.

What causes people’s first glimpses into the bad room is heterogeneous. For some people, it will be the earliest signs of schizophrenia. For others, it will be metastatic lung cancer. For still others, it will be something stupid, something unbelievably stupid, like having a leg amputated because you scratched yourself on the wrong rock and now that wound has developed necrotizing fasciitis and is quickly dissolving the surrounding flesh. If you are lucky, you get to soon leave that room, clawing your way back to normality. But someday, you will be stuck in the bad room, forever, nobody ever knowing quite what to do with you ever again.

You see this realization a lot. On Twitter, I have noted at least three cases of a very smart person, who works in something largely useless outside of The Market, suddenly falling prey—through no fault of their own!—to some terrible, deeply understudied disease. Then they bemoan on social media how terrible modern medicine is, and how no doctor knows what is actually going on. I empathize! But they never take that next logical step, to try to help solve the set of problems they just suddenly realized is perhaps the only set of problems that actually matter. During these moments, I wish I could reach out through my screen to shake them by the shoulders and tell them to stop complaining and get to work. Because, in truth, the problem they are facing today is just the tip of the iceberg. Their eyes are slowly decaying, and that if they manage to hit fifty, there is a one-in-ten chance that there will be a creaking, incurable black hole in the middle of their sight, expanding day after day. Think! Think! Do something about it!

I appreciate that many fields also demand this level of obedience to the ‘cause’, the same installation of ‘this is the only thing that matters!’. The energy, climate change, and artificial-intelligence sectors have similar do-or-die mission statements. But you know the main difference between those fields and biology?

In every other game, you can at least pretend the losers are going to be someone else, somewhere else in the world, happening to some poor schmuck who didn’t have your money or your foresight or your connections to do the Obviously Correct Thing. Instead, people hope to be a winner. A robot in my house to do my laundry, a plane that gets me from San Francisco to New York City in only an hour, an infinite movie generator so I can turn all my inner thoughts into reality. Wow! Capital-A Abundance beyond my wildest dreams! This is all well and good, but the unfortunate reality of the situation is that you will be a loser, an explicit loser, guaranteed to be a loser, in one specific game: biology. You will not escape being the butt of the joke here, because it will be you that betrays you, not the you who is reading this essay, but you, the you that cannot think, the you that has been shoddily shaped by the last several eons of evolution. Yes, others will also have their time underneath this harsh spotlight, but you will see your day in it too.

My pitch for working in biology is that you will be working to either prevent, or at the very least alleviate, the inevitable moment that Mother Nature decides to extract a pound of flesh from you, giggling and gnashing you between her teeth like a cat plays with a baby mouse. Because it will happen! It may happen tomorrow, it may happen twenty years from now, maybe it’s already happened. Either way, the flesh taking is only going to accelerate the more time you spend shuffling around this world.

Yes, things outside of biology are important too. Optimized supply chains matter, good marketing matters, and accurate securities risk assessments matter. Industries work together in weird ways. The people working on better short-form video and payroll startups and FAANGs are part of an economic engine that generates the immense taxable wealth required to fund the NIH grants. I know that the world runs on invisible glue.

Still, I can’t help but think that people’s priorities are enormously out of touch with what will actually matter most to their future selves. It feels as if people seem to have this mental model where medical progress simply happens. Like there’s some natural law of the universe that says “treatments improve by X% per year” and we’re all just passengers with a dumb grin on this predetermined trajectory. They see headlines about better FDA guidelines or CRISPR or immunotherapy or AI-accelerated protein folding and think, “Great, the authorities got it covered. By the time I need it, they’ll have figured it out.”. But that’s not how any of this works! Nobody has it covered! Medical progress happens because specific people chose to work on specific problems instead of doing something else with their finite time on Earth.

A reasonably large fraction of the humanity seems to have considered this, and simply elected to avert their eyes from the whole unsightly matter. Behind closed doors, they have mutually agreed with one another that they actually live in a different reality, one in which they actually are something divine, something incorruptible, like light or vapor, cast in marble, permanent and perfect. The future, they have decided, will not come for me. I will stay pure. I will stay untouched. It is a mantra they repeat to themselves when they wake up and when they go to bed. Maybe they even start to believe it. It is the only explanation I can think of. Because how else could they go on about their day? How else could they ignore what awaits them?