Cancer and Startups

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.<p>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.<p>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.<p>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.<p>Even something as seemingly superficial as consumer mobile electronics is having major impact on medicine right now.

Beautifully written.<p>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.<p>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 <i>huge</i> 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 <i>that</i> 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 <i>always</i> 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.<p>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.<p>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.

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.<p>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.<p>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.

<i>&#62; Isn't it my moral duty to do that?</i><p>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.<p><i>&#62; Could I have saved Kristie, or if not her, others like her?</i><p>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.<p>Saving others - unlikely, unless you manage to find a cure for any cancer. There seems to be many people working on that.<p>I would say this is a battle you have &#60;0.01% of winning. In such case, the wise thing to do is not to enter in this battle.<p><i>&#62;if this is really the "right" thing to do</i><p>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.<p>Don't fight the battle, but instead, provide care and comfort to the dying person.<p><i>&#62;I'm doing this because I believe that this is the greatest contribution I can make</i><p>Good statement. You do with the cards you are dealt with. Just make sure to take the right decisions to avoid regrets.

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.<p>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.<p>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.<p>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.

(Longtime HN participant using a throwaway account.)<p>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.<p>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.<p>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 <i>is</i> helpful, up to a point. We deeply believe in our product, we know it materially improves people's lives.<p>Working more hours is not a scalable competitive advantage. We're going to succeed because we're smarter and have more guts.

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.<p>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.

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.<p>The Life Sciences desperately needs computer scientists to learn their workflow and build the tooling for better more replicable science.

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.<p>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.<p>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 <i>on top of</i> their web framework so biomedical researchers don't have to reinvent their particular wheel every time?<p>If you build great stuff that is useful, it will have an impact in ways you can't possibly imagine.

A great IDE or language can add "Force multiplication":<p><a href="http://en.wikipedia.org/wiki/Force_multiplication" rel="nofollow">http://en.wikipedia.org/wiki/Force_multiplication</a><p>Hopefully, Light Table will enable developers to many times more productive.

Beautiful Chris. Thanks for the hard work, I am proud to be a backer of light table.<p>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 <a href="http://spectrum.ieee.org/biomedical/devices/the-gene-machine-and-me" rel="nofollow">http://spectrum.ieee.org/biomedical/devices/the-gene-machine...</a>

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.<p>Doctors solve problems that are occurring <i>right now</i>. They save lives <i>right now</i>. They're assisted by nurses, and the guy who resets the sheets on the beds. They're all important.<p>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.<p>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.<p>Are any of these things more important than each other? I don't think so. Doctors and nurses save lives <i>now</i>. Hospital workers and people who build hospital software help make them <i>more efficient</i>. Researchers create understanding that allows <i>whole new avenues</i> of live saving to occur.<p>It's all important.

Best wishes to you and your family at this tough time, Chris. Hang in there.<p>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: <a href="http://www.youtube.com/watch?v=rTzO-_Yl4d0" rel="nofollow">http://www.youtube.com/watch?v=rTzO-_Yl4d0</a> — 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...

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 <i>way</i> 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).<p>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.<p>We're rooting for you.

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.

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!

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.<p>I hope that you and Kristie stay tenacious. All the best.

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

Thank you Chris. This is one of the best posts I have <i>ever</i> read.<p>I know what that doubt is like. I don't know what helping someone through terminal cancer is like - yet. Thinking of you all.

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.<p>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.<p>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, <a href="http://breakrs.com" rel="nofollow">http://breakrs.com</a>.<p>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 &#60;i&#62;and&#60;/i&#62; feel as though you've failed to educate them.<p>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 &#60;i&#62;not&#60;/i&#62; 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.<p>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.<p>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.

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

Checkout the Life Extension Foundation.

Inspiring. Thanks Chris for sharing.

Hang in there. Stay strong.

Powerful

LoL

&#62; my mother's partner was diagnosed<p>What business is this mother in? An accountancy? Perhaps you meant to say spouse?