Ways of Seeing: perspectives on gaining perspective

Unpacking the opportunity embedded in the adjacent possible, captured so neatly in?Steven Johnson’s?list of?6 kinds of less tangible innovation, let’s start with the first.

Ways of seeing

Johnson summarises some of the examples given in his book - where ideas, technologies or inventions from often-unrelated fields were the foundations of a new idea:

Microscopes and medical imaging technology gave us a direct look at some of the pathogens and rogue cells that were killing us, which helped us dream up new ways of fighting back against them. But so did John Snow’s map of the Broad Street outbreak; so did the ring vaccination approach that William Foege invented on the fly in Liberia. Seeing the pattern that outbreaks took geographically—the bird’s-eye view—turned out to be just as important as the tight focus of the microscopic lens.

Seeing things that were there, but smaller than we’d been able to resolve, or mapping against geography, or the simple act of noticing, are all great demonstrations that seeing isn’t the same as looking.?

We use a lot of words in pharma to describe ‘seeing’, some of which map directly (insight, observations) or we even apply metaphors such as ‘landscape’ or map to help visualise collections of facts of assumptions. We chart data to make it easier to share and understand - to help us see it collectively.

But innovation can come from seeing differently.

First of all, you have to want to. I covered some of this a while ago in?Seeing differently, exploring the wonderful world of the ‘magic mirror’… but it’s a non-obvious insight that we’d want to challenge what we’re seeing, to understand if it represents not just truth, but the whole truth, and perhaps to understand other perspectives. My own quote, ‘without a plan, 10 can see no further than one’ is based on that idea: we’re not just relying on others' eyes, but their vantage point and their experience - their ability to see, interpret and understand, as well as their eyesight.

I always loved the Charles Kuralt quote:?‘Thanks to the Interstate Highway System, it is now possible to travel across the country from coast to coast without seeing anything.’?In essence, it’s possible to do what we’re doing faster, and more efficiently, but completely miss the point. We might see our approach to phase I or ‘translational’ medicine this way - hurtling through at 65mph with only road ahead and behind. We know we’re getting somewhere, but we don’t know what we could have otherwise seen.

Certainly our tools for seeing are unrecognisable from the telescopes and microscopes of Zacharias Janssen and Galileo Galilei: MRI, CT, radiography, ultrasound, electron microscopy, crystallography… But we know their limitations, too.

We have largely relied on humans to do our seeing, but now we can have machines do it for us - certainly at a scale that would be impossible, or at a level of reliability, otherwise. That can apply to images, for sure, but also they can see patterns in data that we could not - and it is critical for us to understand what they’re seeing and what it means, but also what they’re?not?seeing and why. If we know how they like to see, we can give them more to look at - there remains a risk that we don’t take that opportunity to harness their power, and keep them looking backwards instead of forwards. We’re starving some of our best AI with data collected following processes laid down decades ago, datasets that were imagined for humans. We have designed a system to collect data that humans can interpret, when we know that there are algorithms that could unlock petabytes more…

Are proteins sequences of amino acids, or is there something in the folding? Is it just physics and chemistry, or does biology have something to say? Can we completely understand a cell once we can see its DNA sequence? Is that true if it’s a stem cell or a skin cell? Seeing DNA as static low-resolution images meant its discovery as a dynamic molecule took longer to achieve.

When we see patients, do we see them as a whole or as a number? Is their tumour homogenous? Does it matter where in the body it is? Do we see it as a static or dynamic system? Does the biopsy that we can see represent the tumour it came from?

It’s lore now that the ways we use to ‘see’ the response of a cancer drug in a patient failed the immuno-oncology pioneers - RECIST criteria, scanning a patient in 2 dimensions, we expect to see a tumour shrink when we apply anti-cancer drugs. So a tumour that seemingly is ‘growing’ in size must show the drug’s not working? Not if the drugs are recruiting immune cells and more to the fight… We could ‘see’ one thing, but not what mattered. Similarly, it took someone to?notice?that tumours in real patients were hot, and not the lifeless grey collection of cells in the dish post-surgery, for angiogenesis to become a cornerstone of therapy.

The precision of naming takes away from the uniqueness of seeing.?Pierre Bonnard

Do we see my blood glucose levels via a once-per-day finger prick, through latent evaluation of HbA1c or via continuous glucose measurement? Do we see my brain’s amyloid, my circulating tumour cells, my atherosclerosis? We may suspect they’re there, but don’t go looking too often, partly because we’ve done so reactively, post-symptomatically. How do we ‘see’ things working as they should??

Asymmetry could mean we see different things, or that we see the same thing differently. If we see the same thing differently, how do we know who’s right??

If we’re going to look for asymmetry in how we learn, we will need to be looking for how to see, and what to look for. Like Gloria Swanson in the quote below, many pharma companies are looking out the same window…

My mother and I could always look out the same window without ever seeing the same thing.?Gloria Swanson

Vision is the art of seeing what is invisible to others.?Jonathan Swift

…so the question becomes about empowering us to see both what they see, and what they don’t…

While many in pharma focus on the first part of the Schopenhauer quote, finding ways to ‘drug the undruggable’ or applying material science, delivery science and more to a task, it’s possible that the next wave of innovation comes from seeing things no-one else has thought of. Inventing new ways to ‘see’ may reveal ‘only’ different perspectives on what we have now. But it might not. The path may be more oblique, but seeing targets no-one else can see always leads to something…

Talent hits a target no one else can hit; Genius hits a target no one else can see.?Arthur Schopenhauer