Introducing Untold Health and The Trajectory of Discovery
In February 2020, I was wrestling with a thought about the direction of medical knowledge. Two institutes at the university I attended were re-named after pharmaceutical companies, and everyone around me seemed to be conducting either diabetes research or working within cardiology; even the ones in cardiology were somehow linking their work to diabetes - either through investigating the effects of diabetes on the heart or how diabetes medication might be able to improve the progression of heart disease and failure. The ubiquity of diabetes was stunning, and quite frankly I got a bit fed up of hearing about it - much to the dismay of my friends doing the research.
But more importantly, I also became slightly concerned about the direction of research, since it clearly couldn’t be prudent to spend so many resources on one disease group. There had to be an opportunity cost associated with pouring so many human and financial resources into such a narrow set of research directions. Why was diabetes so prevalent?
Novo Nordisk, the Danish pharmaceutical company known mostly for insulin therapies and more recently weight-loss medications (such as Wegovy™, which has received an incredible amount of hype!), seemed to be the obvious explanation. As by far the biggest pharmaceutical company in Denmark (where I happen to be), their reach is enormous. They’re officially owned by Novo Holdings, a holding company for the Novo Nordisk Foundation (the largest charitable foundation in the world), which also owns Novozymes and a whole host of other assets. Through the Foundation, they also sponsor an enormous amount of both basic and clinical research. Unsurprisingly, however, their largest research area is metabolic diseases, of which diabetes is front and center. The “Novo effect” certainly isn’t the only reason for this skew towards diabetes, but it’s by far the most tangible. Their cultural reach is enormous.
While the connection is rather obvious, it got me thinking about what other factors play a role in steering the direction of research, setting me on a two-year long path that leads us into the present day, where I can finally share that I’ve written The Trajectory of Discovery.
The trajectory of what?
The Trajectory of Discovery is a book about what determines the rate and direction of medical progress, and will be officially released in May by Cambridge University Press (CUP). It’s available to pre-order on the CUP website or on Bookshop.org/Amazon/wherever you get your books.
So what’s it really about? Here’s the official blurb for the book:
Medical research works in trajectories. Scientists and researchers must choose to pursue certain scientific pathways and omit others, limited by resources, attention, and time. The trajectory of medical progress is therefore characterised by two crucial characteristics: rate and direction. These two components form the foundation for this book - what are the forces that determine the rate and direction of progress in medicine? This book brings together the worlds of scientific policy, economics, sociology, philosophy, and innovation to describe why the world of medical research looks the way it does. The book also addresses fundamental contemporary issues in medicine, how they influence progress, and how we might improve medical research going forward. The contemporary issues discussed include: flawed incentive structures, a concentration of power and resources among few actors and disease groups, the potential distortionary effects of lobbying by different scientific actors, and missing novelty in drug development.
On a more fundamental level, I see The Trajectory of Discovery as a contribution to the ongoing and larger discussion about how we can improve science for the greater good. In many ways, it is an offshoot of progress studies, which is concerned with what drives discoveries and inventions. The Trajectory of Discovery builds on this spirit, albeit with a more explicit focus on medical research.
The intention of the book is not to provide an encyclopaedic collection of all the factors that influence the rate and direction of progress, but rather to serve as an introduction to a way of thinking about medical progress that builds on the ideas of progress studies in the current age. It’s written to convince doctors and other healthcare professionals that these thoughts are important - not least because we spend our lives working to improve the lives of patients.
Wait… but what about Untold Health?
Untold Health was and is a podcast I started in 2019 to investigate areas of health that are significant but overlooked. It led me to investigate topics spanning from HIV in Ukraine to the role of design in health. All previous episodes are already available here on the Substack or on Apple Podcasts/Spotify.
While it’s been on a hiatus, this Substack is a revival of Untold Health - both as a podcast but also as a written reflection on untold health topics. These podcasts and essays might include discussions about topics that didn’t make the book, funny historical quirks in healthcare, and perhaps some philosophical reflections on health more broadly. This dual approach hopefully provides some variety for you, the reader/listener, but also allows me to experiment with some different topics and formats.
Concretely, I’ll be aiming to post at least one written essay or podcast episode (with transcription) a month, and I hope to get others to share their thoughts on the Untold Health Substack too!
Anyways, I hope you’ll sign up to the newsletter - and I look forward to sharing some fascinating untold health stories in the near future!
/Mark