Change is closely related to learning new knowledge

By: Dr. George Spaeth

Change is closely related to learning new knowledge and then acting differently on the basis of knowing something not known before. “Knowledge is the wing wherewith we fly to heaven.” (Shakespeare) Change also occurs as a result of randomness – or seeming randomness. Consider the following possibility: On my way to work another commuter rushing to “make the light” crashes into the driver’s side of my car, crushing me, killing me, and altering not just my life but those of others. That “change” may not have been totally random, but surely events occur that appear to be beyond our control. It seems reasonable to believe that change is more likely to be what we hope for when we act in a way designed to lead to the desired outcome than when we rely solely on chance. Examples can quickly be given where an action intended to lead to one outcome resulted in an unintended result. However, most of us run our lives – to the extent that any of us can do that – by considering what we want to have or where we want to go or become or do and then acting in a way we consider will move us in that direction.

One of the synonyms for knowledge is “awareness.” Cells have awareness, in the sense of ‘knowing’ what to do and how to respond in order to survive. Cells, organisms, and groups that have more awareness of how to survive are likely to do so better than those with less knowledge. This is true, however, only if that understanding is activated, is acted upon.

Both knowing and acting, then, are needed to move towards a desired outcome. “Heaven” may be the goal, but we get there only by having a wing on which to fly. Development of desired new knowledge then is a way to reach or, at any rate, move towards a desired goal. The following comments are centered on medical research, particularly that related to the eye and the visual system, but if valid they probably apply to other types and areas of knowledge acquisition, that is, to research in general.

Who or what determines what new knowledge is developed, which aspects of reality are seen for the first time, what intangible ideas are turned into tangible realities? Sincere inexperienced investigators often think of a question they want to answer. For example, they learn – (new knowledge to them) that one of the major reasons people with chronic disease get worse is because they don’t do what is known to be of benefit to them (knowledge that has been around for years, but the awareness of which is still not widespread). So they say to themselves, “How can I develop new knowledge about that?” They speak to an experienced investigator who says, “Because it is difficult and expensive to change people’s behavior, figure out how a drop can be designed that will have an extremely long duration of action so that it only needs to be administered once every two years?” or “Find out why do some people take their eye drops and other people do not take their eye drops?” It is not likely the experienced investigator will say, “How can people who don’t take their drops be changed so they do take them?” Students think of the question they want to answer, not about how to answer it or whether it “can” be answered. (One of the joys of working with young people, college students especially, is they usually ask questions they believe are worthy of being asked, which is not only stimulating, but also an unpleasant, but welcome thorn reminding me that they are asking the right questions!) In contrast, the experienced investigator considers: 1) Will there be funding for that study? 2) Can the question be answered using available methodology? 3) Does the study fit into my (my department’s) plan? 4) Can we produce a paper that will be publishable? (Political correctness, fashion, what editors are interested in publishing are always issues to consider.)

From where does funding come? Industry, entrepreneurs, government, not-for-profits, foundations and philanthropists. Industry want to sponsor a study that will increase profit margin (merely accruing the good will of those who use their products can help). Entrepreneurs love the excitement of product development itself but without a potential pot of gold at the end of the rainbow, they are not likely to stand in the rain. Government (including the National Institutes of Health and the Centers for Disease Control) MUST consider whether the study will be defensible to the tax payer. Not-for-profits always have criteria for acceptable funding projects (these criteria are usually established by the giver of the funds). Foundations tend to be interested only in narrow areas that are related to the giver or the giver’s family. And philanthropists have their own personal agendas, among which is gratitude to a particular person or institution. Except for those who are independently wealthy, or who are willing to go into debt, then, what gets studied depends on what can get funded. This system does not encourage creativity, does not reward the “crazy ideas” that are in fact the breakthroughs that lead to real change, unless the person can link up with an entrepreneur or wealthy philanthropist. Dionysians are not likely to be looked on favorably by department heads or established, responsible funding sources because most crazy ideas are indeed that, crazy ideas from crackpots. The conjunction of forces that lived in and surrounded Steve Jobs is extraordinarily rare. Routine, Apollonian research is also important, but often merely designed to “pay the bills,” the bills of the investigator, the department, or the funding source.

What are the studies that really need to be done? Done for what purpose? Done to make the world more likely to survive gracefully. They mostly relate to one subject: human behavior. How can humans live in a way that will be most likely to their being as healthy as they can and creating societies that encourage healthy and sustainability for all? How can they care for themselves best? Health does not mean preservation of sight or absence of heart disease. It means a condition in which one feels well and relates well to his or her surroundings, recognizing that the latter aspect is essential to achieving the former. The first step is to ask the big question. The second is to get a valid answer – not one desired by industry or an entrepreneur or an agency or a philanthropist, but one that is a true uncovering of hidden reality, one that increases awareness of what really exists. Is this knowledge for knowledge sake? No, it is knowledge for the sake of making choices, of acting, of using our wings to fly to the world we want, to heaven.

The student mentioned earlier is disturbed that people don’t care for themselves properly. The successful mentor points them in the direction of fundable studies. The troublesome mentor says, “You are asking, ‘How do you change human behavior?’ That is a question worth answering; let’s work on it, but recognize that considering that issue won’t get you into an ophthalmology residency training program, and you will probably fail to find the outcome which you search. But, you will be using your wings to try to get to heaven.”

Earlier in this report it said “Sincere inexperienced investigators. . .” and “they usually ask questions. . .” Another of the great joys of working at a place such as Wills is that a number of people want to come work here. Among those are some who want to strengthen their curriculum vitae by having “done research.” They ask questions to become visible and to seem interested or even knowledgeable. I try to give them what they need and help them within their limited scope of vision. But, there are also others who catch fire, and who recognize that the only hope for themselves as well as the world is to know more than we know now, know more about reality, and then act on the basis of that knowledge, to think and act differently than we are thinking and acting now. But not just differently: To think and act realistically, bravely, and courageous, fully aware that changing the status quo is always threatening to most, difficult at best, but the only hope for us and others.

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The Glaucoma Service Foundation’s mission is to preserve or enhance the health of all people with glaucoma and to provide a model of medical care by supporting the educational and research efforts of the physicians on the Wills Eye Institute Glaucoma Service, the largest glaucoma diagnosis and treatment center in the country.

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