In the lab, we spend a lot of time discussing when to stop innovating. Let me explain. Innovation is the heart and soul of science. We must innovate to move forward, to keep learning. But we want to be a translational lab. Our mission is to bring something to the point where it can go out and help patients. In this context, one must decide, when is good enough, good enough? When can we take what we have and stop tinkering with it and making it better and instead move it forward to the next step. One has to decide this knowing that there will always be something potentially better, safer, more effective or more tolerable to be developed. This then becomes and ethical question. When do the potential benefits to patients outweigh the risks of moving the current technology forward. When does the delay in bringing a badly needed therapy to patients outweigh the potential of future benefits of developing the technology further.
The details matter. The answer to these questions depends in large part on the current state of the field. What are current outcomes for patients? Can the disease be managed? Are there current treatments? If current treatments are good and the disease can be managed, the bar is set much higher. In the disease I study, Huntington’s disease, the bar is relatively low. It disrupts patient’s lives, often in their prime. It slowly and progressively robs them of their independence and eventually of their lives. Particularly because of its hereditary nature, it is devastating for families and there is currently no treatment to delay the onset or alter the course of the disease. In this case you may think a treatment that would be expected to delay the onset or slow the progression of the disease might be good enough.
By nature I am a cautious person. I weigh my options carefully, avoid unnecessary risk. I have perfectionist tendencies. Perhaps more accurately, I consider myself a recovering perfectionist. I can be competitive, but when given a choice between winning and being right, I would likely choose to be right. As a scientist, these qualities can be both bad and good. I tend to overthink things, to talk myself out of experiments, to avoid risk. Once started, I find things hard to complete. There is always more that could be done. I can always do better, be better. In life as in work it is hard to know when good enough is good enough. Perhaps in life, as in work, it is good to see the question as one of risks and rewards. When does the risk of inaction become unacceptable? When does the price for achieving the extra 0.01% improvement become too high? And the answer, as in everything is, it depends.