How to Solve Big Problems: Lessons Learned From Cancer Scientists

In late November of 1991, a three-year-old girl was diagnosed with leukemia. There was a 30 percent chance she would die.

In the coming months, she would receive a long list of chemotherapy drugs: 6MP, asparaginase, methotrexate, prednisone, and vincrinstine. The miracle was not only that these drugs could potentially cure her, but that they existed at all.

In his fantastic book, The Emperor of All Maladies, author and physician Sid Mukherjee explains the history of cancer and how brilliant physicians and scientists finally began to discover cures for the disease.

You see, for many years, doctors and scientists dreamed of finding a single cure for all cancers. They searched for a radical surgery or a miracle drug that could cure everything from breast cancer to leukemia to prostate cancer. According to Mukherjee, however, breakthroughs finally came when scientists stopped trying to tackle this large scale problem and made the problem smaller.

The first breakthrough came when Sidney Farber, now known as the Father of Modern Chemotheraphy, decided to focus exclusively on treating leukemia. He was one of the first physicians to dedicate his efforts solely to a single type of cancer and by narrowing his focus Farber was able to make significant progress against this single condition.

Eventually, the drugs and treatments Farber uncovered for leukemia led to new solutions for other cancers. By focusing on one tiny vertical, Farber uncovered answers that could be used to treat the larger problem. As Mukherjee put it, “[By] focusing microscopically on a single disease, one could extrapolate into the entire universe of diseases.” [1]

This central idea, that solving large complex problems is often accomplished by first attacking smaller micro-problems, is useful not just for cancer treatments, but for life in general.

How to Solve Complex Problems

The main lesson mentioned above is simple: When you’re facing a complex problem or trying to do something bold, start with a smaller version of the larger problem. Focus exclusively on that small problem and solve it. Use the answers to this small issue to expand your knowledge of the larger issue. Repeat.

If you take a look around, you can see this pattern playing out everywhere.

For example, consider Amazon. The company started by selling books. Once they mastered the online purchase and delivery process of books, they moved on to other products. Today, they sell just about everything.

Amazon could have started by trying to solve the big problem: how do we master digital commerce? Instead, they started with a narrow focus and expanded from there. It has been proven many times that this small-to-large approach works well for businesses, and I think it can be very useful for our personal goals as well.

The Idea in Practice

Let’s consider a few examples of how we might put this idea into practice.

Creativity. BIG PROBLEM: How do I become more creative?

Small solution: If you want to become a good photographer, then start small. Learn how to take a really good picture of a chair. Once you can take a fantastic picture of a chair, use those principles — light, composition, lines, curves — to take better pictures of everything.

Exercise. BIG PROBLEM: How can I start exercising consistently?

Small solution: If you can’t crack the fitness code and struggle to exercise consistently, then forget about every other exercise and just learn how to do one pushup. Use the steps I describe here to increase your number slowly. Stick with that one exercise for days, weeks, months. Once you prove to yourself that you can solve this small problem, use the lessons you learn to become more consistent at exercise in general.

Nutrition. BIG PROBLEM: How can I eat healthy each day?

Small solution: Want to improve your nutrition? Maybe you should ignore switching to a new diet at first. You don’t need to change all of your food habits at once. You could start by solving a very small segment of the problem: eat one vegetable today. Master that. Do it for four weeks. Or longer. Take what you learn about being consistent with that one thing and apply it to adding a second healthy food.

And finally…

Narrowing your focus is a mental model that you can apply whenever you want to start a new behavior or take on a new project that seems too big or overwhelming or complex to handle. It is a filter you can run larger problems through to approach issues from a more useful place.

So, how do you solve big problems? Start with a smaller one.

P.S.

That three-year-old girl who was diagnosed with leukemia and treated with the drugs that were discovered through the Father of Chemotherapy, Sidney Farber? It was my sister. More than 20 years later, she is alive and well.

I’m very glad Farber decided to start small.

Click here to leave a comment.

James Clear writes about using behavioral science to master your habits and improve your mental and physical health. If you enjoyed this article, join his free newsletter.

Sources

  1. The Emperor of All Maladies by Sid Mukherjee, pg. 159

85 Comments

  1. Once again, Mr. Clear translates the fundamentals so clearly! What would you say is the small solution to stop smoking?

    • Hi Martin,

      A doctor I do transcription for says the most successful of all methods of quitting smoking is going “cold turkey.” It only takes 2 weeks to get rid of the physical addiction. The hardest part is the psychological battle.

      I’m not James, obviously, but I think the small solution is what he has described in another article he wrote about using the X’s in a chain on your calendar. In other words, just stop smoking for today. Put an X on your calendar. Then do it again tomorrow. Try not to break the chain of Xs.

      There’s a whole lot more to breaking that habit, but that’s part of it that I know from typing it up, and from people I know who quit. My step-uncle smoked for several decades. When he decided to quit, he threw his cigarettes away and never smoked again.

      • Nice piece of writing James, thank you. And as a former leukaemia patient myself, I’m delighted to hear of your sister’s story.

      • I was 3.5 packs per day for about 5 years. I was addicted in every way possible. Tried quitting several times and failed. Then I tried something I’ve never heard of anyone else doing before or since. It’s been over 10 years since I’ve smoked so I guess it worked. This is what did it for me.

        When the urge to have a cigarette got so strong I promised myself I could have one after I got through running. I had to run long enough to get winded. At over 3 packs per day that took about 2-3 minutes tops. Funny thing when you start running and you are gasping for air the urge for a cigarette disappears. I noticed that it did not return for a while after I stopped running.

        Gradually the urge to smoke took longer between little sprints. Eventually it went away. As a side effect of this method I ended up running my first marathon in less than a year.

        BTW I was not in a position that was convenient for running. I was in corporate America uptown in a large office building. I would literally excuse myself from a meeting and go run in the stairs or parking lot in a suit and wing tip shoes. Because if I ran I could have that cigarette after I finished. But the act of running killed the urge. Funny how that worked.

    • Hey there Martin, I’ve never been a smoker, but 2 of my good friends were finally able to quit by reading, Alan Carr’s “Easy Way to Stop Smoking”. It may be a good step in the right direction. Keep us posted. :)

      • I used the Allen Carr “Easy Way” method. I haven’t had a cig since June 26, 2009.

        The first couple 2 weeks suck. But after that, it gets much, much easier.

    • Hey Martin, I’d identify one of the triggers that causes you to smoke and start there. For example, if you always have a cigarette after a meal, switch to gum instead. Once you’ve developed the habit of replaceing the cigarette with gum after a meal, the trigger response for a cigarette will fade. You in essence replace the old habit with the new one and the. The two key points being 1) identify the trigger that creates the desire to smoke in the first place 2) replace it with another harmless behavior that offers a similar reward. There’s a great book called The Power of Habit by Charles Duhigg that covers this in detail.

    • Hi Martin:

      I stopped by slowly cutting back over time, then when I was only down to a few a day, I cold turkey. I would go back and quit again, and it wasn’t until the tiem I went back, lit up, and it tasted like crap, and I’ve been done ever since. I know it’s hard to do, but even one less per day is a step towards the goal. It took me a long time to officially quit, but I know I will never go back. Good luck and be kind to yourself through this process… it’s tough.

      Rebecca

    • I had smoked on and off for most of my life, stopping for a few years in my late 30s and early 40s when I ran marathons. Smoked 10 or less a day for years afterwards then switched to a few cigars.

      Never able to completely stop despite trying many methods, I eventually found the motivation.

      At age 60, I survived a heart attack. I lay on the table with a catheter the size of a pen in my groin, looking at the extent of the damage to my heart on a computer monitor.

      The cardiologist calmly said I was lucky to have survived and suggested it might be a good time to give up smoking permanently.

      I did. Have not had the slightest urge to start again for 4 years.

      Given sufficient motivation quitting is easy.

    • @Martin – A small solution to stop smoking would be to try to postpone smoking a cigarette for 5 minutes …then 10 minutes … then 15 minutes.

      Another small solution would be to eliminate just 1 cigarette from your day.

      That’s my opinion of how to apply the ‘small solutions’ method James describes in this article. That being said, I smoked for about 15 years and made many attempts to quit. Ultimately, I had to get truly mad (think visceral) and quit cold turkey. I hope that the ‘small solution’ method works for you, but if it doesn’t, I hope that you will find something else that is effective for you.

  2. James,

    I love your blogs for their simplicity and the same time for their powerfulness. You write so well that from young children to elder guys … everyone can very well understand and appreciate. More so your writing style is beautiful and without fluff. Congrats for being you. :)

  3. Great advice. Reminds me of some of the wonderful lyrics by Aussie singer/songwriter Paul Kelly; “From little things big things grow”.

  4. Wow, impressive. First I’m happy that your sister is now OK. This is very beneficial specially for those people who really struggle to solve their (big) problem. Solving piece-by-piece will lead you in answering big problem.

  5. Your articles are clear, insightful, and actionable…I appreciate your work and salute the quality of your writing.

    Mahalo and aloha, Bruce

  6. Hi James,

    It is so pleasing to read your articles in the morning. Brings a smile on my face. Doing a wonderful job. :) Keep it up.

  7. Fantastic Sir… Your simple ideas are really “BIG” for me. God Bless You…
    Dhayanithi, Coimbatore, Tamil Nadu, India

  8. Thanks for this great article James!

    I’m currently writing a book, and this article reminds me to work on little parts daily instead of the whole thing at once. One page a day is still a book in a year. I will try to do one chapter at once instead of mixing it al up and making it too complex to ever finish. Especially when doing research for the book. If I try to research for the whole book, I can do research forever… and in the meanwhile forget half of it. If I focus on one chapter, or one page, I can see clearly what I really need… or what I really don’t need.

    Thanks for another great lesson James! And thumbs up for Sidney Farber who helped curing your sister.

  9. Hi,

    Glad that your sister is doing fine. I have used the approach you have mentioned for exercising and it works! I used to actually write on my calendar on the wall how many minutes it took me to run 2 miles everyday. These were the postpartum days when I was carrying around extra weight and not really getting a whole lot of time to exercise but eventually I have worked my way up to exercising regularly and running outside for long distances. Thanks for sharing this tip.

  10. James, I very much appreciate your writings. Thanks.

    This reminds me of the concept of “Vision and Scope”. Vision is the big picture, “where do I want to end up ultimately”, whereas Scope is “what am I going to achieve right now” that supports my Vision. I have used this in software development to bite off a reasonable chunk of functionality while still keeping my eye on the bigger picture. Of course, as successive chunks are implemented, the Vision can change, as more is learned of what you want it to be.

    I guess that this is like shooting for the stars and hitting the moon.

  11. It’s always a great pleasure to read your work sir, but sometimes our mind only focus on the big goals and I hope through accepting doing smaller things the better you become in anything you want to achieve in life. Thanks.

  12. Thank you James Clear for the idea to use success with a narrower focus and apply it to a larger, more complex challenge. Great practical examples. Seed planted. Have begun tending.

    Glad your sister’s here too!

  13. This article is connecting with me!!! As i also started my business with one focus. Thanks James your all articles are incredible learning experience for me.

  14. James, you are by far one of the most refreshing writers on the Internet. Absolutely love your style and the topics you cover with simplicity and authenticity. Keep up the great work. Best wishes from the Mediterranean island of Cyprus.

  15. James, once again you have delivered practical, immediate advice on how to succeed with everyday challenges. I am so glad you wrote about Farber and your sister. Will, focus, knowledge, consistent effort, faith and love can move mountains.

  16. I have goose bumps… I am so grateful for those docs and your sister still being with you! Sharing this story is such a great reminder that we can accomplish big things by starting small. Thank you James!

  17. James,

    Awesome article! As a Nutrition Counselor, this is one of the habits ideas I readily use (Your 1 push-up idea… except with a new healthier food). People are looking for instant results when trying a new diet. I continually repeat that this is a lifestyle change that takes a while to develop. I’m often forced to remind them that they didn’t become overweight over the course of a month or two, that their weight gain is due to years of poor dietary choices and it can take up to a year to notice the effects of their healthier lifestyle choices. It is consistency that counts! Thanks for the articles! I look forward to them!

    Kasie

  18. Thank you for your clear, concise, and inspriational messages. I save them all to a folder with your name and re-read them over time. I have implemented most of your recommendations in a small but growing way.

  19. James, this is an absolutely brilliant post!

    I’m familiar with the concept yet you bring in a very new and fresh perspective.

    Thank you champ.

  20. Excellent post. Such wise advice, delivered with emotional impact and Clear honesty! Thank you!

    For writers, Anne Lamott’s book, “Bird by Bird,” offers similar counsel of starting small, tackling projects bit by bit, not getting overwhelmed. It’s a good read.

    Thanks again for a wonderful reminder not to let the Enormities overwhelm. :-)

  21. I’m a new reader, but I’m already hooked. :-)

    As far as fitness is concerned, I’m doing just that. I don’t bother anymore about the perfect routine. I started a booty challenge two weeks ago and I focus solely on that. Done is better than perfect.

  22. I know this “starting small” process to be true, yet every well-written reinforcement is absolutely necessary to yank me back to the reality of the single grain. The small chunk. The defining moment. The one step that leads to the journey of a lifetime. Thank you for reinforcing me today.

    This process also works with forgiveness. Over and over. Every single day.

    I’m rejoicing for your sister!

  23. I use this strategy with my kids when it’s time to clean up. They look at the mess and tell me it’s too much to clean. I tell one child to pick up all the shoes and the other child to pick up just the legos. Once they’re done I give them another item to focus on. Before long the floor is clean. By having them focus on one little task they don’t feel so overwhelmed. They also feel empowered when they are done because they did a job they thought was too hard at first. Great article. Thanks for your research and insights.

  24. James,

    I’m really grateful for your weekly post. You have such a creative and simple way of writing.

    It’s hard not to apply what you teach. Plus, each topic always seems to hit home. Keep up the hard work!

    You’re changing lives dude!
    Adam

  25. Hi James, as somebody whose daughter is in treatment for Leukemia, it’s always great to hear stories of those who have gone before us who are doing well. She’s not quite 4 yet but her favorite place is the hospital and we are so thankful for those who have increased survival rates from 70% when your sister was diagnosed to the 96% we were quoted when Lucy was diagnosed.

  26. This is such a beautiful post James! Thanks for the story about your sister. Thanks to you, I started with one pushup and now up to twenty without breaking. Arnold Schwarzenegger has nothing on me! Lol seriously though, thanks for this lovely reminder on the beauty of small steps. :)

  27. James,

    Thanks so much for the effort that you consistently put in on your articles.

    I loved this one; particularly when you circle back and tells us that the 3-year-old girl was your sister.

    Cheers,
    -Brian

  28. I’ve worked in pediatric oncology, as both a nurse and a nurse practitioner, for over 12 yrs. My last 4 yrs were spent coordinating our hospital’s Childhood Cancer Survivorship Program where we deal with the long term effects of the intensive treatments the kids receive. So obviously I found your example highly relatable. The more I thought about how we approach cancer treatments, the more I saw how well your methodology of effectively solving large problems was represented. All of our treatment plans for kids with cancer are based on research protocols. Within these different protocols, we are testing and comparing our ideas of fixing one small problem within the larger picture of treating a child with a malignancy. Each new protocol that is released is usually based on addressing micro problems–like decreased rates of mucositis, shorter periods of bone marrow suppression, or fewer adolescents with avascular necrosis–that can lead to the bigger problems of treatment failure, death from toxicities, or poor quality of life for survivors. So, great point. And tell your sister excellent job!

    • Thanks for sharing, Jocelyn! It’s very interesting (and affirming) for me to hear that these strategies are working on the front lines of healthcare.

      Thank you for reading and keep up the great work!

  29. Many thanks. Your messages are really very instructive and positive. You are doing a very good job and it’s very helpfull for many people (for me of course). Go on, I read it all. Thank you very much.

  30. Dear James,

    I enjoy reading your essays. They’re innovative, creative and provide practical advice. Regarding cures for cancer and other diseases, the mainstream Western medical and pharmaceutical machine has been crushing brilliant scientists and innovation that has led to cures since the 1920s. You can read about it in the book Politics in Healing: The suppression and manipulation of American Medicine by Daniel Haley, a former NYS assemblyman. I also watched a YouTube video an aryuvedic medicine that demonstrated cures for cancer. It was fascinating. Ayurveda: The Art of Being directed by Nalin Pan.

  31. Thank you so much for telling about your sister. I am delighted to know she is with you and well.

    It is also an excellent example of tackling the small bite first. I have always had a tendency to try to solve every possible problem with planning to do something, plus have plans A, B, and C in place in case something goes wrong. It’s been a very big lesson to stop anticipating the negative in particular and take small steps, and I still have to keep reminding myself of that.

    Thanks,
    Summer

  32. Excellent post as usual, James. I’m just thinking though a lot of these big problems could also benefit from occasional lateral thinking and top view framework else we could get stuck in one form of solution for decades as with with chemotherapy and radiotherapy which is still the most common treatment for cancer but are sledgehammer approaches. Same with environment and socio-political issues, we would always need combinations of big thinking, small thinking, lateral and vertical approaches (ex: Ken Wilber frameworks).

  33. The philosophy behind this idea is so simple and yet revolutionary.The empowerment that comes from overcoming a small yet stubborn difficulty releases confidence, new energy and an enhanced awareness of one’s own self-discipline.

    Thank you for this very salient advice for life.

  34. Dear James,
    Thank you for sharing your writing. I enjoy your articles, I find them concise and with information I find valuable.
    All the best,

  35. James,

    I always read your articles and find them true, practical and inspirational. Thank you and keep it up. It really makes a difference.

    Nick

  36. James,

    Thanks for another excellent piece, and I’m so glad to hear about your sister’s recovery. I had leukemia last year, and now I’m well, and using your columns to use the gift of my “bonus days” even better. Life is beautiful.

    Bonnie

  37. Hey, James! Thanks so much for sharing this with us, your readers. I love your newsletters! I’m glad you’re back after your sabatical. Today’s article touched me, not only cuz it spoke the truth, but also cuz you were inspired to write it because of your sister. I’m glad she made it and that’s she’s healthy and able to share great moments with you.

  38. Totally agree with you James. As a lifestyle family wellness physician, for years I gave people long lists of things they could do to improve their health. What happened? Very few people did it. Now, I give them one thing at a time. Yes it takes longer, but more people can do that and then we add the next thing when they are ready.

  39. Loved this, James, especially the reveal at the end. Great reminder to break big things down into smaller parts.

  40. Your topics and ideas never fail to inspire my thinking and adding great perspective and value to my business as a professional life coach. Today I will tackle standing up my new website in smaller chunks. Much appreciated !! Linda

  41. Hi James

    Another outstanding article!!! I learned more from you then all the teachers in University that I had.

    Amazing writer.

  42. Wow! That just blew my mind! I feel happy to know this.

    I stop and spend time reading your articles; slowly. They’re short and packed with such great knowledge. It’s like I’m listening to a friend.

  43. Hi James,

    I know you’re not a guru, but I’m wondering how your start small strategy (which I strongly agree with) might apply to a person who wants to lose weight.

    Best regards,
    Michael Morris
    Israel

  44. As a cancer survivor myself (Breast not leukemia), thank you Dr. Farber, for starting small.

    What an important insight! Being an “idea” person, I struggle with bringing them to fruition. The only way is to start small. I have a particular issue I am dealing with right now, and what a perfect reminder!

    Thank you James!

  45. Hi James,

    It was heartening to know about your sister’s fight with cancer and her eventual victory. I think this was the first time you shared something so deeply personal on such a platform. (Or the first time I read about it.) It requires great courage to do so, in my opinion.

    Thanks for making me (us) a part of your journey.

    God bless!

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