01Two Modes of Thinking — and Their Weight
Musk distinguishes two ways of thinking. The first is reasoning by analogy: you look at something that already exists, adjust it slightly, and apply it. The cognitive load is low, and most of daily life runs on it. The second is reasoning from first principles: you break a problem down to its most basic, irreducible facts and rebuild from there. The load is high, but you reach the substance.
This is not an argument against analogical thinking. Accumulated precedent is the foundation of knowledge, and in healthcare, referencing existing evidence is part of what keeps patients safe. The problem Musk targets is the inertia that analogy can produce — the unexamined assumption that because something has always been a certain way, it must remain so.
02Battery Packs at $600, Broken Down to $80
The canonical example: when Musk was building Tesla, battery packs cost roughly $600 per kWh. The industry consensus was that they were expensive, had always been expensive, and would stay that way. Musk stopped and reframed the question: what are the constituent materials — cobalt, nickel, aluminium, carbon, polymer for the separator, steel for the casing — and what would each cost if purchased on the London Metal Exchange?
The arithmetic came out to roughly $80/kWh on a materials basis. The gap between $600 and $80 was not a physical law; it was a manufacturing problem. That read proved directionally correct. By 2023, EV battery pack prices had fallen to around $128/kWh, a steep drop from where they stood when Musk ran those early calculations.
The key move was refusing to conflate "the going price" with "the physical floor." The $600 figure was not a constraint imposed by chemistry or thermodynamics; it was the outcome of a question nobody had thought to ask. That distinction — between a physical law and an untested assumption — is what sits at the centre of first principles thinking.
"Conventional assumptions about price aren't laws of physics — they're just conclusions nobody has challenged. Question the premise and rebuild from basic facts." ── Elon Musk (Startup Archive)
03Pulling This Into Pharmaceutical Practice
I have heard the phrase "the package insert says so" more times than I can count. That posture is correct in the sense that regulatory documents must be followed carefully, and deviations carry real risk for patients. But reading a label and understanding why that label reads the way it does — which trial design, which sample size, which primary endpoint generated that conclusion — are two different acts.
Breaking an evidence claim down to its trial-design components is, in effect, first principles thinking applied to medical literature. "Drug A is effective for condition B" looks simple until you decompose it into the study population, dosing regimen, follow-up duration, and outcome definition. Just as Musk went back to the raw materials, going back to the trial design is what makes it possible to ask whether a given assumption holds outside its original context.
04Material Structures and the Weight of "We've Always Done It This Way"
The same inertia shows up in medical communication. The structure of promotional materials, the sequence of information delivery, the chart formats chosen for presenting data — many of these persist because they have always been done that way. That is analogical thinking accumulated over years.
A first-principles approach would start from the other end: what is the purpose of delivering this information to this physician at this moment, and does this structure and format serve that purpose optimally? Where resources allow, that question is worth asking. Tracing a guideline recommendation back to its primary source literature, understanding why it was written as it was, and building materials on that foundation rather than on convention — that kind of discipline is a slow departure from inertia, but a real one.
05The Costs and Friction of First Principles Thinking
None of this is without cost. Calculating the materials-basis price of a battery pack still required time, domain knowledge, and arithmetic. If every assumption had to be rebuilt from first principles every time, no organisation would move. Choosing where to spend the cost of a first-principles inquiry is itself a judgment that requires experience.
There is also a social cost within organisations. Raising a first-principles question can read as troublemaking — why are you digging into something that has always worked? Musk is describing a personal cognitive mode, but applying it inside a team or company involves friction that his accounts rarely dwell on. Ignoring that friction makes first principles thinking sound like a universal tool when it is better understood as a selective one.
06The Danger of Misuse — The Trap of "Back to Basics"
There is a further risk worth naming: the misuse of "first principles" as rhetorical cover for overriding inconvenient constraints. Framing an existing standard as an untested assumption can be used to dismiss knowledge or regulation that exists for good reasons. In healthcare, accumulated evidence and regulatory frameworks embody lessons from past failures. They are not all inertia.
The materials-cost calculation and the design standards for a clinical trial are structurally different. The first is verifiable through physics and chemistry. The second encodes ethics, statistical validity, and patient safety in ways that do not yield to a simple decomposition. First principles thinking is a powerful instrument for questioning assumptions, but wielded without understanding why the existing practice came to be, it starts cutting noise rather than substance.
07Holding Questions at the Right Granularity
The most practically useful thing I take from Musk's approach is the habit of asking questions at the right level of granularity. Not "is this expensive?" but "what proportion of the cost comes from which component, and which of those is a physical floor versus a process artifact?" Not "is this drug effective?" but "effective by which endpoint, in which population, over which time horizon?"
That habit transfers into pharmaceutical and medical work without requiring that every assumption be questioned every time. The more realistic practice is choosing which assumptions to question, and knowing the difference between a regulatory boundary that exists because patients were harmed and a convention that exists because nobody revisited it.
A good day, every day — Nichi Nichi Kore Kojitsu. I think that means, in part, carrying a question into each day and letting it open a little more of the view.