The world of research relies heavily on what we might call scientific capital. Scientific capital is the collection of research experiences, publications, citations, and relationships forged with others that a researcher has accumulated over their scientific career. However, this pursuit of scientific capital affects the rate and direction of medical progress in two ways. Firstly, since scientific capital determines who gets to participate in the world of research, it indirectly influences who gets to affect the rate and direction of progress. Secondly, there is a strong incentive to accumulate scientific capital. These incentives end up changing the types of research projects we choose to pursue. It rewards the pursuit of conservative and incremental research that produces quick results and boosts publication and citation metrics, creating a culture of publish or perish. Chapter 1 is concerned with how this can have negative long-term consequences on medical progress.