Wednesday, March 23, 2011

Technophilia in the opposition to healthcare reform and environmentalism

Paul Krugman posted an interesting tidbit on his blog at the New York Times today, titled "American Superiority Complex." In part, he writes:
Aaron Carroll has a very good takedown of an op-ed article by Senator Ron Johnson, who basically exploits his infant daughter’s medical experience to make an incoherent attack on the Affordable Care Act. His daughter received excellent treatment, and he asserts that she wouldn’t have received that kind of treatment under universal health insurance, because …. well, he doesn’t explain. [...]

But what struck me about the whole piece was the assumption that modern medicine in general is something only we lucky free-market Americans have, while in Europe they’re still using leeches or something. In other words, it’s part of the superiority complex you often encounter in U.S. politics; people just know that we’re the best, and won’t believe you when you tell them that actually they have the Internet, cell phones, and antibiotics in Europe too.

But what strikes me, looking at the original piece by Senator Johnson, is that he valorizes specifically the technological aspects of Western medicine—it was a complex surgery that saved his daughter, and he refers later specifically to joint replacements, cataract surgery, and radiation, all technology-intensive procedures. He closes his piece talking about innovation, choice, and competition, all concepts that seem curiously placed in a mini-manifesto about healthcare. After all, how many patients complain their doctor isn't innovative or competitive enough or doesn't order enough tests? 

Virtually everyone I know wants medical care from doctors who pay attention to them, who perform the lost art of the physical exam, who spend more than 4 minutes half-listening, half-reading a chart while they scribble a prescription for the next test. This time-crunched scenario, by the way, is the very situation that has driven up healthcare costs in the first place.  It is far more “efficient” (another phrase often bandied about in these discussions) for both patient and physician to spend time together creating a thorough history, getting to know the patient’s life circumstances, personality, etc., than for the doctor to order a battery of tests relatively blind to that crucial information. Some things just take time and care; listening is one such activity, and properly reading tests is another.* Lack of time and lack of simple, low- (or really no-)tech checks and balances are responsible for most medical mistakes, misdiagnoses, and subsequent malpractice suits.**

Back to Senator Johnson and the arguments promulgated by the current crop of anti-healthcare-reformers, who apparently not only want healthcare not to be available to everyone, but also want it to be expensive, technology-driven, and less efficient. Leaving aside for a moment the deep problems with the tests themselves (false positives, false negatives, false reliance on tests as "objective", lab companies saving money by not recalibrating equipment frequently enough, not having an actual pathologist examine the specimens, etc.), this is a really screwy set-up. The only ones sure to benefit from it are the companies that make the equipment, read the labs, and make the drugs.

In fairness, I do not think it is all about greed (though it would be interesting to learn  how much money the anti-healthcare-reform politicians receive not just in donations from Big Pharma and Big Insurance, but from their own investments in these huge industries). I think science and technology, like divinity, provide a sense of magic and mystery that speaks to the human need to feel awe. They  also, again like religion, promise that there might be, after all, a way for us to exert some control over the vicissitudes of life.

This is a dangerous myth, however, and it is costing us dearly. 

It operates not just in healthcare, where we spend the vast majority of resources on the first and last six months of life, desperate to hold onto continued existence at any cost, never questioning whether the quantity of days spent technically alive should take precedence over the quality of the life thus endured or forced upon the unwitting. Technophilia is also an impediment to the environmental movement, because much of the public discourse is based on the assumption that the environment is endlessly plastic (!), amenable to our technological control, and thus we can "out-invent" and "out-compete" our way in developing "innovative new technologies" to battle rising sea levels, rising temperatures, etc. But this idea that Nature is to be controlled or conquered for our benefit is at the very root of our problems.  And there is little if any talk of developing technologies to reduce the amount of pollution that is dumped into the air, land and sea—only technologies to minimize the climate change effects of that pollution. This, too, is very odd, since if we cannot bring ourselves to alter an industrial process so that it is cleaner, it seems like outright megalomania to think we could send up some enormous swath of material to deflect sunlight or patch the ozone layer (all the while dumping more toxins into the atmosphere). There is a strange hatred of change toward the much cleaner technologies and processes already available, and a preference for far-fetched fantasy.

Does anyone else find this curious?


*Inter-rater and  intra-rater variability in interpreting  images such as chest X-rays and mammograms are shockingly high; see Jerome Groopman's excellent treatment of this issue in How Doctors Think

** Cf. Atul Gawande, The Checklist Manifesto.


  1. I not only find it curious, I find it disconcerting! I do get the sense that people think we'll "invent" some technology that will allow us to continue destroying the environment at the current pace.
    People are delusional.
    "never questioning whether the quantity of days spent technically alive should take precedence over the quality of the life thus endured or forced upon the unwitting. "
    This is very very true! I've seen people do this over and over again. Even people who claim not to want this, once they are sick, they demand to be saved no matter how poor their life quality is.

  2. It's been said (by I forget whom) that the desire to cling to life is inversely proportional to one's satisfaction with it. In other words, people who have been fulfilled in their lives are willing to let go; people who've been miserable want to cling in hope that they can somehow make it right and finally experience the happiness they sense others have enjoyed. I think there is much truth to that; I also think this is part of why Americans in particular are so unwilling to face death squarely -- something about the forced optimism I referred to in an earlier post divorces people from reality.

  3. your website is extraordinarily compelling- i found you through Dominique Browning's wonderful Slow Love Life...if you haven't read this piece on american exceptionalism by eizabeth young-bruehl, i highly encourage you to do seems relevant to krugman's observation. thank you for your provocative and important musings:

  4. Pamingram: thank you so much for stopping by, for reading, and for commenting. I agree about Dominique Browning: her blog is absolutely wonderful!

    And thank you for the link to EYB's essay --a delightful coincidence, for I have been mulling over a series of posts on the link between personal pathology (narcissism) and our social woes! I am a little abashed (one always hopes one has something original to say) but I am also thrilled to know that others are probing the same sorts of ideas and putting them out there. If I can add my two cents' worth to the cultural conversation, I may yet be able to do some good.

  5. oh and thank you, via Dominique's blog for the link to the very effective ad about not dismantling the clean air act. have sent it to many people already...

  6. Thanks so much for your entry on S Hough's blog re: S Isserlis' Telegraph article. Much compelling and distressing reading to be sure but it seems everyone is having some element of similar experience. Your blog is a wonderful resource as well and I appreciate the comments too! I sincerely hope that you do that series on personal pathology and social woes.

  7. Thank you for dropping in and commenting -- yes, Steven Isserlis' essay was so moving and so necessary. These issues touch all of us, and I do think there is much we can do to evoke change, but it will take greater awareness of numerous contributing factors, which I hope to begin unraveling here. And I am definitely working on the personal pathology/social woes connection, as well as the social pathology/personal woes connection. :)