Using Technology to Deepen Democracy, Using Democracy to Ensure Technology Benefits Us All

Saturday, June 04, 2011

Transhumanist Unveils Healthcare Reform Plan

From his misnamed blog Science Not Fiction, misnamed in my view because like most futurologists he is endlessly pretending fiction is science there, Kyle Munkittrick (who I haven't ridiculed for a lamentably long time), writes:
Health care is broken. In the US quality of care is tanking. Even in countries with successful universal health care systems costs are rising too fast for the systems to cope. So what do we do?
Actually, as Paul Krugman noted earlier today, there is little reason to declare that single-payer healthcare systems (including US Medicare) are unsustainable, but few would deny that Munkittrick's topic is an important one. What I would deny is that it makes any sense to pretend a futurologist has anything useful to say about the topic, at least to the extent that he is speaking as a futurologist. Munkittrick's column seems to me quite typical in this regard.

Munkittrick directs our attention first to Atul Gawande, who he describes as "one of the few sane voices in the health care debate." As it happens, there really is a surfeit of sane voices concerning healthcare policy and reform in America and around the world, and it is unlikely that Gawande himself would disagree with my saying so; indeed, there is a consensus among healthcare professionals and policy-makers about both the cost-containment and more equitable healthcare provided by single-payer healthcare systems (I suspect Munkittrick largely agrees with this consensus, too, but what matters to me is that there is nothing about his futurology that properly contributes to that agreement or is relevant to those who of us who would want to shape actual policy in consequence of that agreement, quite the contrary, in fact).

As with the consensus about anthropogenic climate change, the recognition among macroeconomic literates that government stimulus becomes indispensable at the zero bound, the recognition that harm reduction drug policy is better in most objective measures than the disastrously failed and unjust prohibitionism of the racist War on (some) Drugs, the widespread grasp of the unfairness, waste and inefficacy of capital punishment, the demonstrated preferability of sex-education over abstinence-exhortation, the proven effectiveness of and wide support among law-enforcement professionals for strict gun control regulation, and in countless comparable issues, the problem is not that there are few sane voices but that our bought-and-paid-for political system seems incapable of connecting sane voices to sane policy making when our political institutions are in thrall, whichever party is notionally in control of them, to an organized Movement Republicanism that disdains science and fairness and sense altogether.

But what I want to emphasize in this post is what I would take to be Munkittrick's effort to be regarded as one of the "sane voices" in the healthcare debate himself qua futurologist by hitching his own wagon here to Gawande. Even more to the point, I want to object to the proposal that there is something that futurological discourse in particular has at its disposal in the way of a unique analytic methodology or unique imaginative vantage that makes futurologists "sane voices" -- especially futurologists caught up in the full froth of transhumanist and singularitarian sub(cult)ures -- in policy debates like this one in the first place.

Central to Gawande's case is that we must avoid techno-fetishism and the promotion of techno-fix gimmicks as we take up the challenges of cutting-edge but still equitable and sustainable healthcare provision in the years to come. Munkittrick properly summarizes Gawande's recent widely-read Harvard Medical School Commencement Address as proposing that doctors should use checklists to improve quality care and should also re-imagine the healthcare provider's ethos as more that of a member of a team rather than as autonomous problem solvers.

Gawande insists that the proliferation of effective healthcare treatments cannot provide the longer healthier life to most of the planet's inhabitants they seem to promise unless healthcare culture takes up new best practices embedded in a different organizational mode. But, as Munkittrick continues: "later on in his speech, [Gawande] says that the solution to the health care conundrum is not technology. To a large degree, I agree with him. But not completely."

There are two concerns I want to stress here. First, Munkittrick says here that he "large[ly]... agree[s]" with Gawande that "technology" is not the solution to the healthcare conundrum we face (actually, we face more than one, but no matter). Nevertheless, Munkittrick's column proceeds from there exactly as if he doesn't agree with Gawande at all on this point. Munkittrick's whole piece is suffused with the usual futurological techno-whizbang.

Indeed, the image that accompanies and encapsulates Munkittrick's post graphically proposes that an iPhone app is "greater than or equal to" a team of healthcare workers. This is of course, diametrically opposed to the Gawande thesis he pretends to endorse before junking it altogether to indulge in typical techno-utopian handwaving about X-Prizes and imaginary artifacts. Even the slightly more modest proposal of his title, "If Doctors Need Pit Crews, Then Tricorders Should Be Part of the Team" hyperbolizes tools into colleagues in a way with which I strongly suspect Gawande would (certainly he should) take issue.

A second concern of mine might seem a bit abstruse, but I do want to point out that Gawande's methodological and organizational recommendations actually involve changes in technique. The techno-fetishization in futurology of whatever are taken to be "cutting edge gizmos" by the prevailing hackery of marketing and promotional discourse -- of which futurological discourse remains in my view essentially an extreme variation, often to the point of quasi-religious transcendentalizing hyperbole -- profoundly distorts and constrains our sense of what the technological properly consists and the ways in which collective agency might be differently articulated by available techniques and artifacts. That is to say, futurology makes it harder to speak sensibly about the very technodevelopmental focus it would claim defines its special sphere of interest.

Also, and I do think this is important: iPhones are simply not tricorders. To pretend or even hope otherwise is simply to be a kind of tragic fashion victim, a sad dupe of CGI advertizing imagery (transhumanists among my readership may be crestfallen to discover that neither will using the Droid handheld nor chewing Wrigley's "5" gum immerse them in a virtual reality like a cross between the heart of the Death Star and a writhing pit of robotic gelatinous sexually promising tentacles, not now, not ever).

The techno-fetishizing discounting of social organizing for glossy gizmo ads is a definitive gesture of futurological discourse, as is the proposal of techno-fixes in the face of real problems as pseudo-solutions the principal force of which is to diminish the lived urgency of real problems and distract attention and resources from real solutions. Incidentally, the inclusion of strong statements against techno-fetishism, techno-determinism, and techno-fixes preceding prolonged inane indulgence in all three has also become an indispensable ritual in "serious" futurological policy-making discourse. Munkittrick's column exhibits all of these symptoms, and is therefore at best serious in the way futurological discourse sometimes manages to be, serious as a heart attack.

I leave for last yet another definitive symptom of the futurological on display in Munkittrick's post: the treatment of science fiction as a lens through which seriously to contemplate actual factual dilemmas.
In Star Trek: The Next Generation, Beverly Crusher is responsible for a starship with just over a thousand crew members of varying ages and species. Sickbay is, however, not manned by a huge number of staffers. Normally it’s just Dr. Crusher and an assistant or two… Yet Crusher is able to handle a hypothetical complexity that should blow to smithereens anything current doctors could possibly face. How?
My answer, quite a bit less elaborate than Munkittrick's, and if I may say so possibly much more to the point, is because she's written that way.


Martin said...

The old argument from fiction -- like citing Atlas Shrugged to prove a point about work ethic.

jimf said...

> > Yet Crusher is able to handle [more than] anything current
> > doctors could possibly face. How?
> My answer. . . because she's written that way.

That suggests an interesting crossover genre. _Grey's Anatomy_
in space. The starship is still there, but it's just
background to the hospital drama.

Think it would fly?

My answer. . . Of course not! The sci-fi special effects
wouldn't add anything to the story, and would cost a

jimf said...

> . . .iPhones are simply not tricorders. To pretend or
> even hope otherwise is simply to be a kind of tragic
> fashion victim, a sad dupe of CGI advertizing imagery. . .

I'm reminded here of something that Joel Spolsky called
"the iceberg problem"

If you show a nonprogrammer a screen which has a user
interface which is 100% beautiful, they will think the
program is almost done.

People who aren't programmers are just looking at the
screen and seeing some pixels. And if the pixels look
like they make up a program which does something,
they think "oh, gosh, how much harder could it be
to make it actually work?"

The big risk here is that if you mock up the UI first,
presumably so you can get some conversations going
with the customer, then everybody's going to think
you're almost done. And then when you spend the next
year working "under the covers," so to speak, nobody
will really see what you're doing and they'll think
it's nothing.

I wonder -- does the iPhone "tricorder app" do the
tricorder sound effects too?


jimf said...

Hey, maybe the iPhone will turn into a medical
tricorder after all!

"When does cryonics' time arrive?"
by "Mark Plus"
February 26, 2011
[Ray Kurzweil] claims that inventions depend on other
enabling technological trends to succeed as new products,
and that he has found a way to predict when the windows
of opportunity open. . .

Assuming that Kurzweil's technique does have some
validity. . . [w]hat metrics should we look at to
determine our timing for the factors of cryonics'
success? . . .

I endorse the idea of looking at the development of
medical apps for smart phones. The smart phone shows
signs of becoming a platform for solving the problems
of learning when something has gone seriously wrong in
our bodies so that we need medical attention. . .
Diagnosing conditions like diabetes, elevated LDL levels,
leukemia, heart arrythmia or kidney failure early could
make huge differences in your health prospects. (It
wouldn't surprise me if Chi9na and other East Asian
countries do this with smart phones ahead of Western
countries, if they haven't started already.)

Martin said...

And Plus concludes (apparently completely oblivious to the irony), "we can see the contrast between the fantasy and the reality, and often have a good laugh at our youthful folly."

Except FM-2030 wasn't a kid when he made those statements. What makes Plus (and all the rest) think they are smarter?

Futurology is the art of making a fool of yourself in the future.