Religion, Technology and Management
Religion
Mention religion and the links between individuals and their creator, if they think they have one, come to mind. We imagine an individual fasting, meditating, or kneeling in prayer.
It was more common in the past however to think of a people, like the People of Israel and their God.
Our rulers, whether Kings or Pharaohs, stood in loco divinitas as the person designated to keep the people, the flock, safe. The person through whom at least in part the Good Shepherd would act. The position brought temptations – sometimes the Ruler seems to have thought he was a God.
Clinical medicine, which treats the individual, and public health, which tries to keep the tribe safe, map roughly onto this ‘religious’ divide.
In our time, the supreme virtue for individuals is to be healthy rather than holy. Our individual pursuit of health in gyms and with health foods often blinds us to the wider policy issues tackling which might stand a better chance than a workout in the gym of keeping us and others alive longer.
Technology
The other-worldly monk or nun praying in a cave or cell is not usually thought of as being interested in technologies, which are all about improving this world. Our Rulers for much of the last two millennia didn’t seem unduly invested in technologies either, except when it came to weapons, when there was no option but to keep up.
But, while simple living seems to be in line with the Bible, which contains warnings that efforts to improve our situation risks producing a Tower of Babel outcome, a strong case can be made that Xtianity, and perhaps other religions too, have celebrated efforts to improve our lot on earth.
In The Religion of Technology, David Noble, took this idea one step further. Far from religion being anti-science, as the repeated re-telling of the clash between Galileo and the Church seems designed to convey, he traces the roots of science to a religious celebration of practical virtue – an interest to develop technologies and machines.
The pace of technological developments has now quickened and here’s where the rub comes. As Noble tells the story, this coincides with an increasing sense that it might be possible to restore Eden on earth. The Biblical story, at times in his hands, feels like it might be recast not as a Fall from Grace and exile from Eden but a Quest for Eden.
Recast by the believers in technology. An increasing number of scientists linked to the military, who have been the primary supporter of technology especially in the United States, and in particular those who were behind the Atomic Bomb and Space Technology, have been committed Xtians.
Where the Bible talks about the Elect being Saved in the end days, the few who remain faithful, it seems that some of these believers figure this is absolutely the way things are going to go – as the Earth destructs, they will escape by rocket to somewhere else. This underpins their urgency to push forward with a technical agenda in our day. They have pretty well said it that explicitly.
Management
Noble’s work prior to Religion of Technology looked at the growing application of technologies to manufacturing processes in America after the War. This all fell loosely under the heading of Cybernetics and comprised everything that gave rise to servo-mechanisms, algorithms and later the Internet.
Cybernetics was heavily sponsored by the military. Military involvement is not a problem as such. But in the 1950s, with a Cold War raging outside and McCarthyism inside, some in the military viewed manufacturing workers as the enemy within. The skilled machine operator constituted a class whose sympathies might lie with communism. Could these people be depended on to produce the aircraft, rocket and computer parts that might be needed in the event of a conflict?
(One of the creators of Cybernetics, Norbert Wiener, had used his mathematical and computational skills to improve anti-aircraft weaponry before World War II began. After the War, he would have nothing to do with anything that could be turned to military purposes and made this very clear).
Cybernetics also underpinned the Post-War development of management science under headings like Systems Theory and Operationalism.
A new breed of American managers, many returning from the armed forces, took over the running of factories and businesses. They replacing owners, the entrepreneurs (risk takers who had set the business up). The new management was all about developing processes – flowcharts, guidelines, standards. Risk management rather than risk-taking. The new managers were bureaucrats.
These managers were hostile to the labor force, the shopfloor, primarily machinists in the case of manufacturing, in a way that owners hadn’t been. Most entrepreneurs knew they didn’t know how to operate machines. Comfortable in their own skills, they appreciated the craft of machinists in something like the way that religious orders who until recently owned many hospitals knew they didn’t have the shopfloor healthcare knowledge that nurses or doctors had.
Around 1950 managers were moving into manufacturing. Around 1980 they began moving into health services.
In 1950, automation offered a chance to replace workers. The argument was automation would reduce costs, enhance profits (and get rid of labor unrest). The jobs did in fact leave manufacturing but costs didn’t fall as expected. The machines and their repairs cost more than anticipated and a huge increase in managers had to be paid for.
Having a factory automated and operating on the basis of programs that management had commissioned, though, meant that skilled machinists could be replaced by lower-skilled operators. This left management in a position of feeling it knew more about what was going on in the factory, more about the job, than anyone else. Made management feel more comfortable.
The emergence of guidelines in the 1990s underpinned a similar dynamic in health services. Prior to that, health had administrators who made sure that the building stock and payroll systems worked but who depended on the discretion of nurses and doctors when it came to clinical issues.
Guidelines transformed these administrators into managers who knew what the treatments should be and could now take issue with and fire medical and nursing staff who exercised any discretion. Some doctors and nurses migrated into management. Those who didn’t increasingly found the job dictated by a bureaucracy that put filling paperwork ahead of engaging with patients.
Taken away from the factory floor and put in a medical setting, this looks less like the old clash between capital and labor that Noble reports. There is a turn to process – to bureaucratic technique.
The same transformation arguably happened in the early Xtian Church, who split off from Judaism complaining about the Pharisaical turn to process and appearances.
But every organization, even a Church, needs an administration. The Xtian administrators prayed for grace to help with the job of guiding the faithful. The grace of Kubernesis (from the Greek for Pilot).
From Kubernesis, we get government and governance and cybernetics, one derivative of which is modern management science.
The Church administration shape shifted into a management, a hierarchy, who figured that guidelines (Canon Law) were needed. There are good things to Canon Law. It gave rise to Western legal systems. But it also made the hierarchy feel comfortable. Left them feeling they knew more than the guys on the shopfloor what it was all about. The rest of us needed to be steered. We couldn’t be let think for ourselves.
Anarchy
In 1641, the English kicked off a Civil War which began when Charles attempted to impose a lockdown – a quarantine – to try and manage an episode of plaque. The War lasted the better part of 10 years at the end of which Charles I had his head chopped off.
The roots of the War lay in Luther’s rejection of Church Management in 1517 with a ‘this doesn’t make sense on the shopfloor’ moment.
It also coincided with a huge increase in printing technologies. Many more people were now reading the Bible and deciding what it meant for themselves, in addition to acting as their own lawyers and even physicians.
From the execution stand, Charles made a speech saying that the people didn’t want to rule themselves. That’s a job for Rulers.
“As for the people, truly I desire their liberty and freedom as much as anybody… but I must tell you that their liberty and freedom consist in having of government those laws by which their life and their goods may be most their own. It is not for having share in government, sirs: that is nothing pertaining to them; a subject and a sovereign are clear different things. And, therefore, until they do that, I mean that you do put the people in that liberty, as I say, certainly they will never enjoy themselves.”
The people who had turned the world upside down and executed their Ruler ended up restoring government. The herd needed managing. The twenty years in between the two sets of management were among the most fruitful ever for the development of science and technology.
Fetish
There is yet another religious element to technology. We fetish it. Marx was one of the first to draw attention to this.
It becomes very easy to think guns kill people rather than people kill people. The machines can seem to be inherently productive, where it is we who are productive. Drugs seem to cure people rather than doctors. The magic leaches out of people and into the technology.
Drugs in our day have even become sacraments – something that can only do good and cannot harm. Social media and Governments won’t allow any mention of the harms that a drug or vaccine might cause. In this they have become more other-worldly than the Catholic Church who recognise that the Eucharist can harm and needs to come in gluten free versions.
The fundamental point is that Techniques don’t enhance or diminish us. We do the enhancing. And if we don’t, we diminish.
The degree to which social media has been algorithmithised is a growing problem. The room for us to enhance, to exercise discretion is shrinking rapidly. When information about the harms a medicine can cause, information necessary for any discussion a medical person and I might have if she is going to help me if I come to her for help, is automatically banned, we have a problem.
The problem is not going away because treatment is an Act of Magic. It involves bringing good out of the use of a poison or from a mutilation. It happens when two people engage and make a judgement call. This does not compute for social medial algorithms, or for insurers, or for managers.
Technologies are one dimensional. An algorithm cannot contain an internal contradiction, like poisoning or mutilating. Our decisions often do. And it is deciding with someone else on a course of action that we make each other. A Decernimus Ergo Summus moment.
This post meshes with
Illustration: The Heart of Medicine, © 2013 created by Billiam James
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Gang aft a-gley
“The best laid plans of mice and men”
– ‘Comfortable in their own skills’ –
‘Skin’ – in the Game
A common saying at the Food and Drug Administration is: “In God we trust, all others must bring data.”
FDA’s sacred principle: In God we trust, all others must bring data
By ROBERT M. CALIFF
https://davidhealy.org/decernimus-ergo-summus-citizens-assemblies/
So you dudes who work for Forest or GSK, despite all logic you guys have to refrain from assigning causality until the RCTs proving the point get done. The fact that they will never get done, that it would be unethical to do them, is irrelevant. Come to think of it there are no RCTs of anyone ever dying from Zyklon B – maybe time to rewrite that bit of history.
The above scenario is for real. It is not a nightmare. The first person I heard push it was Ian Hudson, then of GSK, now head of Britains MHRA (FDA). But it may be the case that at least some people in what Iain Chalmers and Ben Goldacre continue to laud as the most ethical outfit in the universe and in other companies have recognized the lunacy of this and are quietly doing something else.
Difficult to know. But it pays to read the small print and maybe translate it for your doctor – or lawyer.
Prescription for Murder ABCD
https://rxisk.org/prescription-for-murder-abcd/
There are unquestionably many people now in jail who possibly should not be because of a drug they were on, dead who should not be because of drugs someone else was on, or who will not get a fair trial because when it comes to the small print vanishingly few people realize what is being said.
-Skin in the Game
-Or Should Do
By Robert Burns
The full quote is “The best laid schemes o’ mice an’ men. Gang aft a-gley”. Or to translate, the best laid plans of mice and men can still go wrong.
Why write a poem to a mouse?
For people who aren’t very keen on poetry, it might seem strange that somebody would write a poem to a mouse. After all, it’s not as if the mouse is going to write back saying “Thanks for the poem. I forgive you”.
Our gods have their acolytes they have hierarchies within hierachies who protect each others’ interests while claiming to be working tirelessly for the good of us all. Some of the most powerful have close links with governments and are funded by tax payers whilst claiming charitable status and therefore tax perks We don’t put donations in the charity box .We have no option but to pay for them eg the MHRA; NICE; and even the GMC. Their claimed independance is a con. Much of so called voluntary sector is another arm of the state many of whose members prostitute themselves by jumping into bed with politicians for funding . When they move on to do good deeds elsewhere there is a warm seat waiting at pharma companies or the house of lords The NHS in UK is celebrated with the mantra of providing equal health care for all – but much of it has been privatised without all of us realising the extent , or when we realise a service procedure is run by a private company told not to worry as the NHS is still free. GP
practices are businesses, some are massive enterprises which have eaten up others in the area, they are paid in a way many of are not aware of and they all have to balance the books. eg payments to vaccinate are an incentive especially for these huge practices. There are all sorts of targets doctors are manipulated to comply with by use of incentives.
I am possibly going off course but it all seems to contribute to the situation where medics as well as those who consult them in good faith are put in a bind. They know the systems are corrupt, Many who use the NHS are cynical about the prescriptions they are given or are withheld because the computer says ‘no’. They are not always designed for the good but every action is collated by a computer and sent to data gathers for analysing individual medics’ use of drugs/treatments . The practice can lose funding and force non compliers to change – knowing they are not providing adequate treatment for individuals. We are all classed as members of this group or that and the ‘guidelines’ decide. eg a friend who had been diagnosed with ‘schizophrenia’ told his GP he was giving up the drugs. He had been trialing it without help anyway . She told him his benefits would be removed if he did. Soon after he was told he would be asked to agree to be removed from his flat to some kind of community centre miles from anywhere . He was never a danger to himself or anyone else, he spent his time quietly cooking and writing poetry . Then he disappeared Whether her attitude was based on what treatment a logarithm ordered or her personality I wouldn’t know . But there is the rub – even if logarithms and check boxes and all the rest of the paraphanalia was scrapped – it is still a jump of faith to assume a ‘good’ skillfull ,compassionate doctor with some degree of research mentality which pushes them to really look into an individual’s problem. will be found. Many in the past got away with with ‘in my clinical judgement’ …..
We interrupt this nightmare to ring in the New year with a bit of levity. If covid canceled your party this may or may not cheer you up.
https://warmnetwork.net/listening-2/
When I worked in a hospital (I was a health care assistant) I was taught many things like doing various obs and I learnt a lot in the years I worked there but the only thing I learnt that was most important was not so much what you were taught but your own natural observational skills and instincts were the most important.
Example a young man 18 who had been in an RTA and had had emergency surgery with blood transfusions was looking to me clammy and pale when I approached him. I did his obs and although they were on the low side they were not dangerously low. I was still concerned so I asked him if he was ok and he smiled and said he felt great. I was not convinced so I told the agency nurse in charge. She checked the patient and told me he was ok. I was not happy my gut instinct knew he was not right.
I left it for a while and attended other patients but when I went back to him and I was even more concerned he still looked clammy and pale. I asked him again “do you feel ok” and he smiled again and said he felt fine. I still wasn’t convinced and done his obs again and noticed his blood pressure had slightly fallen. I went back to the nurse who again told me he was ok.
I’m now getting worried I’ve told this nurse I’m worried and she has basically shouted at me there is nothing wrong with him. My instincts are telling differently.
I’m so angry now with this nurse for her disinterest and shouting at me I decided to get another BP chart and do my own 15 min observations. I did his blood pressure, pulse and resp’s for several hours. He kept looking at me like I was crazy too.
After about three hours I had the evidence I needed. His blood pressure was dropping his pulse and resp’s were increasing. I then went back to the nurse and almost dragged her back to see the patient. She looked at the chart and then asked the patient “are you ok” he replied “yes I’m ok” she then walked away.
By now I’m fuming and think I’m going mad “why is this nurse ignoring me”? this man’s OBS is not normal!.
Decision time,: I see a Dr walking into the ward I decide to approach him even though it’s not my place to overide a trained member of nursing staff as they are qualified I am not.
I begged and ask him to have a look at this patient. He looked to see who it was and yelped “omg that’s my patient”. He took the obs chart and was really concerned and grabbed some syringes and bottles and asked me to rush the bloods to the blood bank. He said this patient had lost lots of blood in the operatiing theatre and was very concerned with his obs.
Results come back the Dr was very worried and had this poor boy transferred to the coronary care unit for more blood transfusions.
This now has a very important life saving message. You don’t have to be trained or follow any guideines or rules to know someone is desperatly ill. Just common sense tells you something is not right.
Some people get it and unfortunately some dont even though they are trained and following guide lines and rules.
Your last sentence says it all Anne-Marie. Guidelines and rulebooks come way ahead of common sense and genuine concern – that is why the system is in such a mess. That is why family comments/concerns count so little in MH matters – in fact they are ridiculed and discounted just as you described your attempts to gain the support of the so-called ‘experts’. Empathy is lacking – not only towards the patients but also those, like yourself, who put themselves out to build a fuller picture for the professionals to work with. Why are they so scared of our support? I feel that it has a lot to do with their own confidence – that ‘going with their gut’ would leave them uncomfortable therefore they do the only thing that they feel comfortable with which is following the guidelines and rules. The resulting mess is clear for all to see.
Message from Katinka Blackford Newman : “With the news of antidepressant use soaring to 6 million during the pandemic, I’m sharing my campaign to highlight the dangerous side effects for a significant minority. If you have a story you’d like to share, please contact me.”
Know Your Drugs
Katinka Blackford Newman
I’m sharing an 8 minute reversion of a campaign film I made with my children to highlight the dangers of antidepressants.
I hope that by sharing what happened to us and others in the film, I can highlight how these pills can destroy lives.
THE PILL THAT STEALS LIVES – 8 MINUTE CAMPAIGN FILM
http://www.thepillthatsteals.com/#:~:text=The%20Pill%20That%20Steals%20Lives%20is%20a%20bestselling,can%20be%20lethal%20and%20can%20steal%20lives%20permanently.
A Family’s journey – a must watch
An massive increase of suicide is potentially a hideous possiblity as a result of Covid .The massive increase in people being prescribed psych drugs during the pandemic will be very likely given without proper warnings or regular follow up.
New study: antidepressants significantly raise the risk of suicide in the treatment of depression for adults
by Admin on 25/06/2019 in News, Psychiatric drugs
Adults who start treatment with antidepressants for depression are 2.5 times more likely to attempt suicide when compared to placebo, according to new research published today in the journal Psychotherapy and Psychosomatics.
The study found that approximately 1 in every 200 people who start treatment will attempt suicide due to the pharmacologic effects of the drug. This number is significant given around 7.4 million people were prescribed antidepressants in England alone last year, and given international estimates which suggest around 1 in 20 suicide attempts will end in death.
AntiDepAware Retweeted
hundredfamilies
@hundredfamilies
·
10 Jan
Coroner calls for clearer risk information on medication following young man’s suicide.
https://www.judiciary.uk/wp-content/uploads/2021/01/Samuel-Morgan-2020-0276_Redacted.pdf
On the 9th January 2020 he had been prescribed a 14 day course of 10 mg citalopram antidepressants. A review assessment was not set at the time of the medicine being prescribed in contravention of NICE Guidance.
CORONER’S CONCERNS
During the course of the inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths could occur unless action is taken. In the circumstances it is my statutory duty to report to you.
The MATTERS OF CONCERN …
Every medicine pack includes a patient information leaflet (PIL), which provides information on using the medicine safely and allows patients to read at their leisure. However, it has been suggested that the “Black Box Warning” (as developed by the Food and Drug Administration in the USA) would have a more 2 immediate impact and capture some patient’s attention highlighting any risks.
The simple and clear message in this specific case would be that there is an increased risk of suicidal thinking in young adults. The benefits of such simple and direct messaging extends to all prescribed medicines and associated major risks.
ACTION SHOULD BE TAKEN
In my opinion action should be taken to prevent future deaths and I believe you and/or your organisation have the power to take such action.
YOUR RESPONSE …
It’s like people have become robots and just follow the guidelines and rules and have given up on instincts and common sense. Their not able to think for themselves anymore. I’m not saying all staff are like that but there a many robots out there who are blind to the obvious staring them in the face.
D
The efforts to change things have had some success but it doesn’t seem likely that Coroners and prescribers are likely to be putting psych drugs as a contributing factor in deaths especially as Covid rules change their obligations . Activism has had some wonderful admirable success but is still limited. Would it be an dea to actually employ someone with expertise in maybe advertising or promoting campaigns?