In March 2015, the cover of National Geographic featured a picture of the moon-landing with a title The War on Science and a strapline: climate change does not exist; evolution never happened; the moon landing was fake; vaccination can lead to autism; genetically modified food is evil. See Here.
Even before elections in Europe and America in 2016 gave us Fake News, a progressive commentariat had lumped climate change deniers and anti-vaxxers together as a threat to rationality and science. This has now extended to anyone who ends up drug-wrecked or device-wrecked.
There is a deep background here. For science to develop an accommodation had to be reached. God’s truths were revealed in two books not one – The Book (Biblos) and in the Book of Nature. Religion offered a framework for belief. Science operated through doubt.
This doubt spread in the nineteenth century to the Bible itself. We began to doubt the Bible and started believing in science.
The Second World War, the Nazi death camps, and the Atomic Bomb produced a crisis for those who believed in progress. So too did the history of science which pointed to a progressive replacement of the “truths” at the heart of science. Questions arose about whether it is possible to be objective about history.
The mid-century shocks gave rise to post-modernism which contested the claims of scientists to truth. When the history of science showed that much of what scientists swore was truth one year was discarded the next, how could they claim truth for what they were saying now.
Cybernetics also shaped post-modernism, as caught by Marshall McLuhan’s phrase – the medium is the message. Information had begun to hyper-circulate and instant feedback rather than the content of messages would now dictate how we behaved. The signifiers were becoming as important as the signified. Again raising the question that is all too acute now – if so, where does objectivity lie?
For some, science lacked an anchor in philosophy, and without this could not be assumed to have a meaning, and certainly not a moral arc bending toward truth. Others noted that “truth” derives from trust and asked if science, especially the human sciences, could flourish in a society that was not true or free?
Postmodernist questioning of the natural sciences triggered the Science Wars. Physicists and physiologists who viewed science as real faced post-modernists, for whom scientific articles had become texts of uncertain truth value. The scientists called post-modernism a Cargo Cult. In World War II, US Air Force planes flying into Pacific islands disgorged all sorts of goods. The islanders were so impressed by these flying cornucopias that, after the military left, they maintained the runways and control huts, and flew the American flag, in the belief the right appearances would lead to the right results. These were the Cargo Cults – see image above.
The scientists turned to the Latin word for truth – Veritas – from which we get verification procedures. For them, verification procedures, the rules of the game, may be added to but are never reversed or undone and it is this that means planes fly. Post-modernism can conjure up airstrips and a flag but can’t get off the ground.
Medicine involves both trust and verification? Medical modernism began in Paris around 1800. From then, slowly at first, there was extraordinary progress, culminating in 1950s advances that seemed very far removed from a Cargo Cult.
But by 1968, Ivan Illich, Michel Foucault and others claimed a new technical medicine was arrogating to itself the right to pronounce on life, death, and disability. Medicalization was alienating us from our true selves rather than liberating us. An apparatus was replacing our natural moral instincts with a bureaucratic morality.
Battle lines were drawn over “the medical gaze” with one side seeing this gaze as a good, and the other as dehumanizing. The rhetoric pitted scientists, physicians and capitalism against post-modernists and socialism. The issues were vigorously contested – up to 1990.
It’s too simple to say the turn to quantification and operationalism in medicine triumphed. But for whatever reason, “critique” fractured into post-ism – post-structuralism, post-modernism, and now post-humanism.
While there had been a growing appreciation of the originality of the historical Marx, around 1990, with the fall of the Berlin Wall, the emergence of Prozac, talk of the Human Genome Project, the twentieth century discourse analysis and post-ism spin-offs from Marx’s work seemed an empty sociobabble that matched the psychobabble of psychoanalysis – and just as dispensable.
Just when it became credible to say that what passed for biomedicine offers the appearances of science rather than the real thing, that drugs are obviously being fetished, and the health care planes are stalling in flight, Michel Foucault and his successors bought into a biobabble – or in this case a bio-sociobabble.
Foucault pushed biopower and biopolitics and everyone else starting pushing bio even though those pushing it had little idea what they were saying. This was terribly obvious to anyone who had worked in a lab, or on anything that had a link to real biology.
The last thing any of us needed in the face of a tidal wave of new drugs – statins, osteoporosis drugs, SSRIs, ADHD drugs, hypogylcemics and others – none of which saved lives was to have more babble but that’s what we got. (Googling biobabble turns up the image below with some chinese characters attached to it. I’m not sure what it is but it looks appropriate).
When Guidelines can recommend medicines that are less effective and more expensive than older drugs, when the ability to Care is being replaced by conformity to mission statements that say: “Because our name is on it, We Care”, we need Adults in the Room. We have anything but. Wonderful people like Roy Porter – see What Happened – Nicholas Rose and others diverted into a toothless commentary on what was happening to us.
Any questioning of the changing climate in health is resisted by pro-vaccine and pro-drug climate change denialists from the BMJ and NEJM to the BBC, the NYT and Guardian, co-ordinated by outsourced industry PR groups like Sense about Science or the Science Media Centre, who mobilize the media and politicians to quarantine people with problems that have arisen from the vaccines they have given their children and the drugs they have taken themselves – because they were pro-vaccine and pro-drug.
The 1980s critiques of claims for the reality of diseases and the efficacy of treatments had some basis to them and they forced doctors to justify themselves, which is no bad thing – especially as most drugs are now given for non diseases.
But now pharmaceutical marketers can rewrite the text that is the human body from year to year with afflictions such as osteopenia, erectile dysfunction, and pediatric bipolar disorder conjured up by ghostwriters with not a peep from anyone. By the time anyone catches up, if ever, a new text will be in place. Its straight out of Orwell.
You’d have thought that it would be a simple enough matter to stop ghostwriting and make clinical trial data open to scrutiny but there is not a Minister of Health in the Western World willing to get involved.
The media are good at rotten apple in barrel problems but are unwilling to take on rotten barrel problems and at this point if they make programs about rotten apples they add to the problem by distracting attention from the barrel.
BBC’s File on Four prides itself on taking on the Mafia, the Israeli Secret Service, and all kinds of scary people – but ducked out of tackling NICE and their recommendations about antidepressants given to kids. What is it about NICE that I don’t understand that causes the BBC, Guardian and NY Times to soil their pants?
Through to 2000, we were at risk from a marketing good enough to conjure up air-strips and flags that fooled doctors. Our problems have become dramatically worse since our social media companies came into being on the back of weaponizing behaviourist ideas first put forward by John Locke and Alexander Bain, and later Ivan Pavlov and B.F. Skinner.
Previously it was the natural sciences that kept planes in the air – not the human sciences despite all the hot air they produced. But social media behaviourism has developed into a set of human science techniques good enough to keep planes flying. We and our doctors can now be tracked and manipulated nearly as precisely as the particles in Cern’s Hadron Particle Collider.
Big Panacea can now be confident that even if outcomes on treatment get worse there will be no consumer (medical) concern, because the consumers are so controlled they cannot conceive of alternatives. There is almost no possibility of discrepant data emerging to trigger an unwelcome thought. The control of information in this market is total.
Perhaps the greatest irony of all is this. Friedrich Hayek has been the bete noire for all post-ism practitioners. Faced with The Road to Serfdom, the foundational text of neoliberalism, they reach for the garlic and the crucifix. But no-one has captured the climate within our current totalitarianism as well as Hayek in his description of Eastern European science in 1944:
“The general intellectual climate which this produces, the spirit of complex cynicism as regards truth which it engenders, the loss of the sense of even the meaning of truth, the disappearance of the spirit of independent inquiry and of the belief in the power of rational conviction, the way in which differences of opinion in every branch of knowledge become political issues to be decided by authority are all things which one must personally experience – no short description can convey their extent”.
Rubber Hits Runway
Post-ism failed at a critical moment. It lacked a rubber hits the runway moment.
No-one in the last three decades analyzing the discourse of biomedicine has ever engaged with a drug wreck. None of those now agonizing about the objectivity of history or qualitative research have looked at the history taking or qualitative interviewing critical to caring when someone presents with a problem on treatment. No-one ever steps out of line and says – that drug has caused this person the problem they think it has caused.
Its almost impossible to imagine a mission statement to the effect that – We Care means that if need be we will take on pharmaceutical corporations and governments.
Will anything change now that life expectancy is falling?
Something Happened was Joseph Heller’s follow-up to Catch-22. It sank without trace. Even George Clooney might not know about its existence. Here are some quotes.
I suppose it is just about impossible for someone like me to rebel anymore and produce any kind of lasting effect. I have lost the power to upset things that I had as a child; I can no longer change my environment or even disturb it seriously.
I frequently feel I’m being taken advantage of merely because I’m asked to do the work I’m paid to do.
Some people are born mediocre. Some achieve mediocrity. And some have mediocrity thrust upon them.