‘Every age thinks it’s the modern age, but this one really is.’ [Tom Stoppard]
The saying goes that you can tell something about a person by the company he keeps. If books are your company, then what you read may say something about what makes you tick (although the history of the 20th century provides plenty of examples of the love of high culture by many barbarians and butchers — medical humanists, please note). So, if I look back over the year, what sort of company have I been keeping?
Well, start with the Glenn Greenwald book about Ed Snowden and move onto Laura Poitras’s brilliant film, ‘Citizenfour’. Then look at why governments like surveillance, and why surveillance likes information monopolies, with a book I have been putting off reading for many years, Tim Wu’s magisterial treatise on the history of communication technology, The Master Switch. The latter not only serves as a primer on the relation between the control of communication, the state and the communication corporations, but opened by eyes to the way Bell (Labs/ AT&T) blocked human progress: the Kronos effect, whereby advance is retarded because it threatens those who have had a hand in creating it. If you think the internet really is different, read on and worry. Along the way, for those interested like me in tech and learning, remember:
The invention of film, wrote D. W. Griffith in the 1920s, meant that “children in the public schools will be taught practically everything by moving pictures. Certainly they will never be obliged to read history again.” In 1970, a Sloan Foundation report compared the advent of cable television to that of movable type: “the revolution now in sight may be nothing less … it may conceivably be more.”
I have read lots on education. Alison Wolf (Does Education matter?) demolishes lazy thinking relating education to innovation and wealth creation. I wish the GMC would read a little more on this theme. Rich DeMillo’s most recent book (Revolution in Higher Education) was not such an eye-opener for me as his earlier book, Abelard to Apple, but that is probably because I came to it later. For all the naysayers re MOOCs and tech, HigherEd is in a problem because it no longer represents good value for many of those who have been encouraged to go, and because its business model is falling apart. It does some things well — even very well — in comparison with many organisations, but ‘basic’ higher education — is not one of them. The finances all round are not going to get any better, and as even I got into academic print, many university VCs have a lot in common with the much derided CEOs of record companies when Napster and Steven Jobs and iTunes changed things a little. On this theme, Michael Crow’s ‘Designing the New American University’ is up there, too.
Universities, as well as financial problems, have existential problems. They have become lazy corporations, that have left ‘Donnish Dominion’ behind, and replaced it with a facade of consumerism, whilst pretending that they can still be guardians of integrity (and are worth our support for that reason, alone). Well, this is what was called Kissingeritis, or in anther context, the criticism Robert Oppenheimer received: you can be at the centre of power and ‘influential’, or you can speak the truth, but you can seldom do both within the same time frame. As yet, I haven’t had a chance to dip into my copy of ‘Reshaping the University: the rise of the regulated market in higher education’ by David Palfreyman and Ted Tapper. Lots of our UK universities think they are BMWs or Jaguars, imagining themselves close to Ivy League institutions, but the finances say otherwise, as does any scrutiny of how they have taken to looking after their academic staff or their students. Not Fiat 500s, but with effort and reform, they could be useful Golfs, but leave the rest for the glossy prospectuses.
I have been reading about medicine too, but my take on this is that there is even less serious work out there about medicine and medical education, than about our universities. De Selby got it right: ‘serious work takes over from relevance’ and besides everybody is now just too busy for serious work, let alone relevance. Indeed, the anodyne phrase that seems to end every media story about medical research, ‘more research is needed’ [subtext, please give generously], really has no place in medical education. I for one, would wish people would stop publishing papers, and instead join the dots about what we already know. It is as though we collect yet more and more studies linking smoking with poor health outcomes with smaller and smaller odds ratios, all published in journals that nobody reads, and then continue to dole out the Capstan full strength (untipped, of course) to our students. In any case, as in many walks of life, change in this area is unlikely to come from the academy, but from outside. Follow the money. Many years ago, Sydney Brenner, one of the handful of scientists who made the revolution that is modern genetics, wrote an article in Science. The series theme was the influence of Science on Society, but Brenner, true to form, looked at things differently, writing instead about the (largely pernicious) effects of society on science. Universities take note: our laboratories are not as fecund as Sydney Brenner’s.
If one thing surprises me about what I read and what I want to read — because I think it important — it is the irrelevance of much of the scientific establishment to some of out problems, a statement that I speak with some shame. Kenneth Galbraith commented (from memory) that ‘the denigration of value judgement is one of the way the scientific establishment maintains its irrelevance’. I loved the phrase when I read it but couldn’t quite ‘get it’. I do now. Tim Wu’s account of the communication industry makes no sense without the successive waves of technical advance that underpin that change. On the other hand, we learn that the way society and corporations chose to behave limited advance, and closed off ways to maximise human potential. The institutions we create, or allow to exist, all seem to me more critical than ever — for good or bad. The lesson for anybody brought up of natural science, that somehow it is all like the hero in Arrowsmith, that somehow magical discoveries by disinterested scientists will solve all our problems, is magical itself. Magical, as in mythical, or just plain untrue. Look at Jack Scannell’s work on drug pricing for a start, on why institutions as well as molecules are important.
Which sort of brings me to something else that I think important, and that is Larry Lessig’s work on institutional corruption which I have only just come across, despite having read some of his books:
“Institutional corruption is manifest when there is a systemic and strategic influence which is legal, or even currently ethical, that undermines the institution’s effectiveness by diverting it from its purpose or weakening its ability to achieve its purpose, including, to the extent relevant to its purpose, weakening either the public’s trust in that institution or the institution’s inherent trustworthiness.”
The field of “institutional corruption” was launched to help ethics grow up.
‘To help ethics grow up‘. I wish I had said that. GMC please note.
In the final chapter of the ‘Ascent of Man’, titled ‘The long childhood’ Jacob Bronowski after 400 pages on science and the culture of science, returns to a theme he has written about elsewhere, namely the relation between integrity, science and society. Bronowski was an optimist, and yet here he is wondering if Shakespeare and Newton will become historical fossils, in the way that Homer and Euclid are now. I feel less certain in 2016, than I did at the beginning of 2015. Hopeful, but less optimistic.