“The true creator is necessity, who is the mother of our invention.” – Plato, The Republic
I was at the Aspen Institute last week, where I am participating as a Health Innovation Fellow. During the four weeks we spend present at the Aspen locale itself, we use much of it to discuss, college seminar style, some of the great works of political, philosophical and social history. It is all very intellectual and a refreshing change from the every day, where Sophocles and Marx and De Tocqueville and Confucius rarely make an appearance. Especially in venture capital, we hear very little from Marx.
This particular week, The Aspen Seminar, was focused on how we, as people, can best define “The Good Society.” Hundreds of pages of reading and many hours of discussion were focused on the dichotomies of Freedom vs. Equality and Efficiency vs. Community. Great stuff. I had actually read most of the readings before when I was working towards my Masters in Political Science (or as I like to call it, my plan for permanent unemployment at great expense). But as an actual adult, or what passes for one anyway, these great works of great thinkers were so much more profound and their meaning marinated greatly by experience.
As we tooled through Plato’s The Republic (and I bet most of you haven’t read that in a while – I know I didn’t have it on my summer reading list), the quote at the top of this post popped up – necessity is the mother of invention. We hear this all the time, but I had forgotten where it came from. But what was far more interesting to contemplate was what one of the great moderators of the session, Keith Berwick, asked of the group as we read this, “At what point does invention become the mother of necessity?” It made me think this: has our current tech-obsessed culture turned Plato’s assertion on its head? And furthermore, is invention now the mother of desire rather than necessity, making it even more worrisome?
Now, our buddy Marx would definitely say that the inevitability of advancing productivity/technology has driven the bourgeoisie to keep up with the Joneses, driving everything to hell in a handbasket (my paraphrase ☺). And in some ways he may be right.
I was looking around the room of about 22 and every single person had an iPhone or equivalent. Many also had iPads or laptops and some had all three and even more stuff; I doubt the Space Shuttle has as much technology as this cohort of 22 people had on their immediate persons. This may not be the norm in rural South Dakota, but it certainly is in Northern California and similar environs. To operate in our local society, one must definitely keep up with the Joneses, or at least the Andreesens and Musks and Cooks. Is all this tech stuff really necessary in the true sense of the word? Definitely not if one looks at it from the standpoint of one’s ability to live in the world. They invented it and we want it and that is a whole other matter. If the lines that form when new iPhones are launched are any indicator, invention has certainly made a good run at becoming the mother of necessity.
I saw a New York Times article last week entitled “Why Useless Surgery is Still Popular.” The article talks about how so many surgical procedures, based on the invention of new technologies, became popular but have proven, over time, to be entirely useless and sometimes result in even worse outcomes than less technologically-“advanced” approaches. And yet, they are still performed with frequency. The author cites spinal fusion, vertebroplasty and some other technology-laden back surgeries as having no better outcome than old fashioned physical therapy. It describes how numerous studies have found that meniscus repair surgery has literally no positive impact on most patient’s ability to function. And yet doctors perform them even still (and patients ask for it), despite numerous clinical studies proving a lack of utility.
You might be cynical enough to say that this is because doctors make more money doing some of these procedures, and I am sure that, for some doctors, this may be true. But if you believe, as most do, that the majority of doctors are actually interested in the best thing for their patients, why does the invention of these procedures translate to their persistent “necessity” in the face of data showing otherwise? Those in the article say that doctors rationalize their decision to use the procedures and their related inventions by selectively remembering when it helped certain patients and forgetting when it didn’t help or actually hurt others.
We are all, it seems, fascinated by technology. Pokemon Go, anyone? But when it becomes the driver of behavior that has no basis in necessity, at least in areas like medicine where it actually matters, it is a really bad thing. This is especially the case when there is real life data that shows us what is actually true.
We are seeing an interesting revolution in medicine driven by 3D printing and virtual reality technologies. And some of these things are going to be inventions borne in every respect from necessity: printable replacement limbs and mental health treatments using visualization are two such examples of things we really need and are not able to get without technology advancements. But we need to be careful, in my opinion, not to go too crazy and start over-using these technologies because they are cool and not because they are necessary. We really suck at remembering that in healthcare. I can only imagine what we might start 3D printing if left to our own devices. Lord knows what Kim Kardashian will look like after the 3D printing revolution takes firm hold. Although maybe she can print herself a less annoying husband or build herself a virtual enough reality to limit seeing the one she already has.
As technology plays a greater and greater role in the medical realm, we have to maintain a much higher level of vigilance about the propensity for need and invention to get confused. It’s one thing to covet an iPhone, iPad, iCan’tBelieveSome oftheCrapISee; quite another to want to use or be subject to emerging medical technologies that may turn out to do more harm than good. This distinction is essential because we are becoming buried under the mountain of rising healthcare costs, but also because we are human and must do the right thing, as so many of the old dead white men who wrote most of the texts we read in Aspen have pointed out. Old, dead and white as they may be, they often had a very legitimate point.
One particular piece we read in Aspen really stuck with me. In his speech entitled The Need for Transcendence in a Post-Modern World, Vaclav Havel wrote this (bear with me – it’s deep and not to be found in BuzzFeed…. and substitute the word “technology” for “science”, which is how I decided to interpret it in my Aspen state of mind):
“The dizzying development of this science, with its unconditional faith in objective reality and its complete dependency on general and rationally knowable laws, led to the birth of modern technological civilization. [Ours] is the first civilization in the history of the human race that spans the entire globe and firmly binds together all human societies, submitting them to a common global destiny. It was this science that enabled man, for the first time, to see Earth from space with his own eyes; that is, to see it as another star in the sky.
At the same time, however, the relationship to the world that the modern science fostered and shaped now appears to have exhausted its potential. It is increasingly clear that, strangely, the relationship is missing something. It fails to connect with the most intrinsic nature of reality and with natural human experience. It is now more of a source of disintegration and doubt than a source of integration and meaning. It produces what amounts to a state of schizophrenia: Man as an observer is becoming completely alienated from himself as a being.
Classical modern science described only the surface of things, a single dimension of reality. And the more dogmatically science treated it as the only dimension, as the very essence of reality, the more misleading it became. Today, for instance, we may know immeasurably more about the universe than our ancestors did, and yet, it increasingly seems they knew something more essential about it than we do, something that escapes us. The same thing is true of nature and of ourselves. The more thoroughly all our organs and their functions, their internal structure, and the biochemical reactions that take place within them are described, the more we seem to fail to grasp the spirit, purpose, and meaning of the system that they create together and that we experience as our unique “self”.
And thus today we find ourselves in a paradoxical situation. We enjoy all the achievements of modern civilization that have made our physical existence on this earth easier so in many important ways. Yet we do not know exactly what to do with ourselves, where to turn. The world of our experiences seems chaotic, disconnected, confusing. There appear to be no integrating forces, no unified meaning, no true inner understanding of phenomena in our experience of the world. Experts can explain anything in the objective world to us, yet we understand our own lives less and less. In short, we live in the postmodern world, where everything is possible and almost nothing is certain.”
In medicine we have seen an emerging movement towards the reclaiming of empathy as a core value. We are seeing a significant interest in improving the patient experience and the physician experience. These are really good developments in my view. We need to put the humans back at the center of healthcare and use technology to solve necessary problems. Technological inventions for their own sake, without the true integration of the human touch, often turn out to be the mother of a kid no one wants to hang out with.
Don’t get me wrong, I’m pro-technology; but I also prefer actual books to Kindles – call me Neanderthal. And yes I am one of those people with an iPhone and a laptop and some of the other stuff that I could sometimes live without. But I have also seen the ill-effects of technology for technology’s sake and much prefer it when my doctor or nurse are talking to me and not to a computer screen. I have had the experience of being offered unproven, unnecessary procedures and also have had the benefit of technologically advanced and effective ones, borne of necessity.
I think the main thing is to find the balance and not give in to the gravitational force of invention driving what we think to be necessary, not what actually is. As Lincoln said, albeit in another context, “We must disenthrall ourselves, and then we shall save our country.” Similarly, we must let medical necessity be the mother of medical invention, and not the reverse, or we shall continue to regret it.