Monthly Archives: October 2014

Medical screening, overdiagnosis, and the motives of for-profit hospitals

Image by @spleenal (Nigel Auchterlounie), who blogs at Spleenal
Image by @spleenal (Nigel Auchterlounie), who blogs at Spleenal

[I don’t seem to be able to display that image anymore, but here’s a link to what I’m talking about.]

This superb graphic was created to dramatize what’s happening these days in the UK, where the National Health Service is being ruthlessly privatized. Here in the US, for-profit medicine is so taken-for-granted that we barely notice it. It’s true, we hear a good deal about conflicts of interest involving pharmaceuticals. Doctors get paid — in one way or another — to increase the profits of Big Pharma, a practice that is detrimental to the financial and/or medical interests of their patients. We hear less about scaring healthy patients into using doctors and services that increase hospital profits (also known as fear mongering). So it was nice to see a recent opinion piece in JAMA that discussed precisely this. Read more

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How we came not to care: Oligarchy of the elite

Side View of Statue of John Harvard by Daniel Chester French

The final post in this series on interrogating inequality is about another possible clue as to why we no longer seem to care about inequality. It’s from the book Excellent Sheep by William Deresiewicz.

The role of elite institutions of higher education

In his book, Deresiewicz argues that elite educational institutions reproduce a class system, exacerbate inequality, retard social mobility, and perpetuate privilege. Not only is the elite class that’s created by these institutions “isolated from the society that it’s supposed to lead.” It runs society for its own exclusive benefit. (emphasis added)

Our educational system, it’s been suggested, is what America developed in lieu of a European-style social welfare state to mitigate inequality. Instead of “handouts,” opportunity. And once upon a time, it worked as advertised. Both the unprecedented expansion of public higher education and the equally unprecedented opening of access to the private sort were instrumental in creating a mass middle class, and a new upper and upper middle class, in the decades after World War II. But now instead of fighting inequality, the system has been captured by it.

I mention this not simply as another possible clue, but because the article (Rebooting Social Science) that prompted me to write this series of posts appeared in Harvard Magazine. That may or may not be relevant to the attitude it expresses towards inequality, an attitude I found troubling. Read more

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How we came not to care: Historical trends

homeless-on-wall-street

Continuing my discussion of interrogating inequality, here is another post with a possible clue as to how we came not to care. This one considers a rather wide expanse of history

We have neglected to cultivate a culture that cares

I recently struggled through the book Governmentality: Power and Rule in Modern Society by Mitchell M. Dean. The book is very clearly written — the publisher calls it “exceptionally clear and lucid,” and it is. The book is intended, however, for experts already familiar with Foucault’s writings and lectures, particularly those on governmentality.

I frequently found myself in a fog, but I persisted. I was hoping to find ideas that would explain the changes that produced the contemporary self, including why we have become a society that fails to care about increasing inequality. And I did find a brief reference to this development in a section where Dean asks: “Where do our notions of ‘care’ come from?” Why do we think the state should care for the welfare of its citizens? Read more

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How we came not to care: Rosanvallon

rosanvallon-the-society-of-equals

How did we become a society that passively accepts the injustice and discrimination inherent in inequality? How did we come not to care? It would undoubtedly take me a very long time to adequately address that question, but in this and the next two posts I offer a few small clues.

We are each the stars of our own lives

First up is Pierre Rosanvallon’s recent book The Society of Equals. In a review of the book, Paul Starr mentions what may be an impediment to a society of equals: We see ourselves not simply as individuals, but as unique singularities. (emphasis added in this and the following quotations)

The story that Rosanvallon tells here is that as new forms of knowledge and economic relations have emerged, people have come to think of their situation in less collective ways. Since the 1980s, he writes, capitalism has put “a new emphasis on the creative abilities of individuals,” and jobs increasingly demand that workers invest their personalities in their work. No longer assured of being able to stay at one company, employees have to develop their distinctive qualities—their “brand”—so as to be able to move nimbly from one position to another.

As a result of both cognitive and social change, “everyone implicitly claims the right to be considered a star, an expert, or an artist, that is, to see his or her ideas and judgments taken into account and recognized as valuable.” The demand to be treated as singular does not come just from celebrities. On Facebook and many other online sites millions are saying: here are my opinions, my music, my photos. The yearning for distinction has become democratized.

Rosanvallon does not criticize the society of singularities, with its “right to be considered a star.” Since it’s now a fact of life, we need to figure out how to deal with it. Read more

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Interrogating inequality: Tony Judt

call-the-midwife-nuns

In a previous post (Interrogating inequality: An annoying article) I discussed an article about a group of interdisciplinary scholars who were “interrogating” the societal consequences of increasing inequality. While the group included individuals with backgrounds in psychology and history, it was dominated by academic scholars who specialized in economics, business, and public policy. (The first three individuals quoted in the article are a professor of business administration, a professor of management practice, and a senior lecturer at Harvard Business School.)

The concluding comments on inequality were offered by a professor of social policy. This particular individual “recently revealed” that he had given up on his long-term research on the social effects of inequality (a project he’d started in the 1960s) because there were no “convincing conclusions.” In other words, research had not been able to provide statistical proof that inequality is in any way harmful to society as a whole. As one of the social scientists put it: (emphasis in original)

The problem is, there is no consensus in the research on the consequences of inequality.

May I suggest that a more significant problem is that social scientists ask the wrong question. As Tony Judt writes (emphasis added): Read more

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