Surrendering to Medical Technology
Medicine, myth, and Neil Postman's Technopoly.
Neil Postman, in his influential book Technopoly, laments the surrender of culture to technology. Part of this is the surrender of medicine to technology; in other words, an increasing reliance on machines (and computers, not to mention the recent advent of AI) to replace the role of doctor.
According to Postman, doctors are particularly eager to perform surgery on patients in American hospitals, despite less of a reliance on technology in European hospitals. He says that:
American doctors use far more X-rays per patient than do doctors in other countries. In one review of the extent of X-ray use, a radiologist discovered cases in which fifty to one hundred X-rays had been taken of a single patient when five would have been sufficient.1
What does this mean? Why are American doctors particularly zealous with technology and surgery? Money is part of the reason, but it also has to do with liability issues. The patient often demands to see the X-ray, so a physician’s recommendations might not be taken. Technology is a double-edged sword.
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Lynn Payer, in Medicine and Culture, describes the mythical dimension of Western medicine:
The once seemingly limitless lands gave rise to a spirit that anything was possible if only the natural environment...could be conquered. Disease could also be conquered, but only by aggressively ferreting it out diagnostically and just as aggressively treating it, preferably by taking something out rather than adding something to increase the resistance. 2
Postman considers the invention of the stethoscope (1816) to be one of the first technologies to distance patients from physicians. It essentially transformed medical practice—a doctor could no longer simply rely on a wealth of precedents and treatments. Their own experience was secondary to a new piece of machinery.
The future technopoly?
Stanley Reiser, in his book Medicine and the Reign of Technology, likens the stethoscope to the effects of the printing press on Western culture, highlighting concepts of objectivity and detachment (as found in writing). Reiser believes that a physician could “move away from involvement with the patient’s experiences” to a supposedly “objective” position. 3
Postman suggests that the stethoscope promoted the ideas that medicine was about disease—not the patient—and that technology was more reliable than either the patient’s or physician’s experience or beliefs. By subordinating the process to an X-ray, CAT scan, ultrasound or even a Hemoglobin A1c, the physician distances themselves from the patient and from their own judgment.
Unfortunately, the physician is placed in an awkward situation if a patient wants immediate results. With the risk of malpractice suits over their heads, especially in the United States where such suits are more common, doctors rely heavily on the technology even if the patient doesn’t need the test. Postman’s main arguments about the influence of technology in medicine can be summed up in three main points.
Technology:
Is not a neutral element in the practice of medicine. Doctors don’t only use technology but are used by it.
Creates its own imperatives and creates a wide-ranging social system to reinforce such imperatives.
Changes the practice of medicine by redefining what doctors are, redirecting attention and changing how they view patients and illness. 4
Expectations are placed on a doctor to act a certain way. We expect a doctor to perform within a social setting. As Joshua Meyrowitz observes in his book No Sense, No Place, we expect a doctor to appear:
Confident, concerned, patient and professional—and slightly superior. We expect a waitress to be efficient, respectful, and non-intrusive. And we demand these differences in “character” even if the waitress is a student earning her way through medical school. 5
These “roles” are not simply masks that are slipped on and off; they are “personalities we become attached to.” When we play a given role, it becomes real not only to the audience, but also to ourselves.
These expectations become part of how a doctor is mythologized—seen as something more than human and someone who is authoritative. In reality, doctors are people too. They may have gone to medical school and recited the Hippocratic oath and learned how to conduct open-heart surgery, but this does not make them superhuman. And it certainly does not make them the ones to have control over a person with diabetes. Indeed, the person who has it needs to make treatment decisions and run the show.
One could almost say, as Meyrowitz does, that access to information is putting a dent in the almighty practice of medicine. He says that:
Citizens are constantly seeking information on their “rights” and looking for protection from potential encroachments by high status people, big business or government. And the general trend toward “self-help care,” the feminist critique of the medical establishment, the return of lay midwifery, and the rise of “alternative birthing centers” suggest the demystification of the once almighty role of the doctor. 6
Ultimately, diabetes management is not something that should be placed solely in the hands of a physician, a machine, or AI. It must be the patient who takes responsibility for weighing the advice of medical professionals, selecting tools for treatment, and acting to manage it the best they can. Because diabetes has not been cured and can only be crudely controlled with insulin, highs and lows happen.
Postman’s Technopoly is a warning, not a prophecy. We should:
Be critical of technology and question its influence on our lives and values.
Promote media and technological literacy.
Ensure technology serves humanity, not the other way around.
We have a long way to go.
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Postman, N. (1992) Technopoly, Vintage, p. 94–95.
Payer, L. (1988) Medicine and Culture:Varieties of Treatments in the U.S., England, West Germany and France, Penguin Books, p. 127, as quoted in Neil Postman (1992) Technopoly, Vintage, p. 95–96.
Reiser, S. (1978) Medicine and the Reign of Technology, Cambridge University Press, as quoted in Neil Postman (1992) Technopoly, Vintage, p. 99.
Postman, N. (1992) Technopoly, Vintage, p. 105.
Meyrowitz, J. (1985) No Sense of Place: The Impact of Electronic Media on Social Behaviour, Oxford University Press, p. 31.
Meyrowitz, J. (1985) No Sense of Place: The Impact of Electronic Media on Social Behaviour, Oxford University Press,p. 167. For a more in-depth account of the feminist revolt against the traditionally male medical establishment, see The Boston Women’s Health Collective (1976) Our Bodies, Ourselves: A Book By and for Women, Simon & Schuster. For a discussion on the rise and fall of the authority of doctors, see Paul Starr (1982) The Social Transformation of American Medicine, Basic Books.