Taylorism and the Doctor’s Office

From this vantage, distant point in my life, childhood meetings with doctors, whether at home–they still made house calls–or whether in the doctor’s clinic, appear as encounters with quasi-avuncular figures, benevolent, mostly-solicitous contacts with a wise, ostensibly caring person. I experienced my share of childhood illnesses, suffered from minor ailments, and almost always looked forward to meeting the doctors who treated me. Consultations took place in their office; preliminary wait in a reception, and then entry into the sanctum sanctorum; I sat on a stool next to the doctor’s desk; the doctor was nearby, walked around to his desk to examine me, and sometimes for more extended examination, moved me to an adjoining recliner. While the waits in the office were sometimes onerous, once told the doctor would see you, you got just that – a ‘meeting’ with the doctor. The doctor’s consultation space seemed made for healing.

The times, they’re a changin’.

To visit a doctor now is to experience a cold, unrelenting blast of Taylorist air, a journey through a land dotted with toll-collectors, each aspiring to rapid and efficient quota completion. You make an appointment and wait in the reception like you always did.  Then you are brusquely asked for your insurance forms, and made to fill out–just like at every other doctor’s office that you’ve been to before–a pile of horribly photocopied forms that ask for details on your medical history, whether you’ve understood your privacy rights, and a host of other legally required disclaimers. Then you wait again. When called in, you don’t meet the doctor. Rather, you are ushered into a small consultancy room, cold and bare, while an assistant screens you by conducting a preliminary examination. (You might have to wait a bit before the assistant shows up.) This preliminary examination over, you are left alone again, sometimes clad in a paper gown.

Then, the doctor–whose voice and form can be dimly discerned as he rushes about in the corridors outside–shows up; clearly in a whirl and a tizzy combined, he is brusque, efficient, and keeping an eye on the clock and his production schedule, his throughput. He reads the pre-examination form quickly, asks a few rapid questions–more often than not, not listening too closely to the stream of information a patient can provide on his body, his ailment–dispenses a quick, snap judgment, and leaves. A battery of tests is ordered; pharmaceutical prescriptions written; and you are told that the ‘assistant’ and the ‘receptionist’ will tie up loose ends. You change, head out the door, are reminded by the receptionist that the co-payment is due, and then, it’s all over. You emerge, blinking, into the sunlight, feeling not so much healed, but as if you had been trussed up, placed on an assembly belt, and had several pounds of flesh withdrawn – by the insurance company, by the doctor’s clinic.

The doctors maximize movement through their clinics; the tests ensure expensive bills can be sent in for insurance claims; the prolific prescriptions pad pharmaceutical profit accounts. The patient, meanwhile, many of his questions unanswered, his possible inputs to the diagnostic process ignored, returns home, disquieted by the experience, disillusioned by the wonders of face-to-face contact with a fellow human being, and supposedly a healer at that.

The Quantity Problem with Peer Review in the Sciences

Jack Hitt’s recent article in the New York Times touting the virtues of crowdsourcing peer review, of public comments on to-be-published or just-published scientific research, prompts me to offer a few thoughts on the problems in traditional peer review in a discipline—computer science—that I have had some exposure to in the past. In this post, I will concentrate on the forum for publication provided by academic meetings such as conferences or workshops.

First and foremost, far too much material is submitted for publication. There are thousands of  computer science conferences and workshops held annually. (This is not an exaggeration.) The reviewing for these events is carried out by the program committee, a loosely organized group of academics brought together to organize the event. Some members of the program committee constitute the original brains trust for the conference; yet others are invited to serve to increase the star rating of the conference—a conference’s quality is often gauged by the pedigree visible in the program committee—and to aid in the reviewing of conference submissions.

When submissions arrive, they are parceled out to the program committee for reviewing. In some cases, to ensure a more nuanced review, papers are assigned to more than one member of the committee; sometimes, however, a paper might receive only one review. This stage of the reviewing is often one-way-blind; the name of the author is known, but the referee remains anonymous to the author. In larger conferences, the reviewing is double-blind.

Academic schedules mean, inevitably, that the program committee member is over-committed: he has signed up for many academic events, and accepted as many invitations as he can, all in a rush to add lines to the CV, to increase his visibility in the community, to network. But now, conference submissions are in the Inbox, demanding careful, sincere, and honest review.

Unsurprisingly, the committee member is late with his reviews. The program committee chair sends out reminder emails; the harried committee member rushes off to review the paper,  gives it a perfunctory reading, and writes a brief summary and critique. This review is almost invariably a superficial assessment. Unsurprisingly a great deal of garbage gets past gatekeepers. Sometimes, the committee member with outsource or sub-contract the reviewing to a PhD student or a colleague.  PhD students can either very harsh or very mild reviewers; the former type bristles with aggression, eager to show off his newly acquired knowledge; the latter, diffidently taking his first steps into the professional academic world, hesitates to make critical judgments.

Sometimes a workshop or a conference will not receive enough submissions. Panic sets in among the program committee; the conference’s viability is threatened. Instructions go out to committee members: ‘Accept papers if they will spark discussion; accept them if they show some promise; accept them even if many call-for-papers guidelines are not met’. The conference is held; the less said about the quality of the papers presented, the better.

In computer science, publications in the proceedings of ‘premier’ conferences confer considerable prestige and are valuable additions to CVs; paper acceptances are a desired commodity. Interestingly enough, at the premier conferences, attendance lists are often made up of the usual suspects. This is partially ensured by the quality of the papers and also by the established authority of  the authors. Double-blind reviewing isn’t really ‘blind’; it is quite easy to determine the identity of authors by an inspection of the writing style, the  subject matter i.e., favorite hobby horses, sometimes even the formatting of mathematical symbols. (One research group always uses MS-Word to format their papers, as opposed to Latex; yet other uses idiosyncratic symbols for mathematical operators.) A not-so-confident reviewer, confronted with a paper written by an ‘authority’, holds fire. The paper makes it through. Yet another, knowing that this is written by an ‘authority’, lets it go through, because ‘it must be good’; others support ‘friendly’ research groups.

That last point brings us to the ‘paradigm problem.’  Fields of research often feature paradigms jostling for preeminence. Thus, reviewers are sometimes disinclined to favorably assess papers cast in the frameworks of competing paradigms but only too happy to enthusiastically accept those that show their own favored paradigm in a good light. Stories abound of academics who have experienced great difficulty in suggesting alternative frameworks to established paradigms that have cornered the market on conference committees and submissions.

Little can be done about the volume of research submitted for review. The modern academy has placed its members on the writing and publishing treadmill; like obedient children, confronted with the promotion and tenure process, academics comply.

But a great deal can be done about the reviewing process. More on that in a future post.

Note: This post is merely a cleaned up version of a post written on an older, now defunct blog (Decoding Liberation, named after the book.) I”m reposting it here because I wanted to reiterate my older worries, and to set up a preliminary to some soon-to-follow thoughts on crowd-sourcing peer review.

The Practice of Science According to Article Abstracts and Headers

Sometimes close reading of article headers can pay rich dividends. On Monday morning, my Philosophy of Biology class and I were slated to discuss a debate crucial to understanding adaptationist  paradigms: the role of bodyplan (Bauplan) constraints in restricting an organism’s  occupancy of possible points in developmental space, which complicates our understanding of the supposed ubiquity and optimific qualities of adaptation. This cluster of debates was kicked off by the Spandrels of San Marco controversy (which later morphed into the Gould-Dennett dustup).

For reading, I had assigned the original Gould-Lewontin article, “The Spandrels of San Marco and the Panglossian Paradigm: A Critique of the Adaptationist Programme“, and Chapter 10 of Dennett’s Darwin’s Dangerous Idea. The class discussion on Monday provided a very good example of how a crucial debate in science and the philosophy of science could be put into a broader context. I began the class by putting up on the projection screen, the first page of the G-L article (from the link above); in the seventy-five minutes of class, we did not get beyond a discussion of the title and the abstract; unpacking the meta-data of the article was extraordinarily useful.

As my students and I noted, this was a reproduced scholarly article, one originally published by a reputable source of scientific knowledge–The Royal Society of London; this led to a consideration of the relative  worth of different sources of scientific knowledge and the standards that might evolve for the publication and promulgation of scientific advances, and relatedly, to the role of copyright law in scientific settings. The fact that this article was now available on the Internet spoke to another set of criteria affecting its current availability. We noted that while author affiliations were not available, we could look them up to find out that in this case, the two scientists worked at a very reputable institution; furthermore, the order of the names at least indicated to us that they might have considered alphabetical ordering of their names as a way to brush past the issue of supposed priority in the authoring.

With this preliminary analysis out of the way, we looked at the abstract itself, whose opening lines establish it as the opening volley of a polemical battle that is sought to be engaged:

An adaptationist programme has dominated evolutionary thought in England and the United States during the past forty years. It is based on faith in the power of natural selection as an optimizing agent.

The first sentence clearly lays out the target of the argument to follow; the second provocatively uses the word ‘faith’ to establish what the authors take to be problematic about the target of their critique.

And then, we were off into a consideration of the article’s arguments as foreshadowed in the abstract. But importantly, we were no longer thinking about them in isolation from the larger, social and political setting of the science, the debates within it (and their rhetorical aspects). At the least, our little close reading of a piece of scientific knowledge had made clear many of the institutional features in a domain of scientific knowledge that underwrite and prop up its claims, and yes, its evolution over time.

Adaptation, Abstraction

This spring semester, teaching Philosophy of Biology–especially the Darwinian model of adaptation and environmental filtration– has reminded me of the philosophical subtleties of  ’abstract model’ and  ’abstraction’. More generally, it has reminded me  that philosophy of science achieves particularly sharp focus in the philosophy of biology, and that classroom discussions are edifying in crucial ways.

In its most general form, the Darwinian theory of adaptation by ‘natural selection’ states that adaptation results if:

There is reproduction with some inheritance of traits in the next generation.

In each generation, among the inherited traits there is always some variation.

The inherited variants differ in their fitness, in their adaptedness to the environment.

In teaching this version (taken from: Richard Lewontin, Adaptation. Scientific American.  239: 212-228 in Rosenberg and Shea’s Philosophy of Biology) I point out how much this concise statement of the theory leaves unspecified–the entity reproducing, ‘traits,’ the mechanisms of reproduction and inheritance, the sources of variance,  the nature of ‘fitness’, the extent of the environment, and the mechanisms and characteristics of the adaptation–even as it provides an explanatory framework of great power and scope. (This under-specification allows  the model’s statement too, in terms of interactors and replicators.)

The generality of the Darwinian specification reminds us of the practicing mathematician’s adage that the sparsest, barest definitions result in the richest, most interesting theorems. In this case, the theory works with a diversity of hereditary mechanisms and sources of variation, and does not require or imply any particular one. Rather, it merely requires that there be some  mechanism for heredity and some source of variation in heritable traits for every generation in every line of beings. I think it’s a fair bet to say that if there were any appreciative reactions in class to this discussion of the theory, they were grounded in a grasp of the theory’s generality.

Getting clear about the abstraction of the Darwinian model is crucial in understanding why it does not issue teleological explanations, why it cannot be understood as ‘progressive’, and why it is plausibly extensible to different levels of theoretical explanation in more than one domain of application. Later, our descriptions of  blind variation and selective retention as algorithmic processes enabled another reckoning with the abstraction of the model’s substrate neutrality. (Discussing this with my students reminded me of teaching the multiply-realizable computational model of the mind in classes on the philosophical foundations of artificial intelligence, especially as our discussion segued into an attempt to understand the abstract notion of computation.) In general, I sought to clarify why the model specified above is an ‘abstract’ one and what relationship its abstraction has to its generality and its explanatory scope.

Unsurprisingly, at moments in my exposition, I found myself rediscovering admiration at the theory’s Spartan outlines.  I was pleasantly surprised too, by how sophisticated my students’ interjections and questions became as they attempted to take on and apply the theory; they forced me to think on my feet in addressing them. More than anything else, their class responses reminded  me that a particularly important species of learning takes place in the course of teaching.

Labor Relations in Low Earth Orbit: The Skylab Strike

Three weeks ago,  the world celebrated the twenty-eighth anniversary of the end of the manned portion of the Skylab mission. Well, not really. Enthusiasts of manned space exploration certainly did; others had to be reminded. Students of the history of science can edify us about the scientific value of the three Skylab missions (meant to replace Apollo 18, 19, and 20). My interest here is to note the significance of Skylab for labor relations in space: the crew of the third Skylab mission, which lasted eighty-four days–Gerald Carr, William Pogue, and Edward Gibson–went on strike for a day during their stay before relenting and going back to work.

Their story remains a fascinating one, one illuminative of the dynamics between a rigid, controlling, science-regulating administration and a group of workers ostensibly selected for their discipline and the psychological wherewithal to resist the stresses of space. (By noting this incident, I do not mean to diminish the crew’s activities, and to reduce their twelve-week stint in space to this story.)

From the moment the crew went into orbit, their lives were a blur of experiment and regulation, tightly controlled by NASA at Houston. For every single second of their waking days the crew was prodded, poked, telemetered, scanned, and required to work through long, tedious check-lists of activities; every bodily function had to be recorded and regulated; this was, after all, a mission whose primary objectives included the study of the effects of long-term habitation in space. The interior of the Skylab space station might have been 350 cubic meters but there was nowhere to hide from Ground Control. This was a scientific experiment, on taxpayer expense, and NASA intended to get its money’s worth.

The trend of excessive, panopticon-like control of the crew had been set from the very beginning, when Bill Pogue had vomited shortly after arriving at the station, and decided, in collusion with the other members of the crew, to not  report the incident back to Houston. But the crew were being monitored and eavesdropped on, and soon they were being castigated like a triplet of hand-in-cookie-jar-schoolboys and being warned that all such incidents had to be recorded and reported. That early ‘eavesdropping’ incident was by far the most trust-destroying interaction between the crew and Ground Control.

Faced with remote discipline at its extreme, the crew asserted resistance. The crew acquired notoriety for ‘complaining’; they certainly had the most combative, unvarnished conversations ever with Houston, a far remove from the usual, sanitized excerpts that read, ‘Houston, all systems go, we are ready to go spacewalk and provide wonderful visuals’. Finally, matters came to a head, as Pogue, Carr and Gibson ‘took a day off’. I do not remember what Pogue and Carr did on their self-enforced furlough but Ed Gibson, the Caltech solar physicist, retired to the solar observation station and spent the entire workday recording images on his own sweet time, not bothering to make any detailed entries in his lab handbooks. ‘Negotiations’ followed; work schedules were altered; expectations adjusted, and work went on.

The Skylab story prompted much discussion about the regulation of work in space including suggestions the ’revolt’ really wasn’t one. But these do not discount the contentious, irritable, edgy relationship between Houston and Skylab-IV, and they certainly do not refute the notion that even highly motivated, highly trained, military types and scientists, fully convinced of the value of their work, when placed in an artificially controlled, too-tightly-regulated environment, are likely to find conditions oppressive and push back.

Nietzsche, Henry Moseley, and Conscript Armies

Years ago, as a schoolboy, I read Isaac Asimov on the evolution of the periodic table from Dmitri Mendeleev’s relative atomic mass version to Henry Moseley’s atomic number version. At the end of the essay, after describing Moseley’s contributions to devising the modern form of the periodic table of the elements, Asimov wistfully noted Moseley’s death in 1915 at Gallipoli (“”In view of what he [Moseley] might still have accomplished … his death might well have been the most costly single death of the War to mankind generally”). Moseley had enlisted (in the Royal Engineers and taken a sniper shot to the head; the Nobel Prize that might have been his in 1916 was never awarded. I was stunned by this coda to the seemingly straightforward story of scientific discovery that I had just been reading, and for years, was haunted by the thought of what the twenty-eight-year-old Moseley might have gone on to do.

It is said that Nietzsche has a line for everything. So, well, from Nietzsche’s Human, All Too Human, Section 442, Chapter 8 (“A Glance at the State”):

Conscript army. The greatest disadvantage of the conscript army, now so widely acclaimed, consists in the squandering of men of the highest civilization; they exist at all only when every circumstance is favorable-how sparingly and anxiously one should deal with them, since it requires great periods of time to create the chance conditions for the production of such delicately organized brains!….and, in fact, it is the men of highest culture who are always sacrificed in the relatively greatest number, the men who guarantee an abundant and good posterity; for these men stand as commanders in the front lines of a battle, and moreover, because of their greater ambition, expose themselves most to dangers.

As always, standard caveats about Nietzsche apply.