The Reith Lectures, podcast and broadcast by the BBC (Radio 4), are an annual series of talks initiated in 1948 by the BBC's first director general, John Reith. Each year an influential thinker is invited to give four separate lectures on a given topic. This year's lectures are by Atul Gawande, a surgeon, Harvard Medical School professor, and a prolific writer of New Yorker pieces and popular OpEds about medicine. He is very persuasive and readable, and thoughtful.
Gawande's lectures are still being aired, with one still to be given, but we wanted to comment on their spirit, as described by Dr Gawande in an introductory interview in the first podcast. We think that MT readers who are interested in his important subject, the status of medicine today, would enjoy listening to them, too.
Gawande says that he wants to dig into the complexities of reality, and what we really face, pulling back the veil to see if we can't find a way through these complexities. As he puts it, he wants to be in the "disturbance business." He wants to disturb "all of us". This view is consistent with what he has written in those of his books and essays with which we're familiar.
"Disturbance" is a good term, one that obviously appeals to us, because in a sense we, too, in our very modest way, have been in the disturbance business. We recently retired from running a molecular genetics lab, though we are still doing at least some research and (hopefully) original writing. More importantly, for several decades we've been part of the system we write about and we believe we at least have some relevant thoughts about its complexities, and about how the system works and how this relates to its objective, the search for truth itself and its application to human betterment.
To some, now and always, any critique of a current way of doing things is seen as just cheap talk by cranks taking pot-shots without consequences, threatening a comfortable system. Or maybe these cranks are simply wrong about what is current in the given field. This is not an unusual reaction, not even in science which flatteringly believes itself to be 'objective'. But science these days is a large industry with many interests both intellectually legitimate and materially vested, and any field that becomes well-endowed and institutionalized will have aspects that deserve examination. Response to this kind of critique is one significant way, other than huge abuse and collapse, that such systems are driven, to change--whether in science, politics, economics, religion, or even more abstract academic fields.
Done right, the "disturbance business" is a necessary part of any field, though of course one always has to wonder the extent to which anyone can unrestrainedly see, much less really or openly dig into the problems in his or her own area. Critics might be outsiders or losers, venting sour grapes or settling one score or another. This sort of ulterior motive is obviously part of the human story, as groups, viewpoints, and so on vie for resources or attention. We grow into our careers to become dependent on ways we know and where we have influence and the like, and defensive reaction to challenge is only natural.
At the same time, there must be criticism, in the proper 'evaluative' sense of the term, and it can be done by people without a personal ax to grind. Critiques rarely have much effect unless they identify legitimate issues that can then resonate with newcomers, supporters, or even established people in any field. In the case of evolution and genetics, the science is as tribal and polarized as any field of human endeavor that controls a lot of resources can be expected to be.
Atul Gawande's critiques are often softballs, not very assertive or penetrating--he is, after all, a Harvard professor, but that is at least partly a matter of style. It can be contrasted with, for example, some of the most strident atheism voiced by some evolutionary biologists. They can be rather abusive in their assertion of the rectitude of their view.
But in genetics and evolution, if you read back into its not very long history, you can see that many of the same issues, perspectives (and vehemence) being debated now were already the subject of heated debate at the inception of these fields. The fact is that we still don't have a clear handle on genetic variation, ways it evolves, its nature of causal determinism, the role of probability, its status as 'information' that can be used predictively, and so on. And it is also a fact that very large amounts of money are being spent in pursuing goals with uncertain payoff, but with minimal, often quickly elided, caveats about the problems.
A common argument is that those in the disturbance business ought to just shut up about the problems and show everybody what to do instead, since criticism is cheap and real new answers not so. It is argued that we're doing our best and that's all we can do. After all, genetics isn't as costly as nuclear submarines or as dangerous an issue as, say, whether, how, or how legally we indulge in torturing prisoners during warfare. Genetics and evolutionary biology are garnering large amounts of resources, but not as much as, say, is being spent on Mars or other space missions with essentially no public payoff beyond some jobs and exciting news stories. So leave the genetics alone!
But that kind of dismissal of critiques is too self-serving. With limited resources, the issue is not whether this or that investigator gets a big grant and maybe doesn't really find much but maintains a job and jobs for his/her lab staff--and, down the line, for people who make DNA sequencers, and DNA extraction kits, and all the chemicals and everything else required to run a genetics lab. That's because there could be other ways of spending the same resources that could have, at least in the short-term, immensely more positive impact than what is being done instead.
We think that evolutionary biology and genetics pose questions every bit as interesting as the origin of the cosmos, and of importance to human edification. But we also think not enough hard attention is being paid the many unanswered questions, compared to the attention being paid to the current technologies and careerism. Just running expensive machines because we've got them, and that's what we know how to do isn't really answering the questions, or perhaps more accurately, diverts attention from even asking the right sorts of questions.
So, there is a need for the disturbance business--so long as it can keep from being its own sort of self-perpetuating system.