If, like me, you follow Ones and Tooze, you will know that Adam recently had heart surgery.
It was a big deal. Luckily, America has some of the best surgeons in the world, to whom only a small handful of Americans have access – but Adam Tooze is one of them. In the episode dedicated to the expensive American healthcare system/Adam’s heart surgery, he talks with great (and deserved) admiration about ‘his team’, the ones who will do the surgery.
We really want these surgeons to be good at what they do. The considerable advances in medicine, medical technologies and surgical techniques is what will (we trust) Save Adam’s life, as indeed they did. We want experts.
But we don’t want them to be dickheads about their expertise – meaning, we’d like them to be ‘our team’ who work with us, acknowledging our agency. And not arrogant, bossy, or taking control of our lives.
See, Adam is not only among America’s privileged (as he acknowledges), but he is also a member of the same professional class as his surgical team. As we all know, this doesn’t guarantee an absence of dickheads.
However, chances are higher that we can see other professionals as members of ‘our team’. By recognizing one another as members of the same class, encountering other members of the PMC helps confirm one’s own values and expertise.
What this also shows is that it is possible to be a niche expert but honour other people’s self-determination, our ability to make choices about our own lives.
Dickheadery is Systemic
Unless you’ve been hiding under a rock you will know that not that long ago, the CEO of UnitedHealthcare was shot and killed. Awful and violent, right. But also. Bullet casings with the words ‘deny’, ‘defend’ and ‘depose’ seem to have captured the ‘structural violence’ that some of the best commentators have argued needs to be understood. That is, there were two kinds of violence at work here. Firstly, someone got shot. And secondly, a kind of violent unfairness is structured into the system.
Australian journalist Rick Morton recently pointed out the ways that this kind of violence is structured through the economy.
Add this to Adam’s analysis of the structural unfairness embedded in the excessively expensive American health system with shameful consequences, including maternal deaths, we can see that systemic dickheadery has consequences that go well beyond hurt feelings to matters of life and death.
The urgency is clear. Daily reports from the USA about suppression of science, health information and government data show that since Trump’s second election, attacks on expertise have escalated beyond rhetoric to slashing universities and the public service – both peoples’ jobs and their ability to do them. This really must be opposed.
However, resentment about meddling experts is real, material and important. The response requires something rather like what I think Keynes was getting at:
If economists could manage to get themselves thought of as competent, humble dentists, that would be splendid. John Maynard Keynes 1936
As we know from Adam Tooze’s surgical team (and everything else…looking at you, climate science) we really need experts. But we also really need them to stop with the Meddling Managerialism, and instead systematize respect. And not just respect for expertise – respect for everyone who needs experts.
And that really is everyone.
{ 4 comments }
CHETAN R MURTHY 02.04.25 at 4:15 am
I clicked-thru the link to the podcast and listened to it. And it seems to me that there are three different sorts of things one might classify as “dickhead-ery”, that we ought to distinguish, b/c they’re different and come from different sources.
(1) It is sort of well-known that surgeons (among all doctors) are the most dickheaded. And that this comes about partially because surgeons are the ones who most directly are responsible for treating human beings as …. machines, not as people. This is to some extent because surgeons do something that is reasonable to view as something God-like. It warps their perception of themselves, and of other humans. Some of that can be fixed, but some of it is not fixable, b/c surgeons are mechanics who treat people like cars — at least, during the surgery itself.
(2) then there is the way that surgeons (in the US) are compensated very, very well, and this has the well-understood effect on the sociopathy of such people.
(3) and then, there are the sociopathic (and psychopathic) systems: bureaucracies, companies, structures of companies, whose goal is not to deliver health care, but instead to extract as much money as possible from as many other participants (and haha esp. patients).
I think structuring the problem this way is useful, because while #1 is something that we might not even -want- to eliminate, #2 is something that we ought to reduce (because extreme inequality is just bad), and #3 is something we MUST eliminate, because #3 is actually harmful to the delivery of health care, full stop. In the limit, you can believe that to get the best surgeons, you really need to compensate them in some crazy way, while still believing that all these rent-seeking bureaucracies full of people whose job it is to claw as much money from every other participant in the system as possible, are a bad, bad thing — a deadweight loss.
Anyway, just food for thought.
John Q 02.04.25 at 5:06 am
Agreeing with Chetan, it’s notable that surgical procedures have fared particularly badly when confronted with demands for Evidence Based Medicine, the advocates of which have a fair degree of arrogance themselves. Danel Davies would have something interesting to say about this, I’m sure.
CHETAN R MURTHY 02.04.25 at 6:12 am
John Q: I remember long ago, reading about some blinded trials where they tested the efficacy of a couple of surgical interventions:
(1) [I think it was] implanting stem cells into Parkinson’s patients brains
(2) opening up the knee and scraping something-or-other
In both cases, they actually went as far as opening up the patient and getting -right- to the point where they were going to do the surgical intervention; then for the control group, they just closed-up the patient. Obviously this required enormous care and informed consent from the patients. Turned out (HAHA) the trials showed that these particular interventions were no better than the control.
But it’s rare that surgeons will go that far to see whether their magic hands are actually doing any good. Rare. I can say that I’ve been lucky in my choice of orthopedic surgeon — he consistently tries every other intervention before reaching for the scalpel. Lots of surgeons aren’t like that.
russell1200 02.04.25 at 3:53 pm
I remember someone in banking telling me how Doctors were a favorite target of certain types of scams. Best I can tell, when a group of people have specialized knowledge, that other people can only get from them, that group will tend to expand its self-perceived competency well beyond its are of expertise. I have noted this with engineers who work within the building trades as well. I suspect that when the knowledge is a little less concrete (life-death, buildings collapsing), the effect will be a bit fuzzier, but it still seems to apply.
Comments on this entry are closed.