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Superconversations Day 11: Zac Davis responds to Benjamin Bratton, "On Deprofessionalizing Surgery"


#1

DAY 11 /// RESPONDING TO BENJAMIN BRATTON – ON DEPROFESSIONALIZING SURGERY, BY ZAC DAVIS

Cystectomy and Bowel Obstruction Surgery in the Gallery

Telesurgery, Photography by Derek Gregory, 2014.

With our intersubjective temporality constantly accelerating, we are now truly in in an age where all disciplines mix with other cross-disciplines, with seemingly no regard for boundaries. As technology increasingly becomes the mediator for the First World’s sociabilities, cybernetics has emerged as an intrinsic base through which all disciplines cross and with which they interact. In the past, many common disciplinary interactions would have been seen as random, while today they identify the enmeshing of complex systems interacting with other complex systems. These expanding systems and networks are the building blocks for what many perceive as simple constructions or operations like web surfing, text messaging, and social media use. More often than not, the tasks completed within these systems are, to at least some extent, automated, but would take longer to explain than most people can pay attention for. This in turn has been slowly subjecting the human mechanism to radical and often rapid changes through immersion, leaving most people with the illusion that “having all knowledge at our fingertips” has made humanity actually smarter. The fact that cognitive testing has shown that multitasking makes the human mechanism smarter, whereas later studies shows it diminishes our memory, confuses the matter further. This should not be conflated however, with the question of whether having a portable encyclopedia in our back pocket is not making us smarter.

Additionally, automation and its ramifications, unconsciously as well as consciously, are gradually becoming embodied within the everyday life of the human mechanism as benign infrastructures, often leading to disasters, and yet, in some ways worse, also leading to an absence of thought, or the ability to think without the support of groupthink and/or mass psychology. Automation also continually and radically blurs the boundaries between the actual and the virtual. One could say that the First World is now living in the society of technical images.

Benjamin Bratton’s On Deprofessionalizing Surgery is at its core about using robotics and assisted-automation in surgery. This practice has been tested for many years already, and has so far yielded some positive results. Anyone who cares about the health and future of the human mechanism should be able to see the benefits of this project. However, certain aspects of Bratton’s image of the summer camp, along with a number of statements made in the paper, strike me as odd, and even a bit contradictory at times. I understand his was a short piece, but in it he presents many grand ideas that do not get properly fleshed out, often leaving the aforementioned thematics hanging and forgotten. Additionally, many claims and justifications are made that are not expanded upon, producing an unsettling opacity with respect to what the central claims of the paper actually are.

Let us begin with the camp. We are told 11-14 year old children with an interest in science or medicine were involved. But we are not told about the selection process, who funded the camp, whether the children had to pay to be involved, etc. We are also told some were skilled video game players. But let’s keep in mind that a video game is always abstract and once the screen shuts off, the player is left powerless and lost. This ties in with the effects of robotics and automation in the sense that the tactile is abandoned in favor of machinic mediation when we are not sure if complete loss of tactile and specialized knowledge would result in actual benefits.

After a few paragraphs of tech-centered analysis, Bratton abruptly introduces Marcuse and his theory that automation could “alter social relations in a capitalist economy by making it unnecessary for humans to perform certain kinds of skilled and unskilled labor”. The next sentence is key: “he [Marcuse] wondered how automation could be used to realize a society based on exploring free time instead of acquiescence to the time of capital”. However, the text hardly formulates a hypothesis to support how this could be possible under current political and economic conditions. Don’t we all know by now that the realization of this ideal requires a society in which capital or the lack thereof does not impede the growth and development of the human mechanism or knowledge production? Is it not difficult to see a society full of “skilled video gamers” using “free time” constructively, or in a way that would benefit society or the planet at large at large? Further, post-Althusserian/Foucauldian and Lacanian thought, specifically Giorgio Agamben’s detournement of Carl Schmitt and his re-reading of the “classics” of political decisionism, has already dealt with the likelihood that the majority of sentient beings today have not and likely never will experience free thought.

One might also consider the drafting of children to perform tasks in this way as an early form of biopolitical thought-shaping: instrumentalized immersion and the production of an image of “having fun” while “learning”, whereas in reality, what we get is only a simulation of both, or someone playing the part of someone who does both. This then, returns our focus to the blurring of actuality and virtuality, and of reality and fantasy. The fact that the children did not experiment on real animals, but rather a piece of pig skin (itself a representation of the pig as well as a simulation of human skin), only further reinforces these points. In sum, the paper begs the question of whether in the “tech” community, the line between projects that are worthwhile advancements and those that are little more than doe-eyed, post sci-fi nerdiness that wastes taxpayer money on glorified cyber toys, is being steadily erased.

Even stranger is the fact that the summer camp culminates in an art installation. Bratton goes to significant lengths to inform us that two $2 million machines were used, a fact which is perfectly in line with the contemporary art world’s love for monetary quantification. How could one help but wonder about such a project when imagining someone becoming sick and choosing to have their surgery performed in the space of a gallery, perhaps as the relational aesthetic experience of others? But the humor, or its sense of unheimlich is lost to the fact that it might indoctrinate children into the sharp teeth of the art world quite early. Surely, a well-dressed crowd must have clapped politely after the performance.

Bratton also speaks about attempts to perform surgery across vast distances via the web, but then warns us that net neutrality laws, specifically the rules governing our global internet exchanges, do differentiate or prioritize certain forms of data over others. We already know that while there must be governing rules for the global exchange of data, conglomerates and government agencies like Google, Apple and NSA easily bypass them many times every nanosecond.

In the conclusion, Bratton introduces one of his own projects, emphasizing that it is based in Mozambique, where abortion was recently legalized, though unfortunately, many forms of backroom surgery still take place. While the attempt to assist is a valiant one, what costs more money: this project, or dealing with the problems at hand, like the generalized inaccessibility of real medical care? At the same time, what is the real effect of simply encouraging higher education, and the necessary building blocks that come before that in a country where only 43% can access clean water, the adult literacy rate barely cracks 50%, the country’s annual mortality rate for children under 5 years of age is 87 per 1000, and the annual GDP is $605? While I understand the importance of women’s rights worldwide, is this the best way to spend money in a country that lacks the most rudimentary basics we take for granted?

Assistance to Mozambique is clearly a positive step. But, at least as presented by Bratton, doing so introduces a number of questions. For example, does technology as such actually benefit anyone besides the data hungry inhabitants of the First World’s Society of Technical Images? Myother question is whether the tech world’s claims of “advancements” aren’t simply the equivalent of children playing with expensive science kits which have been purchased with tax money, while hoping something important or unprecedented might happen? Are these diversions really what we want to be spending our money on while attempting to advance the human mechanism, as well as prepare it for a true post/in/transhumanism? I’m all for social advancement, but why would this necessarily imply throwing out the practices of the old, in their entirety?

Zac Davis is a New York-based artist and musician.


#2

This piece by Bratton and the reply by Davis cited above bring to mind a number of issues when art interacts with science; science in particular as medicine, particularly surgery with art as installation.

The citation of Davis’ response must necessarily speak to a truth, that access to medicine in general remains insecure not only in Mozambique, but in the industrial world, and this circumstance is maintained by and through the unequal distribution of resources by capitalist forces. Secondly, not enough emphasis can be placed on the criticality for access to clean water, and given the claim by Peter Brabeck the CEO of Nestlé that access to water is not a right, we can see Capitalism’s “invisible hand” at work.

First, speaking as a trained physician, as a public health official, and as a scientist I must applaud Davis’ statements - clean water is a fundamental requirement for healthy communities. The allocation of health resources must necessarily go towards secure access to clean water, as well as other clean resources (such as air), and that these must be health priorities. John Snow and the Broad Street Pump Handle is the foundational epic of the science of modern epidemiology. It was through his sleuthing during a London epidemic in 1854 that cholera was found to be transmitted by contaminated water rather than “miasma”.

Recently the New Centre for Research and Practice have engaged speakers and dialogue regarding the repurposing of technology in a post-capitalist society. Consider the possibility of applying the technology lauded in the Bratton piece applied to real time monitoring of critical water supplies measuring flow and contamination and reported through “Big Data” for purposes of protecting and enhancing this essential for health.

Consider an installation with real time mapping of new Ebola cases, or traffic fatalities, or both for comparison, on a GIS based yet artfully designed map. This would serve not only an aesthetic but would communicate via art needful things, and in a manner not readily done via news media.

Surgery has sex appeal, no doubt about that, but thinking in post-capitalist terms, what medical services provide the most benefit? The answers lie in the unsexy medical realm of preventive medicine: access to basic and unsexy medical care where health is monitored for obesity, hypertension, elevated cholesterol, metabolic disorders such as diabetes and hypothyroid; where dietary and exercise regimens are recommended, vaccines given, breasts, prostates, and colons checked for cancer.

We are now learning with the relaxation of the formerly adversarial relationship the USA had with Cuba that this communist nation had prioritized health care and enjoys one of the best health care systems in the world, one which is based on population health. Physicians in Cuba, while esteemed and respected, do not hold the bloated social standing of so many medical specialists in the United States. Consider that if the technology of Big Data were repurposed to monitoring population health and interactions with food supply and other lifestyle choices that potentially great advances could be made affecting entire communities.

There is a need for the surgical technology in the Bratton piece, but the overall benefit to the health and well being of populations is small in comparison to public health interventions, vaccination for instance. In the United States the drive towards procedure based medicine has driven up the cost of medical care and thus enriched the healthcare corporations, pharmaceutical companies, and medical device manufacturers who profit most from these interventions and less so from primary care medicine.

That being said, the use of data and technology can be used to further medical care, reduces cost, and in transdisciplinary ways that are inclusive of practitioners of medicine, public health, IT, and media, but in a more controlled and appropriate setting than the scenarios of the Bratton piece.


#3

Zac raises good points, The Flusser reference and the hunger for data in the West etc. However, I think the outlandish aspects of the summer camp project should remind us of other seemingly benign military or government research projects that were eventually made practical. Think of drones. I don’t think Bratton’s tone is only congratulatory and in fact his neutral descriptions in a subtle way show the potentials but also limits of such technocolonial projects.


#4

I just wanted to add a few links and some thoughts/questions on these the text and the replies generated so far (note these are some rough comments and, like the nature of these two text, open to much debate).

Many of the examples in Benjamin’s essay are, for obvious reasons giving its scope and breath, standard and can also be found in Telementoring and Telesurgery: Future or Fiction? (By Vitor da Silva, Tom McGregor, Reiza Rayman and Patrick PW Luke). The authors back up the necessity of operative timings in the experiments in relation to net-neutrality as a problem of encoding/decoding: “the root cause of this delay are related with the encoding and decoding processes rather than the physical separation distance between operating sites.” Net neutrality is essential for preserving the end-to-end principle: in which the ability to transmit, measure, and acquire information (to encode and decode the bits) happens at the ends of the network and not within the network while this is the controversial pro-Net Neutrality argument it brings us to Zac’s “common-sense” point:

I find an odd, and perhaps tangential relation to this comment and Benjamin’s discussion of the summer camp’s side project: the medical hardware torrent search engine.

This reminds me of Shodan (discussed in Forbes magazine as well). Because I can not find any information about the medical hardware torrent search engine, this seems to be the next closest thing. (Perhaps a superficial relation, but Matherly, the creator of Shodan, graduated with a degree in bioinformatics at UC San Diego, the focus location for Benjamin’s piece). If Benjamin’s text (and the paper I linked) discuss how the advancements of these technologies make these devices and applications more and more prone to threats from time-critical or micro-events (latency and jitter), Shodan exploits device vulnerabilities using the end-to-end principle to search for many devices in today’s “Internet of Things”. Of course security has been taken into consideration for telesurgery (VPNe and such), this new televisuality of Shodan (peering into webcams, hospital operating rooms, etc.) poses a different threat to the time-critical nature of Bratton’s telesurgery dream of deprofessionalized and maybe even ubiquitous future.

On another note. Mohammad mentions the “seemingly benign military or government research projects that were eventually made practical”. I just want to link this article that relates telesurgery to what Mo is talking about here.

-Just want to mention one thing that Telementoring and Telesurgery mentions that isn’t brought up on the importance of training:

"To the laparoscopically naïve surgeon, this translates into a loss of confidence in performing a procedure in which they were previously skilled. Appropriate training and education are therefore essential for a surgeon to develop the necessary skills required in order to comfortably perform a surgery adequately and safely. […] The inability to provide adequate training opportunities and support for surgeons in the community continues to be the limiting factors determining the success and widespread availability of laparoscopic surgeries.”

And to conclude I wanted to quote the above paper because I feel the questions that they pose are interesting and even relate back to Zac’s comments on selection (although less specific to the summer camp itself):

"…who assumes the primary medico-legal responsibility for the long-distance procedure? Is it assigned to the bedside surgeon or the experienced surgeon based from afar? What happens if the telecommunication system fails? Are encrypted VPNe systems truly protected from individuals that are capable of ‘hacking’ into IP lines? There are other issues that exist for the telementor. How do we decide who is credentialed to be a mentor and how do we assign responsibility if the case goes awry? If the most experienced surgeon needs to assume responsibility, then it may be impossible to find any experts that would take on the responsibility of primary patient care without established and reliable financial or academic reward.”


#5

At the core of Benjamin Bratton’s piece is the relationship between speed of signal and clarity of signal, both of which, he explains, are necessary for successful telerobotic surgery via the da Vinci surgical system, and particularly in transcontinental conditions of conduct. While some tasks can be fully automated and thus cleared of such requirements for effective telepresent operations, other tasks still require human operators, at least as presently constituted.

Like the two competing robot policing units in Neill Blomkamp’s Chappie (the telerobotic MOOSE vs. the AI robot Chappie), Bratton asserts two competing future possibilities, either “remote telesurgery infrastructure”, or a “stable automated surgery economy”. Chappie, of course, trumps MOOSE by the end of Blomkamp’s film, but the development of AI in actual robotic surgery is not proceeding nearly as quickly as in the world of fiction, hyperstitional or otherwise. “Surgery in the Age of Intelligent Machines” is not explored in any depth therefore, and our focus remains on the necessary complications of remote telesurgery infrastructure.

The problematic here, therefore, is that of speed vs. acceleration, the latter of which Bratton defined in his introduction to the 2006 edition of Paul Virilio’s Speed and Politics, as “the speed of speed”, asserting that acceleration “is a physical fundament of reality, perhaps the most fundamental fundament.” While the da Vinci surgical system and Blomkamp’s MOOSE both lumber along, trying to find a speedy planetary connection, wouldn’t the more promising acceleration here be something a bit closer to the triumph of AI in Chappie, or in the writings of Amy Ireland?


#6

Yes, totally. They are so neutral rhetorically speaking that the neutrality seems uncannily unlikely. Drones are currently used primarily for military operations, but then in Alex Rivera’s Sleep Dealer, they are hacked and repurposed by precisely those they were developed to target. The printing press too, was developed to propagate the dominant world religions, Christianity in particular, but was also repurposed to different ends. Technocolonialism can be similarly repurposed, and indeed, already has been.


#7

How is this surprising? Aren’t artists waiting for anything that comes their way to turn it into a career opportunity?

That is just a common liberal way of reverting arguments into guilt. The whole issue is not about water or increasing their GDP. The issue at hand is generating new technological possibilities that might change the future of surgery and make it more accessible, not only for Mozambique but potentially the world. They could do the same project in America for all they care, and show it at the Gagosian too (pay a small fee and Larry will help you abort your baby). Yes, it is not really happening right now (and machines are expensive) but did you check out how many surgeons per capita exist in Mozambique? Even here in Canada and the ratio is laughable…

Which practices are you referring to? I think this is crucial. You mean affecting Mozambique’s cultures through acculturation? If so, then did the Americans stop being Americans when they gave up the horse and buggy for the automobile?


#8

I should make clear --as this piece has elicited some quite interesting responses-- that is is a work of fiction. In addition to straight Theory I also write these works of speculative fiction/design. E-flux/Sternberg is publishing a collection of these in the Fall called, Dispute Plan to Prevent Future Luxury Constitution.

The responses from UCSD Medical School have been quite weird and not what I expected. The replies in this discussion are quite welcome and not at all invalidated by having read the text in any particular way, as far as I am concerned… quite to the contrary.

Benjamin


#9

This is from a Facebook thread, but relevant here…

Rory, it is not just for this piece. In addition to straight theory, I also write these speculative fiction texts. See also the “Orchid Mantis of Sanzhi” or “El Proceso” on bratton.info for example. E-flux/Sternberg is publishing a collection in the Fall titled Dispute Plan to Prevent Future Luxury Constitution.

The intention is not “hoax” whatsoever. I find hoax very boring and pedantic (like YesMen). I’ve never had people think the fictions are true and was very surprised and some people did with this piece. It did not occur to me that people might think field surgery in Mozambique with Oculus Rift+gigabit ethernet+small manufacturing bots is, at this time, a viable initiative (for example). The actuality and plausibility of other aspects are what makes the piece (hopefully) provocative.

To your point, Rory Rowan the pieces mix do fact and fiction in ways that are not always readily apparent, but that in itself is not the main point. I assume the reader will know that certain things are true (that da Vinci robotic surgery systems exist and do certain things) and that other things are not true (that you can’t do abortions via Rift) and that in between are things that are factual or not factual, but truer than true in different ways. In the case of the Surgery text, the drier than dry reportage makes the events clinically distant (Ballard was of course the master of this) further de-emphasizing their relative facticity.

The most important teetering is not between what’s factual and what’s not (that is a given assuming that the reader understands this as speculative fiction/ meta-criticism) but rather between what’s a positive or negative vector (remedy or poison?) within the scenario. I can’t decide that in advance, but try to compose possibilities about which I am unsure (if they are positive or negative). Simple advocacy is not interesting to me. If I am unsure and uneasy myself then the scenario may be worth further speculation and experimentation.

Specifically, for the inhuman future into which tumble (including automation robotics, etc.) all that is exciting and wonderful is also disturbing and bizarre, and what is disturbing and bizarre may also be our best bet. To suspend our sense of the probable and the comfortable is just table stakes. The interesting and important moves ensue from there.

I thought the responses and critiques of the text on e-flux supercommunity, such as Zac Davis’ were great. If he critiqued the text as if it were true, so what; the voice of the text described these things as if they were true, and so that alignment is valuable. He offered an assessment of positive and negative implications of the developments staged in the text, and he went straight what is problematic about them. In some cases I thought he identified the seam of that problematic in ways that I intended, and in other cases, its obvious that he clearly sees the future described very different than I do. In the latter, I would emphatically disagree with him, but that disagreement is not a function of the text being fact or fiction, or whether he read it as one or there other, rather of how we see the “inhumanism” as as friend of foe.


#10


#11

To explain something to someone is first of all to show him he cannot understand it by himself. Before being the act of the pedagogue, explication is the myth of pedagogy, the parable of a world divided into knowing minds and ignorant ones, ripe minds and immature ones, the capable and the incapable, the intelligent and the stupid.
-Jacques Ranciere, The Ignorant Schoolmaster

Underpinning the dominant ideology of there-is-no-alternative, is a widespread belief that something needs to change, but that we, the common, everyday people are at the mercy of a big other, a master puppeteer in the guise of cynical politicians, billionaire plutocrats, economic technocrats and wizards of exotic financial instruments. This is largely true, but even deeper runs the belief that these figures possess access to a secret control room and all operate as a singular hive mind. Conspiracy theories abound with this view of the world, and us commoners feel an innate sense of inferiority in respect to these godlike creatures. There always is an other who knows who is responsible for shaping our everyday lives and struggles. This is not meant as a critique of some strand of revolutionary thought or movement, it is the attitude I encounter when speaking to work colleagues or when canvassing for progressive parties.

Bratton’s piece confirms multiple studies in the use of this alternative approach to pedagogy Ranciere proposes. For Ranciere, the traditional teacher, in the form of the master explicator, presupposes a fundamental superiority of the teacher over the students. It is the explicator who has special access to knowledge and only they can enlighten the student, who is deemed of inferior intelligence and unable to acquire knowledge without the help of the teacher. For Ranciere, the teacher’s role should not be one of explication, they must merely provide the space for the student to engage with knowledge. The teacher must awaken the will of the student to learn, but it is the student’s own will that leads to understanding.

It is not for nothing that exclusive private high schools in Australia are often called ‘grammar schools’, nor that top-tier universities mostly remain inaccessible to all but the children of the rich. The leaders of today are trained in these institutions to gain cultural capital, and it through this capital that they can awe us commoners. The truth is, as we know well with the bafflement of these technocrats when the GFC struck, they have no privileged access to the future. Why do they continue to hold such power over us, when they are riddled by internal power struggles and continue to promote simplistic economic and political policies, which not only have led to increasingly difficult conditions for the 99%, but threaten their own long-term interests as well?

Mark Fisher calls this inculcated inferiority complex wounds of class, this deference towards the experts and the rich. This is where I find the vital importance of radical pedagogy in destroying the illusion that keeps the vast majority passive and leads to what we think are bizarre voting decisions, where the working class will vote for Republicans in the US, the conservatives in the UK, or the Liberal in Australia. Of course there are many reasons for these outcomes, I merely wish to highlight the cultural capital aspect as one of many fronts we must be engaging on.

The Internet has democratized knowledge, however I do not believe the mere existence of the Internet is sufficient to begin to heal the deeply rooted wounds of class. Any project of the left should include not just class struggle and resistance towards power, but also include the axiom of radical equality of intelligences and organize similar learning experiments in multiple fields of knowledge. The 1%ers are not cunning oppressors, but merely opportunistic bullies mostly born into wealth and privilege, their Oxbrigde degrees must not intimidate us. We, the working class with little by way of formal education, must not only resist austerity and work conditions but also learn intimately how the economy works. Science and highly skilled professions also merit revisiting. This leads back to Bratton’s piece, both on the technology aspect and the medical profession.

I am not suggesting that we do away with the medical profession and allow any autodidact to perform surgery; this would be an irresponsible stance to take. What I am suggesting is that no domain of knowledge be considered immune from revisiting and we must think of how science and tertiary institutions could operate without the figure of the expert as the unquestioned guardian of its secrets. Zac Davis’s response rightly asked who were the children admitted into the programme, and I would question more generally what are the admission criteria for elite medical schools. Our undeniably complex world necessitates knowledge specialization, how would we organize, not just education, but more broadly - leaving aside the current left focus on revolution and resistance – how would large-scale operational administration of global-scale platforms work? Max Weber called bureaucratic administration ‘dominion through knowledge’, and even the very term bureaucracy today is an epithet. However it is here that we must appropriate the extensive studies in business and sociology to work out how the platform, the process of hegemony, can ensure long-term sustainability and the agility for rapid response to changing conditions by avoiding what business studies call toxic organization culture.

To conclude on the technology aspect, in Nick Srnicek and Alex Williams’s article “Cunning Automata and the limits of the Dromological”, they discuss the current arms race of high-frequency trading to shave a few milliseconds of latency in network links to financial market information systems. If only this network infrastructure was used to allow remote surgery that necessitates just these high quality network links to operate reliably. This again calls for a working class that is technically literate, and once the invisible barriers to the belief in the equal capacity of intelligence are broken and spell is smashed, just these types of projects of technology re-purposing will be possible.


#12

Reverse engineering.


#13

Any project of the left should include not just class struggle and resistance towards power, but also include the axiom of radical equality of intelligences and organize similar learning experiments in multiple fields of knowledge. The 1%ers are not cunning oppressors, but merely opportunistic bullies mostly born into wealth and privilege, their Oxbrigde degrees must not intimidate us. We, the working class with little by way of formal education, must not only resist austerity and work conditions but also learn intimately how the economy works. Science and highly skilled professions also merit revisiting. This leads back to Bratton’s piece, both on the technology aspect and the medical profession.

Absolutely, and one of the most important aspects of Ranciere. At the same time, Ranciere also held, in The Nights of Labour, that we should heed the perspective of the locksmith who, we are told, is very proud of his profession and capacities to carry it out, but who “would rather have been a painter”. The deskilling of surgery then, is not something to be merely lamented, but also something to be embraced insofar as a specialized skill becomes something that is open to many more people than before, who previously only had the nights of their daily labor to engage in, whether painting, protesting, practicing black-market dentistry, or what have you. Yes, the working class should resist the essentialist assumption that the rich are born with gold in their souls, but should also resist the assumption that the acts of painting or surgery are only for them and their progeny. I still recall the position of the tao.ca collective in Canada from when I was completing my MA in Vancouver, around the time of the first vestiges of social media - they held strongly to the view that only by getting into coding could one really have a radical relationship to technology, while those who played around with blogs, Geocities and similar things were not really engaged in technology in a transformative way. While there was some truth to this, why shouldn’t we celebrate this as a mode of partial automation that thereby creates free time for other things, whatever they might be? Certainly we don’t want a technically illiterate proletariat, but at the same time, perhaps a partial literacy is not such a bad thing either, given what it implies ontopolitically.


#14

I agree, and, even if the surgeon profession is highly-paid one, we must not ignore the reality of the many years of formal training, exploitative internship period, and the long, taxing hours that even a top surgeon puts in. This is exactly the Rancieran locksmith here. The demand for specialisation is both a structural one, and necessitated, to a degree by physical human limits. To become top surgeon and practice surgery, one has little time for anything else. And we’re all complex multi-faceted individuals, no one is just their profession.

Just because someone is a highly-paid medical professional, this does not automatically make them a ‘capitalist pig’. It’s not the surgeons who limit access to their knowlegde domain, it is the medical school managment that makes decisions as to who is worthy to begin training. And the surgeon, like any professional today, worries about losing their livelihood. So we combining a Rancierian democratisation of knowledge with an aim towards the end of work and UBI, would eliminate the need for knowledge hoarding by the professional classes.

In regards to your point on needing to know some knowledge domain intimately can there be a radical use of it, I also agree, we are all technologists to a degree, and I’d argue one needs some distance to better look at it critically. I guess my point was more around the problem of cultural capital. A distinction needs to be made between what is commonly known as liberal arts versus technical knowledge. It’s not for nothing that PPE degrees are the preferred by the elites. Awing the masses with big words and Oxford English is more important to them than the behind the scenes work of engineers and medical professionals. It is when these technical domains are uncritical they become tools in the hands of the powerful, so it is more a case of politicising the technical class rather then becoming the technical class.


#15

What does a radical administrative practice, or an administration compatible with a radical mission, look like? I remember reading about Vincennes and Black Mountain College folding because of what were essentially administrative problems. The inability of radicals to think through the problem of administration is, I think, a major obstacle to lasting change. We can think of a durable institution as a form of bounded, local hegemony (that’s what organizational culture is) that doesn’t have to operate within the global social context. To what extend do new protocols like blockchains or more simply productivity apps actually allow for distributed governance?


#16

@dxb setting up systems for automating the creation of irreversible and unhackable proof of work remains the most difficult element of moving from our dominant leftist and rightist organizational schemes (political movements, non profit, for profit and government) to one in which legitimate work will creates its own proof of getting done.


#17

“Read the third line from the top”


#18

A well put point, Ivan, the limits to training at least in the States are in place by a vast network of bureaucracy and regulatory control overseen by the powerful lobby of the American Medical Association. There is the AMA, then the training controls by the ACGME (Accreditation Council for Graduate Medical Education), state medical boards, medical school accreditation bodies, specialty boards, specialty professional societies, and so on. Each organization generates income for its leadership and benefits from fees and surcharges to physicians and surgeons. Access to knowledge, skills, and abilities is not only at the medical school level but at the post-graduate and professional practice levels as well.

In a post-capitalist world how would one repurpose the education of physicians and surgeons? One can already see the shape of things to come with the advent of advance practice nurses replacing the dwindling supply of primary care doctors in rural communities.

And finally the original piece speaks to remotely controlled robotic surgery; will this become a profession like the workers in Alex Rivera’s “Sleep Dealer” or Gavin Hood’s “Ender’s Game”?

And I ask again, what health priorities preserve the well being of communities to greater effect- robotic surgery accessed by those few who can afford it, or preventive services which may be affordable and accessible to many?


#19

I think you’ve hit the nail on the head. In some ways surgery by robots or surgery from a distance is trivial, since it simply takes the existing technical practices to the next level. The real difficulty with technology is always how we will adapt professions like nursing, which is the institutionalization of caring for; or other forms of maintaining/affective labor that are often gendered female.