The best hospitals are now competing not only to have the best medical teams, but the best amenities:
The younger Mr. Frehse contrasted the unit’s mouth-watering menu with the “inedible food” his father faced when he was treated on the non-elite second floor. “Here he has mushroom risotto with heirloom tomatoes,” he said.
The hospital said in a statement: “NewYork-Presbyterian is dedicated to providing a single standard of high quality care to all of our patients.”
At Mount Sinai Medical Center, where the aesthetic of the Eleven West wing is antique mahogany rather than contemporary sleek, and the best room costs $1,600, William Duffy, the hospital’s director of hospitality, said his favorite entree was Colorado rack of lamb, adding, “We pride ourselves on getting anything the patient wants. If they have a craving for lobster tails and we don’t have them on the menu, we’ll go out and get them.”
The 19-room unit, which opened 18 years ago but received a recent face-lift, takes in $3.5 million a year, Mr. Duffy said, estimating that 30 percent of its clientele comes from abroad. If the emergency room is backed up, a regular patient may be upgraded, he added: “Bump ’em up to Business, as we say.”
The question of why this arms race of elite catering seems to have an obvious answer: the rich are richer and can afford it. But there have always been the super wealthy and yet . . . something has changed. Is it that we are staying longer in hospitals over all? Is it that the idea of “in home stay” with a visiting doctor isn’t feasible? Or are these ultra wealthy starting to discover that health care is about more than the most advanced body mechanic checking in on you once an hour. Are theses 1%ers groping towards the next big breakthrough in health care?
When every I watch old movies, there are two options for health care: either a kindly old doctor with a black bag who comes to the house or a traumatic, horrifying hostile hospital in which patients are treated like diseased cattle inside a THX-1138 style sterile environment. Is it really so unbelievable that where you receive your health care and what surrounds you during that treatment affects how you heal?
In a word, no.
Over at Cyborgology (a blog I am amazed I didn’t discover sooner, given its sister site is Sociological Images) Jenny Davis attempts to figure out if the assistive devices built by Ekso Bionics are “ableist” or if they represent genuine progress. She makes a pretty good case:
Less straightforward is the argument that Ekso represents a step backwards, a move towards the further denigration of physically impaired bodies. Here we have a product made to improve the lives of those with spinal cord injuries, and yet, it implies that walking, rather than wheeling, is necessarily the preferable state of mobility. I must point out here that a body in a wheelchair is already an augmented body. The technology of the chair, whether manual or electric, grants the mobility that is organically restricted. A practiced wheelchair user can indeed often move more quickly than a person relying on leg muscles alone. When in a wheelchair facilitating space, a wheeler can maneuver quite easily, accomplishing necessary tasks and acting independently. The problem, of course, is that many places and spaces do not facilitate such free use of a wheelchair. I wrote about this more extensively in an earlier post. With this in mind, I will now elaborate on is the difference between disability and physical impairment. It is in this difference, I argue, that we see the ableism that is built into the Ekso.
According to the social model of disability (as opposed to the medical model), an impairment is simply a physical condition. The legs are immobile. The eyes do not see. The ears do not hear. These conditions are inherently value neutral. They do not, in any essential way, hinder the extent to which a person can engage as an active member of society. These impairments become disabling, however, when experienced within an environment that fails to accommodate the spectrum of physical and mental states. Sight-only crosswalks are disabling for those with vision impairments. Public speeches without sign-language interpreters are disabling for those with hearing impairments. Buildings without ramps and/or elevators are disabling to those with mobility impairments.The technology of the Ekso assumes able-bodied advantage, and so works to fit the impaired body into an ableist environment. The impaired body is, by implication, devalued.
She had me until the section I’ve underlined (bold is the author’s). The problem? Davis conflates using wheelchairs with those who have mobility impairments. They are not the same.
The default state of a person who has mobility impairments is limping, stumbling, crawling or not moving at all. A cane might be all that is needed. Or crutches. Or a wheelchair. Or a power chair. There is a vast spectrum of mobility impairment and to imply that the manual wheelchair holds some sort of privileged status such that it is representative of all who have mobility impairments is faulty logic. Often these discussions tailspin into some “you’re more biased” than I, but that’s not where I’d like to go. Davis’ struggle is an intellectually honest one and she makes a reasoned effort to connect Ekso’s wonderful progress with her desire to prevent the otherizing and devaluing of those who wheel to get about. What her logic misses, however, is that the chair is merely a cruder version of Ekso. They are both mobility assistive devices, but one doesn’t require environmental modification.
Yes, our society is built around those who are able. That is, in large part, due to the fact that the vast majority of people are able-bodied. Ableist privilege can be framed as, “you’re disabled? It’s not worth the effort to change things for you.” Ableism dismisses the need for ramps and elevators or blind-accessible buildings and applications or deaf-accessible speeches and television. But we must also acknowledge what all of these things are: attempts to enable individuals when medical science cannot. We build ramps because we couldn’t come up with something better than a wheelchair. So our innovation turned to the environment, to make it wheelchair friendly. Then Ekso came along and reinvented the wheelchair.
When a person wants to build a tool to make the disabilities of others less disabling, they are not devaluing those with that disability. In a sense, our current effort to recognize the needs of the disabled is by making the man-made environment itself a tool to make a person’s disability less disabling. Any structure or system that makes the life of a person with a disability easier is an act of recognition that those with disabilities have immense value. The Ekso is not a privileged device that says those who wheel are inferior because this isn’t a discussion about those in wheelchairs, it’s a discussion about those who cannot walk. Ekso is a device that is designed to give those who cannot walk another option for mobility. A person who cannot ambulate as an able-bodied person must use an assistive device for mobility. Some of these devices are limited in their abilities and require modifications to the environment to allow the people who use them achieve mobility parity with the people who do not require assistive devices. The Ekso attempts to circumvent that and provide full mobility to those who are disabled without the need to modify the environment.
Technology is reaching a point where those who have been disabled can be re-enabled. We do not say we devalue the disabled when we cast a broken bone or do rehabilitative therapy to ensure someone is able to heal properly and walk again. Thus, those who focus on disability rights must begin coming to terms with the simple fact that options for the disabled will increasingly include a return to being able-bodied. Be it by direct healing of the injury, by-passing the disabled nerves, or by augmenting the body with cybernetics, those who are disabled will have more choices about how they want to be enabled. And that is a great thing. Ekso’s test-pilots seem to think so too.
In short, because everyone is a terrible lecturer. And there is proof from cognitive science studies:
In these test settings, various science curricula were revamped to get them to jibe with the latest cognitive science research on effective learning, which points to more interactive approaches that include immediately and repeatedly putting new information to use. Students in science courses were continually peppered with questions that they all had to answer via wireless handheld clickers. The students were frequently broken into small work groups to try their hands at solving problems using the material they had just learned, and they took at least two midterms each class.
The results have been eye opening. In a study published in the journal Science, one section of a University of British Columbia physics course about electromagnetic waves was taught by the cognitive approach, while another section was taught by the standard course lecture. The first group scored an average of 74 percent when tested on the material, while the second group scored only 41 percent. “We’ve been able to clearly demonstrate how much better we can do in teaching students,” Gilbert says.
Jamais Cascio points out that our vision of the future of technology is the same as it was twenty years ago. But our ability to predict social and cultural change is becoming more and more important, and that is way harder. Why?:
Some of it comes from a long-standing habit in the world of futurism to focus on technologies. Tech is easy to describe, generally follows widely-understood physical laws, offers a bit of spectacle (people don’t ask about “jet packs” because they think they’re a practical transit option!), and — most importantly — is a subject about which businesses are willing to pay for insights. Most foresight work is done as a commercial function, even if done by non-profit organizations. Futurists have to pay the rent and buy groceries like everyone else. If technology forecasts are what the clients want to buy, technology forecasts will be what the foresight consultants are going to sell.
Another big reason is that, simply put, cultural/political/social futures are messy, extremely unpredictable, and partisan in ways that make both practitioners and clients extremely vulnerable to accusations of bias. We’re far more likely to make someone angry or unhappy talking about changing political dynamics or cultural norms than we are talking about new mobile phone technologies; we’re far more likely to be influenced by our own political or cultural beliefs than by our preferences for operating systems. One standard motto for foresight workers (I believe IFTF’s Bob Johansen first said this, but I could be wrong) is that we should have “strong opinions, weakly held” — that is, we should not be locked into unchanging perspectives on the future. Again, this is relatively easy to abide by when it comes to technological paradigms, and much harder when it comes to issues around human rights, economic justice, and environmental risks.
Lastly, there’s a strong argument to be made that futurism as practiced (both the the West and, from what I’ve seen, in Asia) has a strong connection to the topics of interest to politically-dominant males. It would be too easy to caricature this as “boys with toys,” but we have to recognize that much of mainstream futures work over the past fifty years (certainly since Herman Kahn’s “thinking the unthinkable”) has focused on tools of expressing power, and has been performed by men. This is changing; the Institute for the Future employs more women than men, for example. In many respects, futurism in the early 21st century seems very similar to historiography in the post-WW2 era: still dominated by traditional stories of power, but slowly beginning to realize that there’s more to the world.
Data driven health care gets a new input source:
For the system, Proteus has designed sensors called ‘ingestible event markers’, which can be taken with pills or incorporated directly into medicines as part of the manufacturing process. In this system, the sensors will be embedded in a placebo to be taken alongside a medicine. Lloydspharmacy hopes to make the system, which will be marketed to people with chronic conditions, available from September.
[The sensors] are activated by stomach acid and are powered much like ‘potato batteries’, in which two different metals generate a current when inserted into the vegetable.
Each sensor contains a tiny amount of copper and magnesium, says Thompson. “If you swallow one of these devices, you are the potato that creates a voltage, and we use that to power the device that creates the signal”.
The digital signal, he adds, cannot be detected except by a device that attaches to the patient’s skin, much like a bandage. This device also monitors heart rate, respiration and temperature, showing how the patient responds to the medication. These data can then be relayed to a patient’s mobile telephone and shared with whomever the patient chooses.
The Society Pages’ Cyborgology dives into our weird relationship with the otherness of the disabled body. While the piece opens with the predictable discussion of Mullins and Pistorius, I was floored by Sarah Wanenchak’s use of Olympic speed skater Apollo Ohno:
Like the images of Mullins and Pistorius, Ohno’s body is explicitly being presented here as an attractive object. By most standards, Ohno is as able-bodied as one can get. But as I pointed out to my students, he manages this on the back of technology – on specially designed skates, in special aerodynamic suits, with the help of carefully balanced exercise and nutrition plans; almost no athlete is really “natural” anymore. But at least in part because of the closeness of his body to an able-bodied ideal, this presents no explicit threat to our categories. Ohno fits the accepted model of “human”. Who would look at him and doubt it? And if Mullins and Pistorius are perhaps not as close to that ideal, they at least fall into line with it, by virtue of the fact that they don’t explicitly question its legitimacy as an ideal – unless they seek to transcend it.
My point, in short, is this: we are uncomfortable with disabled bodies that question or trouble our accepted, hierarchical categories of abled and disabled, of human and non-human, of organic and machine. We are far more comfortable with them when they perform in such a way that they reinforce the supremacy of those categories. They become acceptable to us.
Ohno literally cannot compete without his equipment. About the only sport that had remained un-cyborgized was swimming (forgiving goggles, swim-caps, shaving, and that it takes place in a pool not open water) until the shark suit. To “disqualify” Mullins and Pistorius because they possess a mechanical advantage (or in the case of Caster Semenya, an unclear biological sex) underlines our poor understanding of sport as a celebration of physical achievement.
The discussion is akin to a question of the land speed record. We have records within circumscribed limits. The fastest km/h for a human, for any living organism (again, on land, ruling out swimming or flying), for a wheel-driven vehicle, and for any vehicle that does not take flight. These records measure different things, such as the athletic determination and dedication of a person mixed with genetics or the sheer engineering marvel necessary to make something break the sound-barrier without leaving the ground. If we simply want to see how fast we can go, Apollo 10 holds the record for manned flight and the Helios probes hold the record speed for any man-made object (faster than Voyager 1! I can’t believe it).
The point here is that as we continue to argue the “authenticity” of an achievement on steroids, or with aluminum bats, or what have you, it’s worth noting that all competitions are only relevant within their context and limitations that we’ve set to make them special.
Evolution is lazy and a spendthrift. Sure, it drives change, but it will cling to anything that is just barely good enough. As a result, every creature alive today has bits and pieces that don’t work so well. For example, humans are prone to choking and sinus infections because our resperatory pathways are fairly terrible for a mammal walking upright. Any worse and they’d kill us more often than not. But they’re just barely good enough.
The benefit of design is that, in theory, hundreds of years down the road (I am not an optimist when it comes to complex genetic re-engineering becoming viable in the near future) we will be able to look at the laundry list of broken and out-dated pieces on the human body and give them a bit more rational design. Randomness is what drives evolution when there is no pressures but those of nature. Design is able to take the errors from that randomness and refine the resulting entity.
Chris Mooney searches for one.
The primary weakness for me is that Mooney is convinced that conservatives are more biased. I don’t think they are. Mooney makes the implicit distinction that somehow liberals are “more tolerant” overall than merely on specific issues:
Moreover, while I dig this whole improving democratic-dialogue-about-science thing, I also think that if there is one group in society that is less open to such dialogue then that’s something we need to know. Political scientist Karen Stenner ends her disturbing book The Authoritarian Dynamic with the sentence, “some people will never live comfortably in a liberal democracy.” Stenner wasn’t talking about people inherently predisposed to deny facts, she was talking about people inherently predisposed to be intolerant of those not like them. But the two may well be connected; and both such predispositions are, in my view, potentially threatening to the kind of science-based democracy that I, for one, want to live in.
Mooney has made a rather strong case that conservatives have a serious anti-science bias, but his main point of research is climate science. In my experience, the bias is rather balanced. While conservatives tend to oppose “pro nature” science, that is, science arguing that nature is precious or powerful (i.e. climate change, evolution) liberals tend to oppose “against nature” science, that is, they either dislike tinkering (i.e. genetically modified foods or geo-engineering) or they accept blindly nature’s “goodness” (homeopathic medicines, silly diets).
He genuinely underestimates liberal bias against science. I would be far more interested in Mooney’s work if he was searching for the various anti-science biases among people.
Bioethics is controversial.
No one endorses the ideas or concepts explored here, not even me.
You will develop a strong opinion about something you find here. I want to hear it. Philosophy is a conversation.
popbioethics [at] gmail [dot] com
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