Something Rose said a couple of days back:
I can’t help wondering if banishing smokers to the outside of hospitals led eventually to the neglect of other patients such as in Mid Staffordshire. After all, it requires an entirely different mindset to go from the tradition of caring for your patients to punishing them…
What was the change in mindset? What happened? Perhaps it was the arrival of Evidence Based Medicine?
Evidence-based medicine (EBM) is a form of medicine that emphasizes the use of evidence from well designed and conducted research in decision-making. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to populations (“evidence-based practice policies”). It has subsequently spread to describe an approach to decision making that is used at virtually every level of health care.
Medicine shifted from an individual, personally tailored, almost-intuitive, family-doctor approach (often based on years of personal experience) to a population-level, statistical approach. Out went the family doctors who knew their patients, and in came mathematical social engineers. And in the process, humanity vanished, and it vanished because the individual person got buried in the crowd. He became a statistic.
It’s like a move from wearing individually-tailored clothes to wearing one-size-fits-all, off-the-peg, mass-produced clothes. The tailor fitted his clothes to the person. But now the person is fitted to the clothes. In the past the individual person was paramount, but now the clothes are. In the past, if the clothes were too tight, they were adjusted to be comfortable. Now if the clothes are too tight, the individual has to slim to fit them.
And what applies to clothes also applies to shoes, houses, offices, cars, and in fact more or less everything.
And one result is that the clothes and shoes never quite fit. They’re always one size too big, or one size too small. They’re never comfortable.
And so, instead of being given clothes that actually fit us, we’re being squeezed to fit the available single-size clothes. And so we have to stop smoking, stop drinking, stop eating. The problem isn’t the clothes; the problem is us. We’re too fat or too thin, too tall or too short. We are always deficient in some way. And we need to be encouraged to change our ways (and our shapes), and if we don’t change we must be forced to change.
It may be something that would seem to be inherent in the mass production of anything. A manufacturer designs something – say, a car for example – and he designs all its component parts, and then produces 100,000 almost-identical cars from the identical component parts. These cars may be too big for some people, and too small for other people, but there’s nothing manufacturers can do about it, and the people will have to adapt to the car, not the car to the people.
But with new manufacturing techniques, like 3D printing, in principle it shouldn’t be necessary to have a one-size-fits-all product. Each and every car could be tailored to fit its future owner, just by scaling the whole car to fit. And so would clothes and shoes and everything else. Everything would be tailored to the individual again. And everything would fit the first time it was put on, or stepped into. The individual would become paramount again.
So when you wanted a new pair of trousers, your precise measurements would go to the 3D trouser printer, and would be used to cut the exact pattern needed to fit you, from cloth of the exact type and colour you selected, simply by changing the parameters fed into the trouser printer. And a single trouser printer or shoe printer would run off thousands of unique trousers or shoes every day, rather than one single-size, single-colour product.
And while everything is a bit uncomfortable now, everything will be comfortable then.
Someone, one of those Indian gurus, once said:
“When the shoe fits, the foot is forgotten.”
Just not yet, however.