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Why the capitalist market model destroys the safeguards of some professions
The neoliberal call for more 'choice', seems hard to resist.
"Some of them are foreign-born and struggle with the language, and all of them are in distress! But I hardly have the time to explain the essentials to them. There's all the paperwork, and we're constantly understaffed.'
Such grievances have become sadly familiar – not only in medicine, but also in education and care-work. Even in more commercial environments, you're liable to hear similar objections: the engineer who wants to deliver quality but is told to focus on efficiency only; the gardener who wants to give the plants time to grow, but is told to focus on speed. The imperatives of productivity, profitability and the market rule.
Complaints come from the other side of the table as well. As patients and students, we want to be treated with care and responsibility, rather than as mere numbers. Wasn't there a time when professionals still knew how to serve us – a cosy, well-ordered world of responsible doctors, wise teachers and caring nurses? In this world, bakers still cared about the quality of their bread, and builders were proud of their constructions. One could trust these professionals; they knew what they were doing and were reliable guardians of their knowledge. Because people poured their souls into it, work was still meaningful – or was it?
In the grip of nostalgia, it's easy to overlook the dark sides of this old vocational model. On top of the fact that professional jobs were structured around hierarchies of gender and race, laypeople were expected to obey expert judgment without even asking questions. Deference to authority was the norm, and there were few ways of holding professionals to account. In Germany, for example, doctors were colloquially called 'demigods in white' because of their status vis-à-vis patients and other staff members. This is not exactly how we might think that citizens of democratic societies should relate to one other now.
Against this backdrop, the call for more autonomy, for more 'choice', seems hard to resist. This is precisely what happened with the rise of neoliberalism after the 1970s, when the advocates of 'New Public Management' promoted the idea that hard-nosed market thinking should be used to structure healthcare, education and other areas that typically belonged to the slow and complicated world of public red tape. In this way, neoliberalism undermined not only public institutions but the very idea of professionalism.
This attack was the culmination of two powerful agendas. The first was an economic argument about the alleged inefficiency of public services or the other non-market structures in which professional knowledge was hosted. Long queues, no choice, no competition, no exit options – that's the chorus that critics of public healthcare systems repeat to this day. The second was an argument about autonomy, about equal status, about liberation – 'Think for yourself!' instead of relying on experts. The advent of the internet seemed to offer perfect conditions for finding information and comparing offers: in short, for acting like a fully informed customer. These two imperatives – the economic and the individualistic – meshed extremely well under neoliberalism. The shift from addressing the needs of citizens to serving the demands of customers or consumers was complete.
We are all customers now; we are all supposed to be kings. But what if 'being a customer' is the wrong model for healthcare, education, and even highly specialised crafts and trades?
What the market-based model overlooks is hyperspecialisation, as the philosopher Elijah Millgram argues in The Great Endarkenment (2015). We depend on other people's knowledge and expertise, because we can learn and study only so many things in our lifetimes. Whenever specialist knowledge is at stake, we are the opposite of a well-informed customer. Often we don't want to have to do our own research, which would be patchy at best; sometimes, we are simply unable to do it, even if we tried. It's much more efficient (yes, efficient!) if we can trust those already in the know.
But it can be hard to trust professionals forced to work in neoliberal regimes. As the political scientist Wendy Brown argued in Undoing the Demos (2015), market logic turns everything, including one's own life, into a question of portfolio management: a series of projects in which you try to maximise the return on investment. By contrast, responsible professionalism imagines work-life as a series of relationships with individuals who are entrusted to you, along with the ethical standards and commitments you uphold as a member of a professional community. But marketisation threatens this collegiality, by introducing competitiveness among workers and undermining the trust that's needed to do a good job.
Is there a way out of this conundrum? Could professionalism be revived? If so, can we avoid its old problems of hierarchy while preserving space for equality and autonomy?
There are some promising proposals and real-life examples of such a revival. In his account of 'civic professionalism', Work and Integrity (2nd ed, 2004), the American education scholar William Sullivan argued that professionals need to be aware of the moral dimensions of their role. They need to be 'experts and citizens alike', and 'learn to think and act cooperatively with us', the non-experts. Similarly, the political theorist Albert Dzur argued in Democratic Professionalism (2008) for a revival of a more self-aware version of 'old' professionalism – one committed to democratic values, and an ongoing dialogue with laypeople. Dzur describes, for example, how experts in the field of bioethics have opened up their discussions to non-experts, reacting to public criticisms, and finding formats for bringing doctors, ethics consultants and laypeople into conversation.
Similar practices could be introduced in many other professions – as well as areas not traditionally understood as specialist vocations, but in which decisionmakers need to draw on highly specialised knowledge. Ideally, this could lead to trust in professionals being not blind, but justified: a trust based on a grasp of the institutional frameworks that hold them accountable, and on an awareness of mechanisms for double-checking and getting additional opinions within the profession.
But in many areas, the pressures of markets or quasi-markets prevail. This leaves our front-line professionals in a difficult spot, as Bernardo Zacka describes in When the State Meets the Street (2017): they are overworked, exhausted, pulled in different directions, and unsure about the whole point of their job. Highly motivated individuals, such as the young doctor I mentioned at the outset, are likely to leave the fields in which they could contribute most. Perhaps this is a price worth paying if it brings huge benefits elsewhere. But that doesn't seem to be happening, and it makes all of us non-experts vulnerable, too. We cannot be informed customers because we know too little – but we can't rely on being simply citizens any longer, either.
Up to a point, professionalisation is built on the persistence of ignorance: specialised knowledge is a form of power, and a form that's rather difficult to control. Yet it's clear that markets and quasi-markets are flawed strategies for dealing with this problem. By continuing to accept them as the only possible models, we forgo the opportunity to imagine and explore alternatives. We must be able to rely on other people's expertise. And for that, as the political philosopher Onora O'Neill argued in her 2002 Reith Lectures, we must be able to trust them.
The young doctor I interviewed had long considered leaving her job – so when the opportunity to get a research-based position came up, she jumped ship. 'The system was forcing me to act against my own best judgment, again and again,' she said. 'It was the opposite of what I thought being a doctor was all about.' Now is the time to help reimagine a system in which she can recover that sense of purpose, to everyone's benefit.
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Certain water beetles can escape from frogs after being consumed.
- A Japanese scientist shows that some beetles can wiggle out of frog's butts after being eaten whole.
- The research suggests the beetle can get out in as little as 7 minutes.
- Most of the beetles swallowed in the experiment survived with no complications after being excreted.
In what is perhaps one of the weirdest experiments ever that comes from the category of "why did anyone need to know this?" scientists have proven that the Regimbartia attenuata beetle can climb out of a frog's butt after being eaten.
The research was carried out by Kobe University ecologist Shinji Sugiura. His team found that the majority of beetles swallowed by black-spotted pond frogs (Pelophylax nigromaculatus) used in their experiment managed to escape about 6 hours after and were perfectly fine.
"Here, I report active escape of the aquatic beetle R. attenuata from the vents of five frog species via the digestive tract," writes Sugiura in a new paper, adding "although adult beetles were easily eaten by frogs, 90 percent of swallowed beetles were excreted within six hours after being eaten and, surprisingly, were still alive."
One bug even got out in as little as 7 minutes.
Sugiura also tried putting wax on the legs of some of the beetles, preventing them from moving. These ones were not able to make it out alive, taking from 38 to 150 hours to be digested.
Naturally, as anyone would upon encountering such a story, you're wondering where's the video. Thankfully, the scientists recorded the proceedings:
The Regimbartia attenuata beetle can be found in the tropics, especially as pests in fish hatcheries. It's not the only kind of creature that can survive being swallowed. A recent study showed that snake eels are able to burrow out of the stomachs of fish using their sharp tails, only to become stuck, die, and be mummified in the gut cavity. Scientists are calling the beetle's ability the first documented "active prey escape." Usually, such travelers through the digestive tract have particular adaptations that make it possible for them to withstand extreme pH and lack of oxygen. The researchers think the beetle's trick is in inducing the frog to open a so-called "vent" controlled by the sphincter muscle.
"Individuals were always excreted head first from the frog vent, suggesting that R. attenuata stimulates the hind gut, urging the frog to defecate," explains Sugiura.
For more information, check out the study published in Current Biology.
Are "humanized" pigs the future of medical research?
The U.S. Food and Drug Administration requires all new medicines to be tested in animals before use in people. Pigs make better medical research subjects than mice, because they are closer to humans in size, physiology and genetic makeup.
In recent years, our team at Iowa State University has found a way to make pigs an even closer stand-in for humans. We have successfully transferred components of the human immune system into pigs that lack a functional immune system. This breakthrough has the potential to accelerate medical research in many areas, including virus and vaccine research, as well as cancer and stem cell therapeutics.
Existing biomedical models
Severe Combined Immunodeficiency, or SCID, is a genetic condition that causes impaired development of the immune system. People can develop SCID, as dramatized in the 1976 movie “The Boy in the Plastic Bubble." Other animals can develop SCID, too, including mice.
Researchers in the 1980s recognized that SCID mice could be implanted with human immune cells for further study. Such mice are called “humanized" mice and have been optimized over the past 30 years to study many questions relevant to human health.
Mice are the most commonly used animal in biomedical research, but results from mice often do not translate well to human responses, thanks to differences in metabolism, size and divergent cell functions compared with people.
Nonhuman primates are also used for medical research and are certainly closer stand-ins for humans. But using them for this purpose raises numerous ethical considerations. With these concerns in mind, the National Institutes of Health retired most of its chimpanzees from biomedical research in 2013.
Alternative animal models are in demand.
Swine are a viable option for medical research because of their similarities to humans. And with their widespread commercial use, pigs are met with fewer ethical dilemmas than primates. Upwards of 100 million hogs are slaughtered each year for food in the U.S.
In 2012, groups at Iowa State University and Kansas State University, including Jack Dekkers, an expert in animal breeding and genetics, and Raymond Rowland, a specialist in animal diseases, serendipitously discovered a naturally occurring genetic mutation in pigs that caused SCID. We wondered if we could develop these pigs to create a new biomedical model.
Our group has worked for nearly a decade developing and optimizing SCID pigs for applications in biomedical research. In 2018, we achieved a twofold milestone when working with animal physiologist Jason Ross and his lab. Together we developed a more immunocompromised pig than the original SCID pig – and successfully humanized it, by transferring cultured human immune stem cells into the livers of developing piglets.
During early fetal development, immune cells develop within the liver, providing an opportunity to introduce human cells. We inject human immune stem cells into fetal pig livers using ultrasound imaging as a guide. As the pig fetus develops, the injected human immune stem cells begin to differentiate – or change into other kinds of cells – and spread through the pig's body. Once SCID piglets are born, we can detect human immune cells in their blood, liver, spleen and thymus gland. This humanization is what makes them so valuable for testing new medical treatments.
We have found that human ovarian tumors survive and grow in SCID pigs, giving us an opportunity to study ovarian cancer in a new way. Similarly, because human skin survives on SCID pigs, scientists may be able to develop new treatments for skin burns. Other research possibilities are numerous.
The ultraclean SCID pig biocontainment facility in Ames, Iowa. Adeline Boettcher, CC BY-SA
Pigs in a bubble
Since our pigs lack essential components of their immune system, they are extremely susceptible to infection and require special housing to help reduce exposure to pathogens.
SCID pigs are raised in bubble biocontainment facilities. Positive pressure rooms, which maintain a higher air pressure than the surrounding environment to keep pathogens out, are coupled with highly filtered air and water. All personnel are required to wear full personal protective equipment. We typically have anywhere from two to 15 SCID pigs and breeding animals at a given time. (Our breeding animals do not have SCID, but they are genetic carriers of the mutation, so their offspring may have SCID.)
As with any animal research, ethical considerations are always front and center. All our protocols are approved by Iowa State University's Institutional Animal Care and Use Committee and are in accordance with The National Institutes of Health's Guide for the Care and Use of Laboratory Animals.
Every day, twice a day, our pigs are checked by expert caretakers who monitor their health status and provide engagement. We have veterinarians on call. If any pigs fall ill, and drug or antibiotic intervention does not improve their condition, the animals are humanely euthanized.
Our goal is to continue optimizing our humanized SCID pigs so they can be more readily available for stem cell therapy testing, as well as research in other areas, including cancer. We hope the development of the SCID pig model will pave the way for advancements in therapeutic testing, with the long-term goal of improving human patient outcomes.
Adeline Boettcher earned her research-based Ph.D. working on the SCID project in 2019.
Satellite imagery can help better predict volcanic eruptions by monitoring changes in surface temperature near volcanoes.
- A recent study used data collected by NASA satellites to conduct a statistical analysis of surface temperatures near volcanoes that erupted from 2002 to 2019.
- The results showed that surface temperatures near volcanoes gradually increased in the months and years prior to eruptions.
- The method was able to detect potential eruptions that were not anticipated by other volcano monitoring methods, such as eruptions in Japan in 2014 and Chile in 2015.
How can modern technology help warn us of impending volcanic eruptions?
One promising answer may lie in satellite imagery. In a recent study published in Nature Geoscience, researchers used infrared data collected by NASA satellites to study the conditions near volcanoes in the months and years before they erupted.
The results revealed a pattern: Prior to eruptions, an unusually large amount of heat had been escaping through soil near volcanoes. This diffusion of subterranean heat — which is a byproduct of "large-scale thermal unrest" — could potentially represent a warning sign of future eruptions.
Conceptual model of large-scale thermal unrestCredit: Girona et al.
For the study, the researchers conducted a statistical analysis of changes in surface temperature near volcanoes, using data collected over 16.5 years by NASA's Terra and Aqua satellites. The results showed that eruptions tended to occur around the time when surface temperatures near the volcanoes peaked.
Eruptions were preceded by "subtle but significant long-term (years), large-scale (tens of square kilometres) increases in their radiant heat flux (up to ~1 °C in median radiant temperature)," the researchers wrote. After eruptions, surface temperatures reliably decreased, though the cool-down period took longer for bigger eruptions.
"Volcanoes can experience thermal unrest for several years before eruption," the researchers wrote. "This thermal unrest is dominated by a large-scale phenomenon operating over extensive areas of volcanic edifices, can be an early indicator of volcanic reactivation, can increase prior to different types of eruption and can be tracked through a statistical analysis of little-processed (that is, radiance or radiant temperature) satellite-based remote sensing data with high temporal resolution."
Temporal variations of target volcanoesCredit: Girona et al.
Although using satellites to monitor thermal unrest wouldn't enable scientists to make hyper-specific eruption predictions (like predicting the exact day), it could significantly improve prediction efforts. Seismologists and volcanologists currently use a range of techniques to forecast eruptions, including monitoring for gas emissions, ground deformation, and changes to nearby water channels, to name a few.
Still, none of these techniques have proven completely reliable, both because of the science and the practical barriers (e.g. funding) standing in the way of large-scale monitoring. In 2014, for example, Japan's Mount Ontake suddenly erupted, killing 63 people. It was the nation's deadliest eruption in nearly a century.
In the study, the researchers found that surface temperatures near Mount Ontake had been increasing in the two years prior to the eruption. To date, no other monitoring method has detected "well-defined" warning signs for the 2014 disaster, the researchers noted.
The researchers hope satellite-based infrared monitoring techniques, combined with existing methods, can improve prediction efforts for volcanic eruptions. Volcanic eruptions have killed about 2,000 people since 2000.
"Our findings can open new horizons to better constrain magma–hydrothermal interaction processes, especially when integrated with other datasets, allowing us to explore the thermal budget of volcanoes and anticipate eruptions that are very difficult to forecast through other geophysical/geochemical methods."