I was staying in Aubervilliers last November for a “Whistleblowers” Lanceurs d’Alerte conference. Aubervilliers is in the North-East of Paris – not one of the tourist areas. Some French friends suggested the reason Paris was hosting the Olympics was because it offered the authorities an opportunity to flatten that part of the city and regenerate it – clearing out the undesirables.

The conference was in the nearby Maison des sciences de l’Homme, whose métro stop is Front Populaire. The station name hints that this district was once at the heart of Parisian socialism. The hotel was on Rue de la Commune, the centre for the Parisian Commune uprising in 1870 that Marx and others thought might be the start of the expected communist revolution. Most of the metro stations, boulevards, and street names round about conjured up left wing heroes.

Rather than the ‘Revolution’, after 1870 the Commune provided an excuse to flatten these parts of Paris, and run wide boulevards through them to make them easier to invade and control. The boulevards helped make Paris the tourist destination it is today pushing it’s people further and further out.

The area from Aubervilliers to the Gare du Nord has its boulevards and parks, but is rundown.  The boulevards had drug dealing streetcorners and the hobos and junkies collected in the parks.  I mentioned to friends in one of the posher areas of the city one evening that I had to head downtown for an interview in a place near the Gare du Nord the following day and figured on walking.  Google maps suggested it would take an hour.

You can’t, I was told. It’s dangerous. You look like an American – you’re bound to be mugged. Please don’t.

I set off the following morning faithfully following Google Maps. There was a complicated bit to navigate, soon after starting, which ran beside a major motorway. There didn’t seem much of a path, more of a track, but it wasn’t much of a stretch, and things seemed likely to improve.

Pretty soon after setting foot on the track, I met a Hobo, who tried to tell me in words and gestures, this was no way to go. Dead end. He was gaunt, dressed in rags, and seemed agitated at what I was up to. Given the warnings I’d had, and aware of the computer and key worldly goods in my backpack, I wasn’t getting too near him for detailed advice. I was more worried that he was just the first of others I was going to have to navigate.

Turned out he was right. The track came to a dead end. The options were to retrace my steps or dash across a busy motorway. Death felt like a real possibility, but I dashed. After some more tortured hop skip and jumps I ended up on a boulevard.  Filled with what looked like drug-dealing or something that was a lot more interesting than I was. The boulevard was rundown, the air was grimy, and very few people in sight looked anything like me. Not a Paris that tourist me had ever seen before.

But I got to the Gare du Nord.

The route had not been pretty, not an advertisement for Paris. It had, however, been efficient and prettiness is skin deep. I’d learnt something more about Paris. But I’d learnt something more as well.  The route was efficient but could have killed me.

The Hobo was a better guide than Google. If I’d heeded him, the route would have been a lot safer, probably cleaner and less polluted.  Is efficiency the supreme virtue or is there more to life than efficiency?

TAiL Wags God

This brings us back to Weber’s dilemma outlined in Technological Assistance in Living – where if anywhere does morality enter into what he then (1900 A.D.) saw as our new science based world?

In Politics as a Vocation, Weber introduces the leader of the nation as the Deus Ex Machina who would bring the element of individual judgement into the technological machine and bureaucratic machinery. But, while he stresses that the leader takes responsibility for doing this and the people might decide to vote him out of office as a result, it feels semi authoritarian, surprisingly so for a liberal like Weber. This may have been why he found it difficult to get a buy-in from German socialists – who he was trying to persuade not to imprison us in an Iron Cage of bureaucracy, a Deep State.

Science gives rise to technologies but science and technology are fundamentally different. Technologies eliminate judgement calls. The algorithm in any technology embodies a fixed path from A to M.  This is the same with bureaucratic techniques, which differ from law in a way that parallels the distinction between science and technology. Bureaucratic technique embodies a fixed path from N to Z.

We need science not technology when a doctor is faced with a person who has become suicidal after consuming a technology like Singulair, Accutane or Cymbalta, someone who has not gone from A to M as planned or hoped. Science involves a judgement call as to how we might now get from A to M. It needs not just a judgement call by a medical leader or dictator, but as with all science a judgement that embodies a consensus.

It was once second nature for doctors to accommodate to the idea that their technologies which could help often didn’t. They now find it increasingly hard to accommodate to this.

In the same way, there is a real crisis in law at the moment, anticipated perhaps by Weber who was worried about an inevitable encroachment of Deep State bureaucracy on government.  In his day, this encroachment was giving rise not just to the Kafkaesque figure of a bureaucrat but also to regulations. Both bureaucratic procedures, and regulations governing the production of technologies like drugs to certain standards, were encroaching on law.

The bureaucrat ethic involves sending 6 million to the gas chamber if that is what the orders from above say. There is no way to hold the bureaucrat personally liable in circumstances like this.

Similarly if companies keep to agreements with regulators like FDA or EMA as to what they need to show in order to get a license for their drug they are effectively above the law, if tens of thousands die, unless perhaps it can be shown they have cheated in some way.

If the Holocaust was the supreme example of where bureaucratic virtue could take us, a company maneuver, twenty years ago, probably not widely known about outside of US medico legal circles is a good example of where regulation can take us.

From 2004, following the Vioxx and the Antidepressants and Suicide catastrophes, companies began arguing that if FDA had approved a drug and drug label, the company was effectively immune from legal action in the event their drug appeared to cause an injury.

The word Pre-Emption came on the radar of everyone with an interest in drug induced injury cases. FDA approval, it was argued, pre-empted actions against a company. The waters got murky at this point. The Pre-Emption argument was put forward by the Chief Counsel to FDA, Dan Troy – who was ex-GSK. This close connection between companies and such a convenient argument likely didn’t help them win in the end but they did win battles on the way and got a lot of cases thrown out.

Innocent until Proven Guilty

Lawyers today have the same sense of bureaucracy and regulation encroaching on what was traditional legal practice, as doctors have of guidelines and FDA approvals encroaching on traditional clinical practice and seeming to convict a person having problems on a drug without the doctor being able to assume the patient was innocent – and their claim the drug is causing the problem is correct – until proven guilty.

In legal circles, many lawyers appear to think they should not defend a figure like Harvey Weinstein.  But as with science, its at moments like these that justice demands a hearing with a jury able to come to their own consensus as to what the evidence they have been faced with indicates – whatever a surrounding bureaucratic, media or cultural consensus might indicate..

In a Weinstein like case, it’s not bureaucratic process or regulation getting in the way – it’s Google or Michel Foucault or both.  Apart a link to Harvey Weinstein through prolific sexual activity, how has Michel Foucault emerged onto this stage?

Briefly a member of the Communist Part in the 1960s, Foucault split from the party and went on embrace an apparently democratic Governance from the Bottom Up rather than Government from the Top Down, which he argued our newly developing abilities to collect data on our activities might put within our reach.  The numbers would replace the Rule of Law – which was a nineteenth century Liberal way of managing the world.

Translated into a new fangled idiom, our data exhaust would enable us to ‘choose’ the efficient, which of course is the rational, course of action.  Google is a machine for doing precisely this.

Google, however, is like Randomized Controlled Trials (RCTs) in that both generate data on non-existent average people. These marriages of technology and technique generate a Deep Mind to complement the Deep State that worried Weber.  Deep Mind in this sense shapes the reactions of lawyers who turn down cases in the way Guidelines shape medical minds so that they increasingly cannot see or hear the innocent person in front of them.

Science and law, in contrast, share a common value centered on a freedom that allows Us to make judgement calls based on the observables We have seen, even if these conflict with what a Deep Mind or Deep State suggest should be happening . The We element of this last sentence points to a democratic basis critical to science and law. Arriving at a ‘We‘ is arriving at a crack through which the light gets in.

Deep Mind affects not just our abilities to do science and law, it looks like it also affects the most intimate things we do, the way we parent for instance, in other words the way we make people, and it may be playing a part in falling Fertility Rates also – see Shrink Yourself to Better than Well.


The post Efficiency is not the Supreme Virtue first appeared on Dr. David Healy.

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