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April 17, 2023

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Sebastiaan Crul
April 17, 2023

Pills, pills, pills

Sebastiaan Crul discusses the inevitability of techno-fixes in a world haunted by crises
Sebastiaan Crul
April 17, 2023
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April 17, 2023

In the past months, healthcare news about a new wonder drug for obesity has dominated headlines. Under brand names such as Wegovy, Mounjari, and Ozempic, a new class of “miracle” weight-loss drugs have taken over the internet. Many celebrities swear by it, and TikTok videos hashtagged “Ozempics” have been watched over 600 million times.

Although the long-term effects still need to be studied carefully, most commentators declare the excitement is justified. This is quite surprising, given the fact that the history of weight-loss treatments is long and often shady. Ineffective drug treatments, dodgy charlatans, and terrible side effects have resulted in a bad reputation for weight-loss drugs, perfectly shown in the tragic unravelling of the character Sara Goldfarb (Requiem for a Dream, 2000). But the new kid in town is showing promising results in studies and trials, hence the widespread enthusiasm.

Originally, this new class of drugs was used to treat diabetes but it also proved to be effective in lowering the speed of gastric emptying and decreasing appetite. The side-effect of weight loss quickly became a goal in itself and medicines such as Wegovy were specifically made for weight-loss treatments. Market analysts think that a variant of the drug made by Eli Lily, “tirzepatide”, could become the best-selling pill of all time. Even though we can hardly criticize a drug that’s effective in countering obesity, the current hype and enthusiasm also symbolize a pattern in our society: the inevitable technological solutions to complex problems, or what we generally call a techno-fix. Apparently, in this world haunted by crisis after crisis, we cannot help but fall back on techno-fixes.

A welcome solution

But let’s not rush into a critical analysis of this repeating pattern. An effective drug for weight loss is most welcome. In 1997, the WHO declared obesity a global epidemic. Numbers vary, but around two-fifth of the worldwide population is overweight or obese and this number could increase to over half by 2035. Confronted as societies and governments are with the enormous size of this health crisis, any treatment that could help mitigate this problem is welcome.

Of course, the launch of this new class of drugs leads to the usual questions of safety and affordability. We simply lack knowledge about long-term consequences and given the fact that people are likely to have to use them for the rest of their lives, caution is essential. But many longitudinal studies are currently running and side effects are carefully studied. Affordability is also problematic: celebrities and the wealthy are among the early adopters, but for ordinary people, it is still rather costly. Furthermore, people with diabetes are now struggling to find Ozempic as the demand is so high. However,  in the long term, competition, government deals, and ending patents could bring down the price and increase supply. All in all, safety and affordability are not bigger issues than usual.  

However, on a deeper level, the news raises the more fundamental question: How is it possible that time after time, we only seem to be capable of handling complex multidimensional health issues with techno-fix panaceas? Drug substances remain the core solution to many health problems characterized by increasing complexity. It has become a pattern in society: we use SSRIs to treat depression, opioids for pain relief, vaccines for Covid, and now we have semaglutides to battle obesity.

Quick techno-fixes for complex problems

Viewed in isolation, it is hard to criticize these technological solutions. Vaccines, antidepressants, and weight-loss drugs (opioids are more debatable) are incredible medical innovations. Vaccines saved millions of lives during the pandemic and antidepressants can also be a life saver for many dealing with chronic depression. If this weight-loss drug lives up to its promises, it will undeniably help millions of people maintain a healthy body weight, lowering their risk of a multitude of health problems such as heart disease, diabetes and various cancers.

But it remains a fundamental problem that, despite the fact that we acknowledge the multi-causality of these health crises, we become too fixated on finding a technological solution to a social problem. We cannot blame this entirely on the government, the healthcare system or big pharma, we need to reflect on the role of society and science as well. I will focus on these last two.

Before we get into the inevitability of techno-fixes in our society, we will briefly revisit the problem of techno-fixes, which has been dealt with in great detail elsewhere. Techno-fixes confront us, again and again, with ugly unforeseen side effects. They are emblematic of short-sightedness and our preference for quick fixes instead of structural solutions. They can be extremely powerful in the short-term, but often at the expense of future generations. Hence, they are frequently superficial and are widely perceived as only dealing with symptoms. For example, now that the Covid pandemic has ended, society’s interest in the root causes of zoonotic diseases, such as ecological destruction, has faded. The vaccine was everything we needed. Another example: drug overdose death rates in the U.S. are alarmingly high and mostly linked to the prescription of opioids, an incredibly effective painkiller. Technological solutionism, as Evgeny Mozorov calls the paradigm of techno-fixes, reduces complex societal issues to snackable, one-dimensional and definable problems that can be solved and monetized.

The individual versus the System

This might seem counterintuitive. Haven’t we recently become more holistic and systemic in our approach to these kinds of problems? Take the issue of obesity for example. An often-heard response to the question of how to solve it nowadays refers to the need to address social and economic factors beyond the individual and her “free” choice. Some accepted measures are making meals in school cafeterias healthier and prohibiting supermarkets from nudging us into unhealthy choices. This has become par for the course for policymakers. But even though these types of action are not completely ineffective, they still feel rather insignificant. The increasing numbers of obesity speak for themselves.

The second impulse of society is then commonly to blame - typically in a cynical vein - capitalism. Then the problem becomes the “System”, written with a capital letter, making it something absolute, abstract and elusive. This is one of the true paradoxes of systemic thinking. Although we have embraced systemic approaches to systemic problems, we do not seem to be capable of actually dealing with a world characterized by systems. We have mainly become very good at proclaiming our captivity in and the inescapability of the systems we live in. But could it not also be the case that our perpetual thinking about overwhelming systems is what keeps us trapped?

In this case, the oppressiveness of the system is repeatedly described in the following way. Government and healthcare institutions can try whatever they want, but the food industry and big pharma companies, with their clever marketing guys and lobbying practices, are simply too powerful. Remarkably, even though we love to scapegoat bad capitalist companies, we often make them passive subjects of the anonymous power and profit play of capitalism as well. If we continue this line of thought, the Capitalist System is thus truly to blame.  

The diagnosis then becomes very clear. Capitalism prioritizes short-sightedness, companies only care about economic growth, and most importantly, the inherent dynamic of capitalism increases inequality. Because health problems such as obesity are intrinsically linked to poverty, unhealthy behavior is not a matter of choice but one of socio-economic variables in a capitalist society. There are too many; it feels like we can try to tweak any of these variables, but in the end, the System will triumph. Unintentionally, nowadays scientists and doctors add to this this feeling of impotency and helplessness of individuals by throwing in some evolutionary and genetic causes, along the lines of “we have simply evolved to hang on to fat, making it so hard to lose it.”

Of course, not everybody agrees. Neoliberals quickly jump in and never fail to address the importance of individual responsibility in public debates. Just do not eat the bag of chips, they tell us. Once the dominant position, I think it is justified to say that this stance seems to be held by a minority these days. When nuanced, they try to refine the image that we are fully victims of the system that imprisons us. However, because their rhetoric around obesity is not always very courteous, they have clearly maneuvered themselves into a difficult position.  

This debate about the powerless individual versus the overwhelming system leads to a dead end and has been going on for quite a while. On the one hand, empirical findings will hopefully enlighten us with new findings on which combination of (preventive) measures and interventions is most efficient (or for the cynics, least ineffective). But from a more theoretical perspective, we are still left with the problem of how a combination of entangled causes leads us to look for a techno-fix time after time.

The inevitability of techno-fixes in a world of crisis

I believe an important reason for this can be found in the ontology and language of thinking in terms of systems. To begin with, there is a tendency in this way of thinking to absolutize the individual and the system. Again, this is counterintuitive because system theory always speaks in terms of the levels of the organization. It is an inherent part of system theory to think in hierarchies or subsystems when analyzing a whole. However, it can hardly be surprising that academia struggles to incorporate the abstract, formal, and often mathematical thinking of this paradigm into our public debates and ethical discussions. Nonetheless, an adequate and rich language is exactly what we need to truly help policymakers and healthcare institutions properly address these difficult issues and counterbalance techno-fixes. No matter how scientifically sound the analysis is, it is also inherently problematic to call a child a subsystem of another subsystem (parents) within a broader system (neighborhood, school, etc.). Thus, perhaps systemic thinking is not so much the solution to multi-dimensional problems, but part of the problem as well (in a coming article, I will address this issue in more detail concerning long Covid).

Second, we are stuck in what we can call the paralyzing late modern worldview of permacrisis, in which we have fully lost the positive meaning and potential of the word crisis. This pushes us towards techno-fixes as the only option left.

Again, one of the causes is systemic thinking as it is intrinsically linked to thinking about inevitable and continuous systemic crises. To understand this intuitively, take a look at the following quote from the authors of the foreword of Ludwig von Bertalanffy 's seminal work General System Theory (2015 revised edition):

“The crises we face are systemic in nature. To overcome those crises we need to understand how systems work. To arrive at such an understanding we need to think systemically.”

It is hard to escape the tautological nature of this argument. My point is not so much that the obesity crisis isn't a huge social issue and that we have inflated the meaning of the notion of crisis. What I want to say is that our contemporary worldview, with its fixation on the idea of a “stack of crises”, can also be used as an excuse to deploy quick techno-fixes and hinder structural change. There is no after-the-crisis and there never will be.

Thus, we are not only stuck in crisis but also in thinking about crisis. Especially if we combine this dynamic with the fact that more insight into the complexity of a health issue does not automatically lead to better interventions. On the contrary, their perceived multi-dimensional nature can also confuse us and turn individuals and representants of the System against each other, thereby only adding to the controversy and impasse. After all, there is always a scientific theory and study available to criticize the other camp and this uncertainty can and will be used strategically.  

If this is all true, then it is not surprising that we are so drawn to the idea of a panacea. The inevitably of a techno-fix becomes inescapable. We simply long for a one-solution-fits-all and will deal with the fallout later. Drug makers, governments, and healthcare providers will all stress the importance of holistic and systemic strategies with multiple interventions, but “for the time being”, a quick fix is our best shot. The problem is that in our world (view) that is plagued by (thinking in terms of) crisis after crisis and tormented by the paradigm of “complexity” thinking, there will never be an end to this “for the time being”.

This dynamic also seems to be true for other complex and “wicked problems” of the 21st century, such as the climate crisis and energy crisis, to which geoengineering now seems to be the only realistic solution to many. In the 21st century, the discourse of persisting crises and wicked problems, merged with the temptations of techno-solutionism, will increasingly confront us with the imperative of “we have no other choice”.

Circumventing, not denying the crisis

If we want to escape this paralyzing and powerless feeling and truly counteract technological solutionism, we need to think radically differently without being naive. We do not need to deny the crises as such, a popular strategy for populists and stoics, let alone define a counternarrative focused on a story of progress, optimism, and opportunities (after the crisis). In my opinion, this would still get bogged down in the dialectics of the worldview fixated by permacrisis. The goal is to circumvent, not deny the crisis.

We need to explore other forms of thinking that escape these tendencies beforehand. This means a cultural diagnosis rooted in paradigms and worldviews that bypass the paralyzing dichotomy between the individual and the system in a world of persisting crises. In a series of upcoming short essays, I will further unravel this complex interplay and explore these different paradigms.

About the author(s)
Economist and philosopher Sebastiaan Crul writes articles on a wide range of topics, including rule of law in digital societies, the virtualization of the lifeworld and internet culture. He is currently working on his doctoral degree on the influence of digitalization on mental health and virtue ethics, having previously published dissertations on the philosophy of play and systemic risks in the finance industry.
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