Duplicated effort

Just about every university in the UK has an 'institutional repository' where staff and student publications are deposited for open access. Why so many, why duplicate all this effort and expense? Why can't we have national repositories - the British Public Library of Science, the British Public Library of Social Science, and so on for the Arts, Humanities, Medicine, etc. 

Putting the book together

Just like runners, writers have a length to which they seem naturally suited. For me, it's about 8000 words - the perfect length for an article in Social Science and Medicine or Sociology of Health and Illness. So for me, beginning to assemble something ten times that length is a purgatorial. I say assembling, rather than writing. Much of what will appear in May and Finch's Normalizing Health Technologies has already been written in one way or another. So I am arranging and organizing what has already been composed and identifying the gaps. 

What's purgatorial about writing a book? I'm immensely privileged, of course. I'm being paid to put our thoughts down on paper, Tracy Finch and I have a publisher arranged (Palgrave MacMillan), and funding for a conference in London next year when we will be able to launch the book alongside the web-enabled toolkit and users manual for Normalization Process Theory. So in some ways, it's a pretty spectacular deal. We're privileged too, because we're getting in near what may be the end of the paper book.

Nothing is ever enough, of course, and so I'm complaining about having to identify the gaps. Our book is part research monograph (reporting on a ten year program of research on telemedicine in the UK) and part introduction to a theory of implementation, embedding, and integration of new technologies/techniques. So the 'gaps' may actually be the spaces where the links between the two come alive. We'll have to wait and see. I think that's what I'm aiming for as I assemble the parts and glue them together with new writing. 

There are some important questions that need to be answered. The book has to do this, I think. One is about the relative location of Normalization Process Theory and other relevant theories - especially Diffusion of Innovations Theory and Actor Network Theory - and how much coverage to give them. We're locating our work in the Science and Technology Studies tradition - and I see the Wikipedia entry for STS places my work within the 'turn to materiality' - but it plainly doesn't quite fit with STS. That's a more complex problem that probably won't get solved in the book. I'm lucky though - I have a lovely garden to work in on a sunny day.

Finally, my friend Carolyn Chew-Graham has been promoted to a personal chair in general practice at Manchester University medical school. Wonderful news....

Doctors, nurses, and their patients.....

Something is troubling me. I've spent the best part of twenty years with research on professional-patient interaction as a focus of my academic work. I'm very familiar with the professional discourses of contemporary healthcare - they emphasise personal care, continuity, management, choice, quality, engagement, empowerment. These are discourses that run in the background of my work on innovations in health technologies too. There are measures of the quality of interaction, of the degree of continuity in care, and of the extent to which treatment decisions are shared and negotiated.

As my friends and I move into middle age, we find ourselves talking about our experiences of health and healthcare more. These conversations seem to me to be messages from a different planet. They're often about struggling to accomplish complex business in a 10 minute consultation, encountering often uninterested and sometimes rude primary care physicians. They're about long waits and interminable queues. The sense we have is not that we are customers, or patients, but that our primary role is to wait in line. We can easily spend six hours queuing for twenty minutes interaction with a hospital doctor, but we may find that our doctor is completely and obviously indifferent to us. But the real sea change is in the way that people talk about nurses. Nurses - especially in hospitals - are no longer 'angels'. Not at all, they're often spoken of with a bitter hostility that's hard to fathom. Unless you're trying to get basic care for an elderly parent, that is.

Doubt and Sarah Palin

Perhaps the thing that defines modernity best is radical doubt. Contemporary ideas about what it means to be an experiencing and knowing person - so wonderfully traced through their historical trajectories by Charles Taylor in Sources of the Self - reflect constantly on a kind of agnosticism and uncertainty. At times like this - when capitalism is in crisis and politics is a moral ruin (in my country, anyway) certainty of any kind is a problem, and faith in the future deeply unfashionable - then doubt is in command.

All around us doubt is institutionalized. Doubt about the identity and probity of citizens is a critical element of the modern State, doubt about the propriety of financial transactions and the truth of claims is central to the direction of prudent commerce. Doubt about matters of faith and science is built in to the social mechanisms of multi-cultural societies and the funding mechanisms of the academy. Doubt is everywhere - always excepting the processes of Darwinian evolution as they are currently understood, where no matters of doubt are permitted amongst otherwise rational doubters.


And then there is Sarah Palin. A person for whom doubt itself is in doubt. She is giving up to be strong. Quitting to carry on. Not retreating but advancing elsewhere. She has no plans except the plans she has. She wants to serve but objects to politics. It's hard to understand what forces are at work here. It seems to me that in a time of doubt, Sarah Palin has nothing to fear except doubt itself.


For those that prefer rigorous doubt to Sarah Palin, I recommend Jennifer Michael Hecht's Doubt: A History, (Harper Collins: San Francisco, 2003). This is a beautifully written book, by an author who wears her considerable learning very lightly.