YOU probably don鈥檛 need to be reminded about the border skirmishes between
scientists and sociologists over what science can and cannot do. The most recent
highlights were the spoof paper by physicist Alan Sokal that appeared in an
American sociological journal Social Text (1996) and the glorious rows
that followed鈥攅ven to this day.

Protagonists in these quarrels have been somewhat at a loss when it comes to
placing Harry Collins and Trevor Pinch: are they friend or foe? Most reviews by
scientists of The Golem (1993) were hostile, or at least suspicious.
But there were sociologists who didn鈥檛 like it either. The confusion should not
have been surprising. Both Collins and Pinch trained as physicists before they
turned sociologists. Their book stressed that they were neither for science nor
against it, rather that they wanted to examine how it actually worked. En route
this necessitated debunking various myths, notably the claim that science
guarantees truth because it is built upon a unique method鈥攁 claim
reiterated by E. O. Wilson in his new book, Consilience (New
快猫短视频, 22 August, p 42).

By contrast, Collins and Pinch chose to liken science to the golem, that
creature from Jewish mythology which, while not evil, is marked by a clumsy
vigour. They held that science is neither all good nor all bad, neither a
shining knight dispelling ignorance and superstition nor a sinister force, doing
capitalism鈥檚 dirty work. Old notions that science is the automatic product of
observation and experimentation should give way to a view of it as a set of
valuable but fallible skills. At its cutting edge, controversy will always rage,
because there is no neutral place, no Archimedean point; in the search for
authority, a kind of infinite regression is unavoidable.

In The Golem at Large, our authors take the opportunity to answer
critics of the first book. Their tone is reassuring, calling for dialogues not
duels between science and the humanities.

They then push their programme on into the domain of technology, posing tough
question. Did Patriot missiles really shoot down Iraq鈥檚 Scuds in the Gulf War?
Who was to blame for the Challenger explosion in 1986? Who actually made the
decisions, and who should have decided?

Rejecting 20/20 hindsight, Collins and Pinch once again avoid the easy
heroes-and-villains option: the Challenger disaster did not occur because 鈥渂ad鈥�
managers overrode 鈥済ood鈥� engineers. Instead, they insist it is a fallacy to
suppose that there can be a correct 鈥渟cientific鈥� way of settling such issues.
Expertise, rather, is a localised and personal matter, and the true expert is
the person with the most relevant skills. Expertise is thus as good as the
experts, not the scientific procedures.

Collins and Pinch score through lively prose and apt selection of supporting
evidence. Take this priceless exchange between a congressman and a brigadier as
to the success of Patriot missiles in the Desert Storm operation:

鈥淐onvers: Well was he [President Bush] in error?

Drolet: No, sir.

Convers: So he was correct when he said 41 out of 42 Scuds were intercepted?

Drolet: Yes, sir.

Convers: You have records to back that up?

Drolet: Intercepted?

Convers: Yes, sir

Drolet: Yes, sir. He did not say killed or destroyed. He said
intercepted. That means that a Scud came in and a Patriot was fired. But he did
not say and we did not say, nor did we every say, that it meant all of the Scuds
were killed.

Convers: He didn鈥檛 mean that they were killed? He meant intercepted,
meaning what in military jargon?

Drolet: He just means that a Patriot and a Scud crossed paths, their
paths in the sky. It was engaged.

Convers: They passed each other in the sky?

Drolet: Yes, sir.鈥�

Targeted at today鈥檚 myths, Collins and Pinch鈥檚 missile, will, I hope, do more
than merely pass them in the sky.

FOR all the hype that surrounds it, modern medicine has actually done little
to overcome the great killer diseases. Rather, it is improved sanitation and
living standards, not least the humble fridge, that have made the greatest
contributions to better health. Antibiotics were wonderful, but foolish
overprescribing has proved counterproductive. Most new drugs since penicillin
have been disappointments. And cancer and degenerative conditions such as
diabetes and Alzheimer鈥檚 continue to spread.

Alexandra Wyke, a managing editor at The Economist, brings this
point鈥攑reviously made by Ivan Illich, among others鈥攈ome in 21st
Century Miracle Medicine. The portrait of 20th-century medicine that she
paints is largely unflattering: ill-kept medical records, misdiagnoses, surgical
bungles, lack of rigorous clinical testing of treatments, exorbitant costs and
poor value for money.

But for Wyke, the fault lies not in high-tech capitalist medicine, but rather
in its absence. The trouble with today鈥檚 medicine, she says, is that it has
failed to become properly rational, scientific and businesslike. Physicians have
enjoyed and abused professional privileges, and our expectation that the
taxpayer will pick up the tab has encouraged profligacy and
unaccountability.

Things are changing, however, and Wyke contends that it is for the better.
Most of 21st Century Miracle Medicineis devoted to extolling the more
powerful and cost-effective medicine of tomorrow that will ensure 鈥渨e can look
forward to a universally hale and hearty future鈥�. But how will our healthcare be
delivered?

In the fiercely competitive American healthcare market, the interplay between
huge health maintenance organisations (HMOs) and similar managed-care
enterprises, 鈥渃utting-edge鈥� medical suppliers and consumer groups, will spur
innovation and reduce waste. In Britain, comparable benefits will be produced by
the internal market within the NHS. The multiplication of superfluous and costly
procedures will cease, and unnecessary drugs will be eliminated. Thanks to the
information revolution brought about by the digitalisation of data, diagnosis
will at last become scientific鈥攊ndeed, increasingly
computer-assisted. Mistakes and malpractice will decline. Healthcare suppliers
and customers will both benefit.

Ruthless cost cutting in healthcare will stimulate innovation in biomedicine,
Wyke claims. The Human Genome Project, once completed, will resolve the
remaining puzzles of disease aetiology, revealing how 鈥渕ost of the diseases we
suffer from are jolted forth by `bad鈥� genes鈥�. Once our genetic flaws鈥攁nd
she includes propensities to criminality here鈥攈ave thus been documented,
defective fetuses can be aborted, while biotechnology and genetic engineering
will enable the correction of any glitches after birth. Gene therapy will make
for a healthier population by energising the long-neglected area of preventive
medicine.

Turning to cures, Wyke envisages a growing uptake of new high-tech
procedures鈥攆or example, keyhole and other precision surgery. Robotic
surgery will flourish.

Above all, monitoring devices will soon be as ubiquitous as watches. Hooked
up to central medical facilities and to personal computers, these devices will
permit individual regulation of health on a day-to-day basis and at a glance.
The sick can then order their own medications along with their supermarket
groceries, thus taking control of their own wellbeing.

In addition to bringing empowerment and choice to the consumer, developments
such as these will slash the numbers of expensive and often blundering
physicians, while imposing more rational work procedures on the rest.

In short, the future will see 鈥渄octors and government melt away鈥�, as one of
the chapter headings proclaims. Tomorrow鈥檚 medicine will sideline the
old-fashioned paternalistic professionals, replacing them with a market
dominated by medical corporations and consumer choice. Sharing Margaret
Thatcher鈥檚 veneration of business and antipathy towards professionals, Wyke sees
medicine鈥檚 future as the extension of the free-market dream to health.

All that, Wyke tells us, will be pure gain. By 2050 the population will be
living longer, few will die of disease, and improved health will come 鈥渕ore
cheaply鈥�. What鈥檚 more, the benefits will not be confined to an elite. For, she
explains, 鈥渁dded to the clinical assets telecommunications technologies can
download on a deprived community, they are capable of markedly dropping overall
medical costs, channelling them into the price range of even the
耻苍辫辞蝉蝉别蝉蝉别诲鈥�.

I found it necessary to read that sentence many times before I got its gist.
This kind of prose pervades the book. Grotesque mixed metaphors abound (for
instance, she has medicine continuing 鈥渢o swallow income hand over fist鈥�), until
the pressure of clich茅s and odd phrases numbs the brain.

Writing of this kind is not merely an affront to the language; it also
mystifies. To return to one of the above quotations, what can it mean to say
that computerised medicine will be within the 鈥減rice range of the unpossessed鈥�?
What sort of 鈥渦npossessed鈥� can afford to purchase sophisticated computerised
healthcare? Promo-speak and marketing jargon are used to obscure realities
here.

And there is no doubt where such verbal smokescreens originate. As Wyke tells
us, the research for her book involved numerous interviews conducted with the
executives of major medical corporations and 鈥渟tart-up鈥� medical laboratories
ranging in location anywhere from the US to Japan. It is their language and
messages that are being relayed, and their version of the future which is being
publicised. As a result, the account Wyke offers of medicine fifty years hence
is partial and partisan.

Many of her predictions are surely sound: there is little doubt that genetic
therapies will increase, and robots will become as normal in the operating
theatre as they are in car-assembly plants. But 21st Century Miracle
Medicine fails to analyse the wider implications of these developments. Let
us return to the idea that the triumph of high-tech medicine within the
capitalist market will reduce costs and improve access for all, including the
鈥湷懿员璐遣醪醣鸩醪醣鸹邂��. What grounds do we have for trusting that assertion? The US
currently leads the world in high-tech medicine and relies more heavily than any
other nation on market mechanisms to adjust healthcare supply. The result is
that nearly 40 million Americans live without medical insurance. There are
dramatic health inequalities, even though the US spends a larger proportion of
its GNP on health than any other industrialised nation.

In short, the notion that market medicine is cost-efficient, and will benefit
all, including the 鈥渦npossessed鈥�, seems positively contradicted by available
experience. While the laws of supply and demand may work quite well for some
commodities, medicine is a separate case: those whose needs are greatest are
rarely in a position to afford it.

There is something appealing about Wyke鈥檚 technological optimism. But when
she writes that 鈥渢omorrow鈥檚 healthcare setting will see the quality of medical
services shift into the position of becoming a supreme requirement for the
accolade of good doctoring鈥�, the impenetrability of the prose is symptomatic of
the woolliness of the thinking.

Gregory takes readers through the successive stages by which Descartes, Newton and the other pioneers of modern experimental physics tackled the peculiar properties of reflection and refraction, leading to the brilliant breakthroughs in physiological psychology made by later experimenters like Hermann von Helmholtz, inventor of the ophthalmoscope. He reveals that what we take to be the common-sense concept of vision was slow to emerge.

From Plato and throughout the Renaissance the dominant theory was that vision was a matter of invisible rays or spirit being shot out by the eyes themselves. Seeing was analogous to touching, the eyes 鈥済rasped鈥� what they saw. Only gradually was that model replaced by the modern notion of light striking the retina, thereby forming images. And that was not fully elucidated until Johannes Kepler, who recognised the sensitivity of the retina, and Newton, whose Opticks (1704) advanced the theory of light as 鈥渇its鈥� or vibrations.

Early views of seeing as 鈥渃apturing鈥� bolstered fears about the 鈥渆vil eye鈥�, with its power to cast a hex upon objects falling under its gaze and of possessing another鈥檚 soul through staring into the windows of their eyes. Equally alarming was the notion that your soul could be seized and destroyed if its image was trapped in a mirror, portrait or, later, a photograph. It also explains the idea that the undead鈥攇hosts, spooks and vampires鈥攇ive themselves away by their inability to produce a mirror image. These kind of superstitions explain the popularity of mirrors in necromancy鈥攁nd widespread anxieties around the world about the black magic that mirrors might wreak.

Tracing the influence of folkloric teachings upon masterpieces like Oscar Wilde鈥檚 The Picture of Dorian Gray鈥攁nd Lewis Carroll鈥檚 Through the Looking-Glass鈥擥regory shows the intimate interplay of the physics of light and the psychology of the mind. The illusions created by mirrors afford striking proofs of the mental programming underpinning perception: ideas are 鈥渆ye-deas鈥�.

And his thoughts provoke the perennial question: how far is the 鈥淚鈥� a product of the eye? Or, to pose that question in its specific historical form, what impact did growing ownership and use of mirrors from the Renaissance onwards have on the Western mind? Did increased familiarity with literal reflections of the self encourage 鈥渟elf-reflection鈥� as we understand it both metaphorically and psychologically?

That is a question much chewed over by historical sociologists. Proposed by Lewis Mumford and refined by Norbert Elias, one influential view argues that the transition from medievalism to modernity was, at its core, the passage from a traditional collective consciousness to a prized individualism. Certain material and technological changes are assumed to have played key parts in that transformation, including the subdivision of household space, allowing members of a family a room of their own, and the coming of the printed book, encouraging private silent reading. Conspicuous among these developments was the spread of the mirror into affluent homes. This allowed people to gaze at themselves, encouraging autobiographical fixations and heightening both the aggressive egoism and the morbid melancholy of the age of Shakespeare.

It also gave many people the chance, for the very first time, to monitor their own facial expressions. From Baldassare Castiglione, who explained the art of the courtier in 16th-century Italy, to the advice Lord Chesterfield gave to his son in Georgian England, writers on manners became obsessed with the management of self-image in a way surely inconceivable without habitual access to the mirror, and its counterpart, the portrait.

What does Gregory make of this collective historical psychology? He hints at a middle course. On the one hand, he is deeply impressed, and rightly so, with the power exerted by the symbolism of mirrors in the writings of Shakespeare and his contemporaries. Yet, putting the hypothesis to scientific test, he candidly notes what seems like powerful negative evidence: the major histories of art he has consulted refer to surprisingly few paintings in which mirrors play a central role.

But here Gregory sells himself short by deferring too readily to the art historians. Had he rooted around a bit more, especially among the minor Flemish and Dutch masters of the Golden Age, he would have hit upon scores of paintings featuring looking glasses or hand mirrors in bourgeois interior scenes that display all the other classic marks of intensified individuality, such as people writing letters or reading books. All this took place in a Netherlands that was giving the world the microscope and telescope鈥攚hile supporting a professional lens-grinder who turned into a master philosopher鈥擝enedict de Spinoza.

On other matters, Gregory is more willing to trust his own vast experience and expertise. He is properly insistent that it was the growing use of lenses and glasses of all kinds that helped to make vision the queen of the senses. It can surely be no coincidence that the Descartes who interpreted light as a pressure transmitted by subtle matter upon the retina was the philosopher who located the all-seeing, all-controlling homunculus behind the eye, within the pineal gland, thus topographically coupling seeing and thinking. Similarly, thanks to the optical revolution of the 17th century, the very terms for cognition that became dominant in British philosophy throughout the significantly named 鈥渆nlightenment鈥� were 鈥減erception鈥� and 鈥渃onception鈥�. Indeed, to signal comprehension we still say: 鈥淚 see鈥�. The mind readily became regarded as the mirror of nature, and the crazy mind was likened to a mirror cracked.

Ever since C. P. Snow, writers have been urged to bridge the two-culture chasm. Good interdisciplinary books must make their technicalities clear to nonscientists and their cultural discussions germane to those who peer down microscopes. On these scores, Mirrors in Mind is a triumph. And, as with all of Gregory鈥檚 writing, here is a book that avoids fancy frills and packs a great deal into a small compass. Holding up a mirror to our minds, Gregory forces us to reconsider the relations between reality and representation.

Who then are his 鈥渧andals鈥�? They are the American masses, who, deluded by
鈥渕edia liberals鈥�, entertain unreasonable expectations of doctors, and when
these are not met, resort to litigation and the lucrative ploy of
victimhood.

History thus dictates, proclaims Faria that the siren strains of healthcare
reform must be resisted. Proper medical practice is private practice, and
market competition also keeps medical costs down, not least because the
informed patient can choose cost-effective procedures. Of course, he admits,
some of the sick won鈥檛 be able to afford free-market medicine, but they need
not fear because 鈥渇or those who cannot afford their service, physicians have
always been happy to provide charity medicine care鈥�. In any case, he argues,
America鈥檚 40 million uninsured largely have themselves to blame, since most
have opted to put health low on their list of budget priorities.

Whether Henry Ford was right to say that history is bunk, Faria鈥檚 history
certainly is, and his prescriptions are pie in the sky. His biased account
never even begins to explain why free-market America presently spends roughly
twice the percentage of its gross national product on medicine as does NHS
Britain.

What will amuse the British reader of Faria鈥檚 diatribe is how closely it
echoes the polemics that were being trumpeted around 1946 by the British
Medical Association in opposition to Aneurin Bevan鈥檚 plans for the provision
of a national health service available to all and free at the point of
delivery. The BMA likewise predicted that the NHS would spell medical
totalitarianism. If one truly wants to learn from history, the fundamental
fact is that state intervention in 1948 gave general practice a new lease of
life (why else did the BMA become the NHS鈥檚 most fervent supporter against the
Thatcher reforms?).

It is truly bizarre that the likes of Faria should believe that a
profession鈥檚 best defence lies in extolling the virtues of the free market.
But then I suppose one of the lessons of history is how little people ever
learn from the past.