Dan Bednarz

 Recently I spoke to a gathering of medical and public health students at Columbia University about the contribution the health sciences can make to Mayor Bloomberg’s PLANYC, a vision for a sustainable New Your City in 2030.

Although I had prepared opening remarks on how I was speaking from a paradigm premised upon the end of the physical expansion of the economy, this discussion quickly became an example of Thomas Kuhn’s incommensurability thesis. This means that proponents of competing paradigms are prone to misunderstanding and misinterpretation and, overall, “talking past” one another as they find one another’s conceptual positions and policy recommendations incomprehensible or absurd. The confusion and conflict stem from the incompatibility of the core metaphors around which the intellectual contents of paradigms are organized. In this instance it is the taken-for-granted physical growth of the economy –the core metaphor the students were operating from- versus one where economic activity is constrained by a finite planet with finite resources.

In short, I was speaking from the limits to growth/ecological paradigm and the students were evaluating my arguments from the received paradigm of perpetual growth and technological progress. (Admittedly, those who hold my view are still a minority in industrial society.) Therefore, despite their impressive intellectual capabilities these student’s comments, questions and counter-arguments evinced no cultural, personal or educational experience outside of the growth paradigm. It was as if they’d never questioned the dominant paradigm, which is a normal state of affairs until a paradigm crisis emerges –and this is now underway at the cultural level and beginning to affect the health sciences.

How did the incommensurability thesis play out between these Ivy League students and me?

I began by asking how many of the approximately 25 present had heard of peak oil. One sheepishly raised her hand to indicate she has a fuzzy conception of it. I then asked how many had read the book or heard of the concept Limits to Growth? No one had. I then asked about Thomas Kuhn’s The Structure of Scientific Revolutions, and one hand went up.

From there I knew my 30-minute presentation with an hour for questions and discussion probably would involve incommensurable communications with the students. I had prepared my talk with this in mind and gave them a reprise of how when I first heard of peak oil I thought it manageable because technology would save us.  This rhetorical tactic to join with them appeared to have little impact –they were skeptical. I made a (possibly poor) decision on the spot to make my presentation as brief as possible –it lasted about 25 minutes- with the hope that I could bridge the “talking past one another” phenomenon during the give and take spontaneity of discussion.

I went on to briefly outline the two paradigms; and I argued that the growth paradigm 1) no longer could solve problems –such as massive unemployment- and 2) that it was now creating them –trying to revive the financial sector as if it is the source of real wealth creation. I connected this to public health and medicine by telling them that the growth paradigm was analogous to the Miasma Theory of disease (to my surprise none of them were familiar with this theory). I suggested that the limits paradigm, which is based in ecological science, would be as profound in its scientific and socio-cultural ramifications as had been the discovery of the microbe –the Germ Theory of Diseases- that revolutionized medicine and made modern public health possible. Despite their  elite IQs, this observation seemed to fly over their heads.

Then I offered summative comments on Mayor Bloomberg’s PLANYC from my perspective, the limits to growth paradigm. The plan for 2030 sustainability revolves around three assumptions:

  1. The city will add a million new residents by 2030.
  2. Aging and failing infrastructure will be repaired and maintained.
  3. Carbon emissions will be reduced by 30%.

I pointed out that I saw no way the city could support another million residents or adequately repair and maintain infrastructure. They were stunned and one student said, “You can’t tell people where they can live,” adding that he thought I was advocating legislation to bar people from moving to New York. I replied that my comments were based upon the fact that infrastructure was already in decline and overstressed and with energy decline now underway the city was more likely to begin to depopulate over the next 19 year than to grow. I offered the example of Detroit as a city forced to contract. This elicited a host of what is best described as “WTF?” looks of disbelief. New York City decline? Depopulate? Simply beyond the pale.

“You’re so pessimistic,” one student said. Another added, “There are alternative energy sources and electric cars that are coming along.” Yet another said, “Look, oil prices are high because of speculation –there’s really lots of oil left.” One student said, “I agree with 70% of what you’re saying, but you’ve offered no solutions. Things are not hopeless. We can develop alternative energy sources.”

I hasten to add that it was a lively and cordial discussion in which the two competing paradigms were in sharp relief. In closing I told them, “You are a transitional generation. All assumptions in health policy about the growth of the economy must be surfaced, assessed, and largely abandoned. They don’t work. The policy question you will face in your careers is this, ‘How to make equitable, socially just health policy with a shrinking economic pie?’ And the way to do that is to reduce the social and technological complexity of society -energy efficiency and conservation are important but inadequate.”

Afterwards several came up to speak with me. The student who said I was advocating legislation to halt in-migration asked if I would read part of his dissertation on energy use in hospitals. One student went home and wrote a long email critiquing my talk in accord with the growth paradigm but leaving space for consideration of my views. Another, who had not spoken during the discussion, said, “I get what you’re saying; it’s pretty damned late to be thinking about this stuff if you’re right, isn’t it?”